Alexander J Dick

AR Assali

E Larose

Jay S Detsky

JS Detsky

Ram Vijayaraghavan

Warren D Foltz

Yuesong Yang

Journal of Cardiovascular Magnetic Resonance

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BioMed Central
Journal of Cardiovascular Magnetic 
Resonance
ssOpen AcceMeeting abstract
2090 Right ventricular involvement in reperfused myocardial 
infarction: an experimental DE-MRI study using inversion recovery 
prepared SSFP
Yuesong Yang*, Jay S Detsky, Warren D Foltz, Ram Vijayaraghavan and 
Alexander J Dick
Address: Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
* Corresponding author    
Introduction
Right ventricular myocardial infarction (RV-MI) and dys-
function have been shown as independent indicators of
poor prognosis in patients with acute myocardial infarc-
tion (AMI) [1,2]. Diagnosis of RV-MI is usually made by
the presence of an ST-segment elevation of 0.1 mV in the
V3R or V4R of the ECG and/or abnormal RV free wall
motion on echocardiography. DE-MRI using IR-FGRE
(inversion recovery fast gradient echo) has been used to
detect the RV involvement in AMI, but its sensitivity and
specificity is limited by the thinned wall and confounded
by the pericardial fat tissue. We hypothesize that an inver-
sion recovery steady state free precession (IR-SSFP) pulse
sequence with the multiple-contrast imaging capability is
a better method for the identification of RV-MI.
Purpose
To investigate an IR-SSFP based DE-MRI sequence in the
detection of RV-MI in a porcine model with reperfused
MI.
Methods
In eight Yorkshire pigs (22–30 kg) a reperfused MI was
produced through a 90-minute percutaneous balloon
occlusion of the left anterior descending coronary artery
proximal to the right ventricular branch. After reperfusion
and full recovery from anesthesia, animals were allowed
to survive for six weeks (n = 7) and one week (n = 1).
The MR study, which included an SSFP functional study,
conventional IR-FGRE based, and IR-SSFP based DE-MRI,
was conducted on a GE 1.5 T Signa Excite system. Both IR-
FGRE and IR-SSFP were performed 15–20 minutes after
double-dose bolus injection of Gd-DTPA. For IR-FGRE, TI
varied from 150 to 300 ms, depending on the null of nor-
mal myocardium. For IR-SSFP, the SSFP is applied during
IR, which means that the longitudinal magnetization is
sampled during the transition process from T1 recovery to
its true steady-state [3]. For both IR-FGRE and IR-SSFP
based DE-MR, the in-plane resolution was around 1
mm*1 mm. Short-axis oblique and/or axial transverse
slices were obtained using both pulse sequences. Upon
the completion of MRI examinations all animals were sac-
rificed for macroscopic examination, TTC staining and/or
histology for the verification of RV-MI and LV-MI.
Results
The macroscopic examination, TTC staining and/or his-
tology confirmed the presence of LV-MI and RV-MI in all
animals (n = 8, Fig. 1A). The gross appearance of chronic
MI (n = 7) was gray-white scarring in both LV and RV with
increased collagen deposition in histology. In TTC stain-
ing, regions of myocardial necrosis were indicated by fail-
ure to stain, appearing as a pale-white area in contrast to
red-stained viable myocardium. Both IR-FGRE and IR-
SSFP based DE-MRI methods identified the presence and
extension of LV-MI in all animals. However, the demon-
stration of RV-MI on short-axis oblique and axial trans-
from 11th Annual SCMR Scientific Sessions
Los Angeles, CA, USA. 1–3 February 2008
Published: 22 October 2008
Journal of Cardiovascular Magnetic Resonance 2008, 10(Suppl 1):A359 doi:10.1186/1532-429X-10-S1-A359
<supplement> <title> <p>Abstracts of the 11<sup>th </sup>Annual SCMR Scientific Sessions - 2008</p> </title> <note>Meeting abstracts – A single PDF containing all abstracts in this Supplement is available <a href="http://www.biomedcentral.com/content/files/pdf/1532-429X-10-s1-full.pdf">here</a>.</note> <url>http://www.biomedcentral.com/content/pdf/1532-429X-10-S1-info.pdf</url> </supplement>
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verse slices was much better using IR-SSFP (87.5%, 7/8)
comparing to using IR-FGRE (12.5%, 1/8). The presence
of pericardial fat tissue and the thinned wall of the right
ventricle were the primary culprits for poor identification
of RV-MI using IR-FGRE based DE-MRI (Fig. 1B). The
multiple-contrast capability using IR-SSFP enabled better
differentiation between the blood pool, pericardial fat
and the delayed hyper-enhanced region of RV involve-
ment (Fig. 1C–D), in which the combined RV- and LV-MI
appeared as the characteristic MR sign of a transverse or
inverted "Y" shape. Moreover, the IR-SSFP provided cine
images that also enabled the better appreciation of RV
wall motion abnormalities in the region of MI.
Conclusion
Inversion-recovery SSFP based DE-MRI is a better tech-
nique for the identification of RV involvement in an
experimental model of reperfused myocardial infarction.
Further clinical investigation is warranted for the true util-
ity of this technique in the identification of RV myocardial
infarction.
References
1. Assali AR, et al.: Am Heart J 2007, 153:231-237.
2. Larose E, et al.: J Am Coll Cardiol 2007, 49:855-862.
3. Detsky JS, et al.: Magn Reson Med 2007, 58:365-372.
RV Involvment in a porcine model with reperfused MIFigure 1
RV Involvment in a porcine model with reperfused MI. A. Gross pale-white appearance of RV-MI and LV-MI. B. Axial IR-FGRE 
base DE-MRI: RV-MI was barely visualized, LV-MI was seen as delayed hyper-enhancement in the anterior septal region of LV; 
C. axial IR-SSFP based DE-MRI (same location as B): RV-MI and LV-MI was much better demonstrated; D. TTC staining con-
firmed the presence of RV involvement.Page 2 of 2
(page number not for citation purposes)


2090 Right ventricular involvement in reperfused myocardial infarction: an experimental DE-MRI study using inversion recovery prepared SSFP

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2090 Right ventricular involvement in reperfused myocardial infarction: an experimental DE-MRI study using inversion recovery prepared SSFP

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