Aletras, Anthony H

Arai, Andrew E

Bagi, Paul S

Booker, O Julian

Greiser, Andreas

Hsu, Li-Yueh

Kellman, Peter

Oki, Abiola J

Ugander, Martin

English

PubMed

Martin Ugander

Paul S Bagi

O Julian Booker

Li-Yueh Hsu

Abiola J Oki

Andreas Greiser

Peter Kellman

Anthony H Aletras

Andrew E Arai

Springer - Publisher Connector

POSTER PRESENTATION Open Access
Edema by T2-weighted imaging in salvaged
myocardium is extracellular, not intracellular
Martin Ugander1*, Paul S Bagi1, O Julian Booker1, Li-Yueh Hsu1, Abiola J Oki1, Andreas Greiser2, Peter Kellman1,
Anthony H Aletras1, Andrew E Arai1
From 2011 SCMR/Euro CMR Joint Scientific Sessions
Nice, France. 3-6 February 2011
Introduction
T2-weighted MRI can image myocardial edema in sal-
vaged, non-infarcted myocardium. However, it is unclear
whether this edema is mostly intra-, extracellular, or
balanced.
Purpose
We tested the hypothesis that edematous non-infarcted
myocardium would show a balanced increase in both
the intra- and extracellular volume.
Methods
Dogs (n=10) underwent coronary occlusion (2h) and
reperfusion (4h). 1.5T CMR images (Siemens) were
taken before and 45 minutes into contrast administra-
tion (0.15mmol/kg Gd-DTPA bolus followed by
0.003mmol/kg/min infusion). Myocardial T1 was mea-
sured by modified Look-Locker imaging (MOLLI),
infarction by late gadolinium enhancement (LGE) ima-
ging, and edema by T2-prepared SSFP. T1 and R1 (1/
T1) pixel maps were generated from MOLLI images.
Contrast agent concentration is proportional to change
in R1 between pre- and post contrast. ECV was defined
as [1-hematocrit] * [DeltaR1myocardium (R1post-R1pre
contrast)]/[DeltaR1blood], thus yielding a quantitative
pixel map of the ECV ranging from 0-100%. Change in
left ventricular mass between baseline and post-reper-
fusion was quantified by cine SSFP imaging. The
change in non-contrast tissue T1 by T1-mapping was
assumed to linearly reflect swelling for both the region
of infarction determined by LGE and salvaged myocar-
dium at risk determined by non-contrast T1 mapping.
In combination with ECV measurements, these mea-
surements allowed for quantification of the absolute
myocardial intra- and extracellular volume at baseline
and in salvaged myocardium. Data is presented as
mean±SD.
Results
Following reperfusion, edema in salvaged myocardium
showed an increase in extracellular volume (4.0±1.7 vs.
2.4±1.1 ml, p=0.006, n=9) but no increase in intracellu-
lar volume (7.5±3.3 ml vs. 7.5±3.3 ml, p=1.0, n=9) com-
pared to pre-occlusion baseline. Consequently, salvaged
myocardium (Arrows in Figure 1) had an ECV of
34±7%, which was greater than normal myocardium
1National Institutes of Health, Bethesda, MD, USA
Full list of author information is available at the end of the article
Figure 1 Edema in non-infarcted, salvaged myocardium (arrows) displays an increased extracellular volume by quantitative ECV imaging.
Ugander et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P70
http://jcmr-online.com/content/13/S1/P70
© 2011 Ugander 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.
(24±3%, p=0.04, n=10) and less than infarcted myocar-
dium (58±13%, p<0.001, n=10). T1 of edematous
salvaged myocardium was greater than normal myocar-
dium before contrast administration (1050±114ms vs
919±66ms, p<0.001, n=10) and lesser after contrast
(461±57ms vs 512±67ms, p<0.001, n=10).
Conclusions
Edema in salvaged non-infarcted myocardium is extra-
cellular, not intracellular. The edema is not balanced.
This edema may be difficult to differentiate from normal
myocardium by LGE imaging because of relatively small
differences in post-contrast T1. Since baseline T1 is dif-
ferent, edematous salvaged myocardium enhances more
than normal myocardium and more than predicted
by only post-contrast LGE images. This explains why
salvaged non-infarcted myocardium is not apparent on
LGE images.
Author details
1National Institutes of Health, Bethesda, MD, USA. 2Siemens AG Healthcare
Sector, Erlangen, Germany.
Published: 2 February 2011
doi:10.1186/1532-429X-13-S1-P70
Cite this article as: Ugander et al.: Edema by T2-weighted imaging in
salvaged myocardium is extracellular, not intracellular. Journal of
Cardiovascular Magnetic Resonance 2011 13(Suppl 1):P70.
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Ugander et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P70
http://jcmr-online.com/content/13/S1/P70
Page 2 of 2


Edema by T2-weighted imaging in salvaged myocardium is extracellular, not intracellular

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Edema by T2-weighted imaging in salvaged myocardium is extracellular, not intracellular

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