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T1 and T2 mapping in the identification of acute myocardial injury in patients with NSTEMI

  • CARDIAC RADIOLOGY
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Abstract

Aims

To test T1 and T2 mapping in the assessment of acute myocardial injury in patients with non-ST-segment elevation myocardial infarction (NSTEMI), evaluated before revascularization.

Methods

Forty-seven patients with acute NSTEMI underwent cardiac magnetic resonance (CMR) at 1.5 T, including T1 and T2 mapping.

Results

Coronary angiography (CA) evidenced an obstructive coronary artery disease (CAD) in 36 patients (80%) and a non-obstructive CAD in 11 patients (20%). Edema was detected in 51.1/65.9% of patients in T1/T2 maps, respectively. This difference was due to artifacts in T1 maps. T1/T2 values were significantly higher in the infarcted myocardium (IM) compared with the remote myocardium (RM) (in T1: 1151.6 ± 53.5 ms vs. 958.2 ± 38.6 ms, respectively; in T2: 69 ± 6 ms vs. 51.9 ± 2.9 ms, respectively; p < 0.0001 for both). We found both an obstructive CAD at CA and myocardial edema at CMR in 53.2% of patients, while 8.5% of patients had a non-obstructive CAD and no edema. However, 25.5% of patients had an obstructive CAD without edema, while 12.8% of patients showed edema despite a non-obstructive CAD. Furthermore, in 6 of the edema-positive patients with multi-vessels obstructive CAD, CMR identified myocardial edema in a vascular territory different from that of the lesion supposed to be the culprit at CA.

Conclusions

In a non-negligible percentage of NSTEMI patients, T1 and T2 mapping detect myocardial edema without significant stenosis at CA and vice versa. Therefore, CA and CMR edema imaging might provide complementary information in the evaluation of NSTEMI.

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Abbreviations

2ch:

Two-chamber

4ch:

Four-chamber

AAR:

Area at risk

CA:

Coronary angiography

CAD:

Coronary artery disease

CMR:

Cardiac magnetic resonance

FFR:

Fractional flow reserve

hs-cTn-T:

High-sensitivity cardiac troponin T

IM:

Infarcted myocardium

LGE:

Late gadolinium enhancement

MI:

Myocardial infarction

MOLLI:

Modified look-locker inversion recovery

NSTE-ACS:

Non-ST-segment elevation acute coronary syndrome

NSTEMI:

Non-ST-segment elevation myocardial infarction

PCI:

Percutaneous coronary intervention

RM:

Remote myocardium

ROI:

Region of interest

STEMI:

ST-segment elevation myocardial infarction

STIR:

Short-tau inversion recovery

WIP:

Work-In-Progress

WMSI:

Wall motion score index

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Authors and Affiliations

  1. Department of Radiology, Versilia Hospital, Via Aurelia 335, 55041, Lido di Camaiore, Italy

    Carlo Tessa, Luca Salvatori & Claudio Vignali

  2. Department of Cardiology, Versilia Hospital, Via Aurelia 335, 55041, Lido di Camaiore, Italy

    Jacopo Del Meglio, Alessio Lilli & Giancarlo Casolo

  3. Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Via Venezia 52, 47521, Cesena, Italy

    Stefano Diciotti

  4. Unit of Medical Physics, Pisa University Hospital “Azienda Ospedaliero-Universitaria Pisana”, Via Roma 67, 56126, Pisa, Italy

    Marco Giannelli

  5. Siemens Healthcare GmbH, Karl-Schall-Str. 6, 91052, Erlangen, Germany

    Andreas Greiser

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  1. Carlo Tessa
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  2. Jacopo Del Meglio
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Correspondence to Carlo Tessa.

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Authors Carlo Tessa, Jacopo Del Meglio, Alessio Lilli, Stefano Diciotti, Luca Salvatori, Marco Giannelli, Claudio Vignali and Giancarlo Casolo declare that they have no conflict of interest. The co-author Andreas Greiser is employee of Siemens Healthcare.

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Tessa, C., Del Meglio, J., Lilli, A. et al. T1 and T2 mapping in the identification of acute myocardial injury in patients with NSTEMI. Radiol med 123, 926–934 (2018). https://doi.org/10.1007/s11547-018-0931-2

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