Fusion of MR coronary angiography and viability imaging: Feasibility and clinical value for the assignment of myocardial infarctions

Purpose: To investigate the feasibility of image fusion of MR-coronary angiography (MRCA) and delayed gadolinium enhancement imaging (LGE) and to assign areas of myocardial infarction to the corresponding supplying coronary arteries. Materials and methods: An interactive segmentation of the coronary arteries was performed in MRCA data sets (n = 25). The LGE slices were matched onto the vessel segmentation to perform a fused analysis of coronary artery anatomy and LGE. The results were compared to the segmental model recommended by the American Heart Association (AHA). Standard of reference was the identification of the culprit lesion in the invasive coronary angiography (CA) (n = 20). Results: The fused analysis allowed the assignment of MI to the supplying coronary artery in 13/20 patients. The sensitivities/specificities for the assignment of MI to the three main vessels were: LAD 63%/100%, LCX 75%/100%, and RCA 56%/100%, respectively. Using the AHA segmental model th e sensitivities/specificities for the correct assignment of MI to the three main vessels were: LAD 88%/58%, LCX 94%/75%, and RCA 77%/73%, respectively. Conclusion: Fusion images of MRCA and LGE provides added diagnostic information in the effort to determine the epicardial vessels responsible for the postischemic myocardial injury and therefore might be helpful to establish appropriate future therapeutic steps

Exercise-induced albuminuria is associated with perivascular renal sinus fat in individuals at increased risk of type 2 diabetes.

Microalbuminuria represents an established surrogate marker of early diabetic nephropathy and glomerular microangiopathy. Increasing evidence is emerging of a role of perivascular adipose tissue (PVAT) as an important link between obesity, insulin resistance and both macro- and microangiopathy. It is not known whether perivascular renal sinus fat (RSF) has an impact on microalbuminuria in the prediabetic stage. We investigated whether RSF quantified by MRI is associated with microalbuminuria before or after exercise. Non-diabetic individuals at increased risk of type 2 diabetes were recruited into the Tubingen Lifestyle Intervention Program (TULIP); 146 participants took part in the analysis. RSF was measured in axial MRI sections at the level of the renal artery. Urine was collected before and after exercise stress testing. Participants (age 47 +/- 12 years; mean +/- SD) reached a mean exercise load of 176 +/- 49 W, with a mean arterial peak pressure (MAPP) of 112 +/- 14 mmHg. After adjusting for sex, age, visceral adipose tissue (VAT) and MAPP during exercise, RSF was significantly associated with postexercise albumin/creatinine ratio (ACR; p = 0.006). No association between RSF and baseline BP could be observed after adjusting for confounders (p = 0.26), and there was no association between RSF and baseline ACR either (p = 0.2). RSF is associated with exercise-induced albuminuria independently of sex, age, VAT and MAPP in a non-diabetic cohort at diabetic risk. We conclude that PVAT in the renal sinus may play a role in the pathogenesis of microalbuminuria