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  • Title: Perfusion MRI at rest in subacute and chronic myocardial infarct.
    Author: Hopp E, Bjørnerud A, Lunde K, Solheim S, Aakhus S, Arnesen H, Forfang K, Edvardsen T, Smith HJ.
    Journal: Acta Radiol; 2013 May; 54(4):401-11. PubMed ID: 23401603.
    Abstract:
    BACKGROUND: Perfusion magnetic resonance imaging (MRI) and delayed contrast-enhanced MRI (DE-MRI) serve as tools for tissue characterization. PURPOSE: To assess and compare semi-quantitative parameters of myocardial infarct (MI) in the subacute and chronic phase, and to correlate these parameters with qualitative enhancement analysis. MATERIAL AND METHODS: Perfusion MRI at rest and DE-MRI were performed in 63 patients with anterior wall MI at 2-3 weeks after revascularization and repeated after 6 months. Descriptive enhancement parameters of contrast arrival time, initial upslope, enhancement at normal tissue peak (TTPn) and wash-out slope, and kinetic tissue parameters rBF, K (trans), k ep and v e were calculated. Subacute infarct tissue was compared to normal myocardium and chronic infarct tissue. Patients were stratified at baseline according to a qualitative grading of hypoenhancement based on first-pass enhancement and presence of microvascular obstruction (MO) at perfusion MRI and on persistent MO at DE-MRI. The qualitative grade was correlated to semi-quantitative perfusion MRI parameters. RESULTS: Initial upslope, enhancement at TTPn, rBF, and k ep were decreased and wash-out slope and v e were increased in infarct tissue (P < 0.001 for all analyses). Infarct tissue v e decreased from baseline to 6 months (P = 0.045). At baseline infarct tissue with persistent MO revealed decreased K (trans) and delayed contrast arrival, and more pronounced decrease of enhancement at TTPn, rBF and k ep compared to other enhancement groups (P < 0.008 for pairwise analyses). CONCLUSION: Perfusion is decreased in subacute reperfused infarct tissue compared to normal tissue. K (trans) is not decreased, consistent with increased surface area of the vascular bed of the subacute infarct. Infarct tissue v e is increased, and decreases with scarring. The presence of persistent MO correlates to more pronounced perfusion reduction and results in delayed contrast arrival, indicating microvascular collateral circulation.
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