Skip to main content
SpringerLink
Log in

Visual estimation of the global myocardial extent of hyperenhancement on delayed contrast-enhanced MRI

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

MRI with paramagnetic contrast agent allows the assessment of the extent of myocardial tissue injury after infarction. Visual segmental scoring has been widely used to define the transmural extent of myocardial infarction, but no attempt has been made to use visual scores in order to assess the percentage of the whole myocardium infarcted. By summing all the segmental scores using a 17-segment model, a global index of the size of the infarcted myocardium is easily obtained. The entire left ventricle of 60 patients with a recent myocardial infarction was scanned using an ECG-gated gradient echo sequence after injection of gadolinium contrast agent. The global score was defined as the sum of the scores on each segment, and expressed as a percentage of the maximum possible score. This index was compared with a planimetric evaluation of hyperenhancement, expressed as a percentage of the left ventricle myocardial volume. There is a good correlation between the two methods (r=0.91; y=1.06x+0.20), and the Bland-Altman plot shows a high concordance between the two approaches (mean of the differences =1.45%). A visual approach based on a 17-segment model can be used to evaluate the global myocardial extent of the hyperenhancement with similar results to planimetry.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Gibbons RJ, Verani MS, Behrenbeck T, Pellikka PA, O’Connor MK, Mahmarian JJ, Chesebro JH, Wackers FJ (1989) Feasibility of tomographic 99mTc-hexakis-2-methoxy-2-methylpropyl-isonitrile imaging for the assessment of myocardial area at risk and the effect of treatment in acute myocardial infarction. Circulation 80:1277–1286

    CAS  PubMed  Google Scholar 

  2. Christian TF, Behrenbeck T, Gersh BJ, Gibbons RJ (1991) Relation of left ventricular volume and function over one year after acute myocardial infarction to infarct size determined by technetium-99m sestamibi. Am J Cardiol 68:21–26

    Article  CAS  PubMed  Google Scholar 

  3. Dendale P, Franken PR, Block P, Pratikakis Y, De Roos A (1998) Contrast enhanced and functional magnetic resonance imaging for the detection of viable myocardium after infarction. Am Heart J 135:875–880

    CAS  PubMed  Google Scholar 

  4. Kim RJ, Chen E-L, Lima JAC, Judd RM (1996) Myocardial Gd-DTPA kinetics determine MRI contrast enhancement and reflect the extent and severity of myocardial injury after acute reperfused infarction. Circulation 94:3318–3326

    CAS  PubMed  Google Scholar 

  5. Kim RJ, Fieno DS, Parrish TB, Harris K, Chen E-L, Simonetti O, Bundy J, Finn P, Klocke FJ, Judd RM (1999) Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation 100:1992–2002

    CAS  PubMed  Google Scholar 

  6. Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Kloche FJ, Bonow RO, Judd RM (2000) The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 343:1445–1453

    Article  CAS  PubMed  Google Scholar 

  7. Gerber BL, Garot J, Bluemke DA, Wu KC, Lima JA (2002) Accuracy of contrast-enhanced magnetic resonance imaging in predicting improvement of regional myocardial function in patients after acute myocardial infarction. Circulation 106:1083–1089

    Article  PubMed  Google Scholar 

  8. Lima JAC, Judd RM, Bazille A, Schulman SP, Atalar E, Zerhouni EA (1995) Regional heterogeneity of human myocardial infarcts demonstrated by contrast-enhanced MRI. Potential mechanisms. Circulation 92:1117–1125

    CAS  PubMed  Google Scholar 

  9. Lipton MJ, Bogaert J, Boxt LM, Reba RC (2002) Imaging of ischemic heart disease. Eur Radiol 12:1061–1080

    Article  PubMed  Google Scholar 

  10. Sandstede JJ, Lipke C, Beer M, Harre K, Pabst T, Kenn W, Neubauer S, Hahn D (2000) Analysis of first-pass and delayed contrast-enhancement patterns of dysfunctional myocardium on MR imaging: use in prediction of myocardial viability. Am J Roentgenol 174:1737–1740

    CAS  Google Scholar 

  11. Sandstede JJW (2003) Assessment of myocardial viability by MR imaging. Eur Radiol 13:52–61

    PubMed  Google Scholar 

  12. Beek AM, Kuhl HP, Bondarenko O, Twisk JW, Hofman MB, van Dockum WG, Visser CA, van Rossum AC (2003) Delayed contrast-enhanced magnetic resonance imaging for the prediction of regional functional improvement after acute myocardial infarction. J Am Coll Cardiol 42:895–901

    Article  PubMed  Google Scholar 

  13. Miller S, Helber U, Brechtel K, Nagele T, Hahn U, Kramer U, Hoffmeister HM, Claussen CD (2003) MR imaging at rest early after myocardial infarction: detection of preserved function in regions with evidence for ischemic injury and non-transmural myocardial infarction. Eur Radiol 13:498–506

    PubMed  Google Scholar 

  14. Mahrholdt H, Wagner A, Holly TA, Elliott MD, Bonow RO, Kim RJ, Judd RM (2002) Reproducibility of chronic infarct size measurement by contrast-enhanced magnetic resonance imaging. Circulation 106:2322–2327

    Article  CAS  PubMed  Google Scholar 

  15. Ramani K, Judd RM, Holly TA, Parrish TB, Rigolin VH, Parker MA, Callahan C, Fitzgerald SW, Bonow RO, Klocke FJ (1998) Contrast magnetic resonance imaging in the assessment of myocardial viability in patients with stable coronary artery disease and left ventricular dysfunction. Circulation 98:2687–2694

    CAS  PubMed  Google Scholar 

  16. Klein C, Nekolla SG, Bengel FM, Momose M, Sammer A, Haas F, Schnackenburg B, Delius W, Mudra H, Wolfram D, Schwaiger M (2002) Assessment of myocardial viability with contrast-enhanced magnetic resonance imaging: comparison with positron emission tomography. Circulation 105:162–167

    Article  PubMed  Google Scholar 

  17. Wu E, Judd RM, Vargas JD, Klocke FJ, Bonow RO, Kim RJ (2001) Visualisation of presence, location, and transmural extent of healed Q-wave and non-Q-wave myocardial infarction. Lancet 357:21–28

    Article  CAS  PubMed  Google Scholar 

  18. Wagner A, Mahrholdt H, Holly TA, Elliott MD, Regenfus M, Parker M, Klocke FJ, Bonow RO, Kim RJ, Judd RM (2003) Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet 361:374–379

    Article  PubMed  Google Scholar 

  19. Choi KM, Kim RJ, Gubernikoff G, Vargas JD, Parker M, Judd RM (2001) Transmural extent of acute myocardial infarction predicts long-term improvement in contractile function. Circulation 104:1101–1107

    CAS  PubMed  Google Scholar 

  20. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. Circulation 105:539–542

    Article  PubMed  Google Scholar 

  21. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 8:307–310

    Google Scholar 

  22. Fieno DS, Kim RJ, Chen EL, Lomasney JW, Kloche FJ, Judd RM (2000) Contrast-enhanced magnetic resonance imaging of myocardium at risk: distinction between reversible and irreversible injury throughout infarct healing. J Am Coll Cardiol 36:1985–1991

    Article  CAS  PubMed  Google Scholar 

  23. Henry WL, DeMaria A, Gramiak R, King DL, Kisslo JA, Popp RL, Sahn DJ, Schiller NB, Tajik A, Teichholz LE, Weyman AE (1980) Report of the American society of echocardiography committee on nomenclature and standards in two-dimensional echocardiography. Circulation 62:212–217

    CAS  PubMed  Google Scholar 

  24. Gibbons RJ, Miller TD, Christian TF (2000) Infarct size measured by single photon emission computed tomographic imaging with (99m)Tc-sestamibi: a measure of the efficacy of therapy in acute myocardial infarction. Circulation 101:101–108

    CAS  PubMed  Google Scholar 

  25. Miller TD, Christian TF, Hopfenspirger MR, Hodge DO, Gersh BJ, Gibbons RJ (1995) Infarct size after acute myocardial infarction measured by quantitative tomographic 99mTc sestamibi imaging predicts subsequent mortality. Circulation 92:334–341

    CAS  PubMed  Google Scholar 

  26. Udelson JE, Coleman PS, Metherall J, Pandian NG, Gomez AR, Griffith JL, Shea NL, Oates E, Konstam MA (1994) Predicting recovery of severe regional ventricular dysfunction. Comparison of resting scintigraphy with 201Tl and 99mTc-sestamibi. Circulation 89:2552–2561

    CAS  PubMed  Google Scholar 

  27. Berman DS, Kang X, Abidov A, Cohen I, Hayes SW, Friedman JD, Sciammarella M, Germano G, Aboul-Enein F, Hachamovitch R (2003) Prognostic value of myocardial perfusion SPECT comparing 17-segment and 20-segment scoring systems. J Am Coll Cardiol 19:445

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Laboratoire de Biophysique, Faculté de Médecine, Université de Bourgogne, BP 87900, 21079, Dijon Cedex, France

    Alexandre Comte, Alain Lalande, Paul M. Walker & Alexandre Cochet

  2. Laboratoire d’informatique Médicale, Faculté de Médecine, Université de Bourgogne, BP 87900, 21079, Dijon Cedex, France

    Louis Legrand

  3. Service de Cardiologie II, Centre Hospitalier Universitaire de Dijon, 2, bld Maréchal de Lattre de Tassigny, 21034, Dijon Cedex, France

    Yves Cottin & Jean-Eric Wolf

  4. Service de Spectroscopie-RMN, Centre Hospitalier Universitaire de Dijon, 2, bld Maréchal de Lattre de Tassigny, 21034, Dijon Cedex, France

    François Brunotte

Authors
  1. Alexandre Comte
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alain Lalande
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul M. Walker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexandre Cochet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Louis Legrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yves Cottin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jean-Eric Wolf
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. François Brunotte
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexandre Comte.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Comte, A., Lalande, A., Walker, P.M. et al. Visual estimation of the global myocardial extent of hyperenhancement on delayed contrast-enhanced MRI. Eur Radiol 14, 2182–2187 (2004). https://doi.org/10.1007/s00330-004-2483-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-004-2483-1

Keywords

Search

Navigation