Luigi Natale MD, Presenter: Nothing to Disclose

Alessandra Porcelli MD, Abstract Co-Author: Nothing to Disclose

Antonio Bernardini MD, Abstract Co-Author: Nothing to Disclose

Agostino Meduri MD, Abstract Co-Author: Nothing to Disclose

Antonella Lombardo MD, Abstract Co-Author: Nothing to Disclose

Lorenzo Bonomo MD, Abstract Co-Author: Nothing to Disclose

Myocardial viability assessment is crucial in prognostic stratification and therapeutic decision making for patients after acute myocardial infarction. MRI has shown high capability in viability assessment, also compared to current clinical tools. The purpose of our study was to define contrast enhanced (CE) MRI role in functional recovery prediction after acute myocardial infarction.

46 consecutive patients with first AMI (65 ± 8 yrs., 39 anterior, 4 inferior, 3 lateral, 40 primary PTCA, 6 thrombolysis) underwent cine- and CE-MRI (GE Signa Excite 2) five to seven days after onset. Cine-MRI was performed in short axis (6-8 slices, Fastcard and FIESTA sequences); first pass imaging (IR-prep FGRE and FGRE-ET with iv 0.1 mmol/kg Gd-DTPA, 3 mL/s) was obtained on three short axis slices (basal, mid-ventricular and apical); multi-slice short axis (6 slices), sometimes with additional HLA or VLA slices, delayed imaging (IR-prep FGRE) was obtained 15 min after 0,2 mmol/Kg Gd-DTPA. First Pass (FP) imaging and Delayed Enhancement (DE) were evaluated together in 736 segments, classified as: normal first-pass, absent or delayed hyperenhancement 50% +/- FP hypoenhancement (Pattern 2); hypoenhancement both at first-pass and delayed imaging (Pattern 3). Additional 828 segments, falling out of first-pass slices, were classified only on the basis of DE as normal or hyperenhanced 50%(= pattern 2) and hypoenhanced (= pattern 3). Patterns 2 and 3 were considered non viable. Six months follow up MRI assessed functional recovery as improvement of segmental WMSI.

Pattern 1 was observed in 1310 segments, with functional recovery appreciated in 1205 (92%). Pattern 3 was present in only 33 segments, without recovery (100%). Pattern 2 was observed in 221 segments: out of them, 49 showed recovery (22%).

Patterns 1 and 3 respectively identify viable and non viable tissue. Pattern 2 is less specific early after AMI, as it may represent also viable myocardium and should be carefully interpreted.

Natale, L, Porcelli, A, Bernardini, A, Meduri, A, Lombardo, A, Bonomo, L, Functional Recovery after Acute Myocardial Infarction: Evaluation by MRI.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4417914.html