Choudhury, Robin P

Erica, Dall'Armellina

Ferreira, Vanessa M

Francis, Jane M

Karamitsos, Theodoros D

Neubauer, Stefan

Piechnik, Stefan K

Robson, Matthew D

English

PubMed

Dall'Armellina Erica

Stefan K Piechnik

Vanessa M Ferreira

Theodoros D Karamitsos

Jane M Francis

Matthew D Robson

Robin P Choudhury

Stefan Neubauer

Springer - Publisher Connector

POSTER PRESENTATION Open Access
Quantification of acute myocardial injury in STEMI
patients post revascularization at 3Tesla.
Comparison of T1-mapping, late gadolinium and
edema imaging
Dall’Armellina Erica*, Stefan K Piechnik, Vanessa M Ferreira, Theodoros D Karamitsos, Jane M Francis,
Matthew D Robson, Robin P Choudhury, Stefan Neubauer
From 2011 SCMR/Euro CMR Joint Scientific Sessions
Nice, France. 3-6 February 2011
Objective
To quantify myocardial injury in patients with acute ST-
elevation myocardial infarcts (STEMI) by T1-mapping
using Shortened Modified Look-Locker Inversion Recov-
ery (ShMOLLI).
Background
Acute CMR imaging using late gadolinium (LGE) and
T2-weighted imaging (T2W) is used to assess salvage-
able myocardium in STEMI patients post percutaneous
coronary intervention (PCI) . However, current methods
of assessing acute myocardial injury are being debated,
and a more robust method would be desirable. T1-map-
ping quantitatively characterizes the myocardium with-
out the need for comparing signal intensities against
reference regions (ROI).
Methods
Seventeen STEMI patients (age 55±8 years) underwent
CMR imaging at 3T (TRIO, SIEMENS) 12-48 hours
post PCI. Forty-seven matching short axis slices were
obtained for cine-SSFP, T2prep-SSFP, LGE, and T1-
mapping (ShMOLLI). Segmentation was based on the
AHA 17-segment model; volumetric fractions of injured
myocardium per segment on LGE and T2W images
were calculated using a signal intensity threshold 2SD
above the mean intensity of a ROI in remote myocar-
dium. Microvascular obstruction (MVO) identified on
LGE images was manually segmented. For quantitative
T1-mapping analyses, a threshold value of 1272ms (10%
above control T1s of 1156±67 at 3T) was used. Wall
motion was scored as normal, hypokinetic and akinetic.
T1 values were calculated for segments with varying %
LGE lesion and/or wall motion abnormalities (WMA)
and for areas of MVO.
Results
All patients had positive findings on cine, LGE, T2W
and T1-mapping. The regions of myocardial injury
assessed by the four modalities co-localized visually. Out
of the 282 segments analysed, 39 were rejected for arti-
facts and 37 were identified as showing MVO and,
hence were analysed separately. There was moderate
correlation between the segmental damaged fraction
assessed by LGE and T2W (r2 =0.51) and by LGE and
OCMR, University of Oxford, Oxford, UK
Figure 1 Damaged fraction of LGE, T2p and T2 (median, 25-75%
percentiles) per segment grouped by wall motion abnormality
(number of segments given in brackets).
Erica et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P146
http://jcmr-online.com/content/13/S1/P146
© 2011 Erica 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.
T1-maps (r2=0.48). A significant relationship was found
between the volume of myocardial injury as assessed by
T1-mapping, T2W and LGE, and the severity of WMA
(p<0.01). (Fig.1). The T1-values increased with the
severity of damage as assessed by LGE (Fig.2) reaching
values significantly longer than the T1s in controls for
segments with greater than 40% damaged fraction (1356
±66ms versus 1233±87ms, p<0.001). T1-values within
areas of MVO were abnormal and included both long
and short values (1025-1380ms; mean ± SD = 1284±83)
while T1s in the myocardium surrounding MVO areas
reached values up to 1563ms (Fig. 3).
Conclusions
ShMOLLI cardiac T1-mapping detects acutely injured
myocardium in patients with STEMI and can identify
segments with different degrees of damage as assessed
by LGE.
Published: 2 February 2011
doi:10.1186/1532-429X-13-S1-P146
Cite this article as: Erica et al.: Quantification of acute myocardial injury
in STEMI patients post revascularization at 3Tesla. Comparison of T1-
mapping, late gadolinium and edema imaging. Journal of Cardiovascular
Magnetic Resonance 2011 13(Suppl 1):P146.
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Figure 2 Segments with increasing damaged fraction assessed by
LGE show longer T1-values.
Figure 3 Example of case of inferior myocardial infarction
completed by MOV (arrows on LGE image). A short axis slice
acquired using three different modalities is displayed.
Erica et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P146
http://jcmr-online.com/content/13/S1/P146
Page 2 of 2


Quantification of acute myocardial injury in STEMI patients post revascularization at 3Tesla. Comparison of T1-mapping, late gadolinium and edema imaging

Quantification of acute myocardial injury in STEMI patients post revascularization at 3Tesla. Comparison of T1-mapping, late gadolinium and edema imaging

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