Kurzfassung

Purpose: Cardiovascular MR imaging (CMR) with assessment of late enhancement (LE) and no-reflow zones (MO) enables prognostic implications for further patient care. In a prospective study, we tried to determine the optimal time point for detection of microvascular obstruction in patients with acute myocardial infarction (AMI).

Materials and Methods: 41 patients (5 female, 36 male, mean age 53 years) with AMI and successful recanalization (acute stent-PTCA) underwent two CMR examinations within...Purpose: Cardiovascular MR imaging (CMR) with assessment of late enhancement (LE) and no-reflow zones (MO) enables prognostic implications for further patient care. In a prospective study, we tried to determine the optimal time point for detection of microvascular obstruction in patients with acute myocardial infarction (AMI).

Materials and Methods: 41 patients (5 female, 36 male, mean age 53 years) with AMI and successful recanalization (acute stent-PTCA) underwent two CMR examinations within 10 days, the first within 48 hours after AMI.
CMR was performed at 1.5 T (Magnetom Sonata , Siemens Medical Systems) using a phased array coil for signal detection. For assessment of LE and MO, we used and inversion prepared 2D and 3D segmented TurboFlash sequence after determination of optimal TI in short-axis orientation of the heart. LE and MO were measured 2 (early enhancement) and 10 minutes (late enhancement) after application of 0.2 mmol Gd-DTPA /kg body weight. The left ventricle was further assessed planimetrically.

Results: Areas of MO were detected in 32/41 early and in 31/41 late after contrast application at exam 1. The number decreased at exam 2 to 23/41 and 15/41 patients, respectively. MO areas significantly decreased from 5.5 to 3.0 % between early and late enhancement (p < 0.001) at exam 1, and from 5.5 to 2.6 at early enhancement (p < 0.001), and from 3.0 to 1.2 at late enhancement (p < 0.001) between exam 1 and 2, respectively. Areas of LE decreased within 10 days between exam 1 and 2 from 19.5 +/- 12.1 % to 14.1 +/- 9.1 % (p < 0.001).

Conclusions: The real extent of MO is best assessed on images obtained 2 minutes after contrast application and within 24-48 after acute MI. The areas of LE decreased from the acute to the subacute phase after AMI. For assessment of prognostic parameters, CMR imaging seems to be preferably done within 48 hours after AMI.
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