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Anatomical and functional evaluation of the myocardium in patients with acute coronary syndrome (NSTEMI) using MR imaging

Valutazione anatomo-funzionale del miocardio nei pazienti con sindrome coronarica acuta (NSTEMI) mediante risonanza magnetica

  • Cardiac Radiology / Cardioradiologia
  • Published:
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Abstract

Purpose

The aim of our study was to evaluate the role of magnetic resonance (MR) imaging in identifying the location and extent of acute ischaemic injury to predict reversibility and distinguish areas of acute from chronic ischaemia in patients with acute coronary syndrome non- ST-elevation myocardial infarction (NSTEMI).

Materials and methods

We evaluated 22 patients with NSTEMI acute coronary syndrome confirmed by coronary angiography (CA). We studied ventricular function indices and segmental changes in wall thickness and kinetics by cine-MR imaging sequences. Subsequently, we evaluated myocardial wall oedema with T2-weighted black-blood short-tau inversion recovery turbo spin echo (T2 BB-STIRTSE) sequences and identified areas of myocardial necrosis using T1-weighted turbo field-echo inversion recovery (T1 TFE-IR) sequences after contrast material administration.

Results

The results obtained with the single sequences were as follows: T2 BB-STIR-TSE: 96.8% sensitivity, 100% specificity, 99.7% negative predictive value, 99.7% positive predictive value; T1 TFE-IR: 45.8% sensitivity, 96.9% specificity, 92.3% negative predictive value, 90.3% positive predictive value; systolic wall thickening: 87.5% sensitivity, 91.8% specificity, 98.7% negative predictive value, 50% positive predictive value, 91.4% accuracy.

Conclusions

Our study suggests that the sequences used for evaluating oedema and assessing viability allow for precise localisation and differentiation of areas of acute and chronic ischaemia by quantifying the possible mismatch between ischaemia and necrosis.

Riassunto

Obiettivo

L’obiettivo del nostro studio è di valutare la capacità della risonanza magnetica (RM) nell’identificare localizzazione ed estensione del danno ischemico acuto, nel predire la reversibilità del danno e nel distinguere fra aree ischemiche acute e croniche nei pazienti con ischemia miocardica senza elevazione del tratto ST (NSTEMI).

Materiali e metodi

Sono stati sottoposti ad esame cardio-RM 22 soggetti con sindrome coronarica acuta riconducibile ad un quadro di infarto NSTEMI, confermato all’esame coronarografico. Abbiamo studiato l’indice della funzione ventricolare e le alterazioni segmentarie dello spessore e della cinetica parietale ventricolare attraverso sequenze cine-RM. Abbiamo successivamente valutato edema parietale attraverso sequenze black-blood (BB) turbo spin echo (TSE) T2 (short tau inversion recovery [STIR]) ed aree miocardiche necrotiche mediante scansioni inversion recovery (IR) 3D turbo field echo (TFE) T1 pesate dopo iniezione di mezzo di contrasto (MdC).

Risultati

I risultati che abbiamo ottenuto sono stati: BB TSE T2w (STIR): sensibilità 96,8%, specificità 100%, valore predittivo negativo (VPN) 99,7%, valore predittico positivo (VPP) 99,7%; IR TFE T1w: sensibilità 45,8%, specificità 96,9%, VPN 92,3%, VPP 90,3%; ispessimento parietale sistolico: sensibilità 87,5%, specificità 91,8%, VPN 98,7%, VPP 50%, accuratezza 91,4%.

Conclusioni

Il nostro studio ha dimostrato che le sequenze per la valutazione della vitalità miocardica e quelle per l’identificazione dell’edema consentono una precisa localizzazione e differenziazione delle aree ischemiche acute dalle croniche, quantificando il mismatch ischemia/necro.

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Authors and Affiliations

  1. Terapia Radiante., Università degli studi di Roma “Tor Vergata” (PTV), Viale Oxford 81, 00133, Roma, Italy

    A. Romagnoli

  2. Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica, Roma, Italy

    M. Sperandio, M. Di Roma, S. Giura, C. Cicciò, F. della Gatta & G. Simonetti

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  1. A. Romagnoli
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  2. M. Sperandio
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  3. M. Di Roma
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  4. S. Giura
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Correspondence to S. Giura.

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Romagnoli, A., Sperandio, M., Di Roma, M. et al. Anatomical and functional evaluation of the myocardium in patients with acute coronary syndrome (NSTEMI) using MR imaging. Radiol med 116, 163–177 (2011). https://doi.org/10.1007/s11547-010-0609-x

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  • DOI: https://doi.org/10.1007/s11547-010-0609-x

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