Carbone, Iacopo

Childs, Helene

Eitel, Ingo

Ferreira, Vanessa M

Friedrich, Matthias G

Mikami, Yoko

English

PubMed

Iacopo Carbone

Helene Childs

Yoko Mikami

Vanessa M Ferreira

Ingo Eitel

Matthias G Friedrich

Springer - Publisher Connector

Standardizing T2 measurements for the quantitative assessment of regional myocardial edema

POSTER PRESENTATION Open Access
Standardizing T2 measurements for the
quantitative assessment of regional
myocardial edema
Iacopo Carbone1*, Helene Childs1, Yoko Mikami1, Vanessa M Ferreira1, Ingo Eitel2, Matthias G Friedrich1
From 2011 SCMR/Euro CMR Joint Scientific Sessions
Nice, France. 3-6 February 2011
Introduction
Accurate analysis of T2-weighted magnetic resonance
images (MRI) is crucial for myocardial edema (ME)
assessment. In view of frequent artifacts from motion,
slow flow and field inhomogenities affecting infarcted
and remote myocardium (ReM), several approaches can
be used to evaluate ME: 1) visual assessment, 2) signal
intensity (SI) > 2 SDs of ReM or 3) normalizing myocar-
dial SI to that of a skeletal muscle: T2 Ratio. Currently,
there is no standardized approach to a (semi-) quantita-
tive edema assessment using T2-weighted imaging.
Purpose
The purpose of this study is to compare different
approaches for the analysis of T2-weighted images in
patients with late reperfused myocardial infarction (MI)
for reproducibility and agreement with the extent of MI,
using LGE as a standard of truth.
Methods
Thirty patients with acute late reperfused MI (time to
reperfusion > 200 minutes) who underwent cardiac MRI
at 1.5 T within 5 days from onset of symptoms were
retrospectively studied. The MRI protocol included
b-SSFP cine, T2-STIR imaging using a body coil and
Late Gadolinium Enhancement (LGE) imaging. Ten
patients demonstrated microvascular obstruction (MVO)
on LGE images and were analyzed separately. Infarct
size was determined on LGE images using a threshold
of 2SD and 5SD above the SI of ReM. Regions of inter-
est were traced manually; edema size was measured
using thresholds of 2, 3 and 5SDs above the SI of ReM,
as well as using the T2 Ratio.
Results
When using LGE with a cutoff of 2SD, the LGE area
with high signal intensity was larger than the area with
high T2 signal intensity (2SD). There was a very good
agreement between LGE/5SD and T2 ratio in both,
patients without MVO (r=0.826, p < 0.001; no signifi-
cant difference, p=0.180) and with MVO (r=0.996, p <
0.001; no significant difference, p=0.224). Infarct size
defined by LGE/5SD was significantly smaller than
edema size using thresholds of 2SD and significantly lar-
ger using a 5SD threshold (both p<0.001).
In contrast, there was no correlation between LGE/
2SD and T2 measurements. Figure 1.
1University of Calgary, Calgary, AB, Canada
Full list of author information is available at the end of the article
Figure 1
Carbone et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P121
http://jcmr-online.com/content/13/S1/P121
© 2011 Carbone et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Conclusion
Using LGE/5SD in patients with late reperfusion acute
myocardial infarction, a normalized T2 signal intensity
ratio appears to be the most accurate approach for the
evaluation of the size of infarct-related edema.
Author details
1University of Calgary, Calgary, AB, Canada. 2Heart Center - University Leipzig,
Leipzig, Germany.
Published: 2 February 2011
doi:10.1186/1532-429X-13-S1-P121
Cite this article as: Carbone et al.: Standardizing T2 measurements for
the quantitative assessment of regional myocardial edema. Journal of
Cardiovascular Magnetic Resonance 2011 13(Suppl 1):P121.
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Carbone et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P121
http://jcmr-online.com/content/13/S1/P121
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Standardizing T2 measurements for the quantitative assessment of regional myocardial edema

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