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, Ktrans, kep and ve 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 kep were decreased and wash-out slope and ve were increased in infarct tissue (P < 0.001 for all analyses). Infarct tissue ve decreased from baseline to 6 months (P = 0.045). At baseline infarct tissue with persistent MO revealed decreased Ktrans and delayed contrast arrival, and more pronounced decrease of enhancement at TTPn, rBF and kep compared to other enhancement groups (P < 0.008 for pairwise analyses).
Conclusion
Perfusion is decreased in subacute reperfused infarct tissue compared to normal tissue. Ktrans is not decreased, consistent with increased surface area of the vascular bed of the subacute infarct. Infarct tissue ve 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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