Giulia Benedetti, Presenter: Nothing to Disclose

Francesco Aldo De Cobelli MD, Abstract Co-Author: Nothing to Disclose

Anna Damascelli MD, Abstract Co-Author: Nothing to Disclose

Mariangela Cava MD, Abstract Co-Author: Nothing to Disclose

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

Alessandro Del Maschio MD, Abstract Co-Author: Nothing to Disclose

Microvascular obstruction (MVO) phenomenon is a well known negative prognostic factor for STEMI pts, it is due to several factors, among them intramyocardial hemorrhage (IMH) plays an important role. IMH seems to be associated with worse infarction and adverse outcome, even if its incidence and its role need to be confirmed. Our aim was to investigate the ability to detect IMH through T2 STIR and T2*.

All STEMI pts enrolled in our study underwent percutaneous coronary intervention (PCI) and CMR within 5 days from the acute event. All pts underwent a CMR examination with Late Gadolinium Enhancement sequences(LGE) and T2 STIR sequences, a subgroup underwent also T2* images. CMR criteria for MVO was the presence of a hypointense region within the infarcted area on LGE. IMH was visualized on T2 STIR and T2* as an hypointense region within the hyperintense infarcted area, in the corresponding area of MVO on LGE.  

55 pts were enrolled in the study, 22 of whom underwent also T2*. Thirty-eightpts out of 55 had MVO at LGE (65%), and 18 pts of them had hemorrage on T2 STIR (31%). In the subgroup of 22 pts who underwent T2*, 13 had evidence of MVO at LE, 8 pts showed IMH at T2 STIR, and 10 showed IMH at T2*. All pts with IMH had MVO at LGE. All pts with hemorrage on T2 STIR had hemorrage alsoat T2*, and the percentage of IMH was higher in T2* sequences than in T2 STIR (T2*: 3.09%± 2.42 ; T2 STIR: 1.00% ± 1.92) . Two pts had evidence of IMH on T2* without having IMH on T2 STIR. Patients with IMH at T2 STIR had higher MVO % at LGE than pts without IMH (6.56 ± 5.01 vs 1.86 ± 2.89, p=0.001). Also pts with IMH at T2* had higher MVo % at LGE than pts without IMH (7.30 ±5.92 vs 0.75 ± 1.76, p=0.010).  

Both T2 STIR and T2* sequences are reliable to detect the presence of IMH. T2 * showed higher sensitivity , beeing able to identify more pts with IMH than T2 STIR and with more IMH %. IMH is strictly linked to MVO, and tends to occur in pts with higher MVO extension. 

T2 STIR and T2 * are reliable sequences in the identification of IMH in STEMI patients.

Benedetti, G, De Cobelli, F, Damascelli, A, Cava, M, Esposito, A, Del Maschio, A, T2 Star(T2*) Sequences and T2 Stir Sequences in the Evaluation of Intramyocardial Hemorrage (IMH) in Patients with Myocardial Infarction After PCI.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014136.html