Nassenstein K, Waltering K, Hollenhorst M, Bruder O, Schlosser T, Hunold P, Barkhausen J
Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen.
Rofo. 2009 Jul;181(7):669-74. doi: 10.1055/s-0028-1109203. Epub 2009 Apr 7.
Microvascular obstruction (MO) and the extent of infarction are important prognostic factors in acute myocardial infarction. Our study aimed to investigate the effect of the time interval between contrast administration and image acquisition on the quantification of microvascular obstruction and myocardial infarction.
50 consecutive patients with acute myocardial infarction (40 male, mean age 58.1 +/- 11.7 years) treated by percutaneous coronary revascularization resulting in a grade 3 flow according to the thrombolysis in myocardial infarction flow classification were examined on a 1.5 T MR scanner within the first 5 days after infarction. 2, 5, 10, and 20 minutes after I.V. administration of 0.2 mmol/kg per kg body weight of Gadodiamid (Omniscan), GE Healthcare Buchler, Germany), a single shot IR-SSFP sequence (TR 2.4 ms, TE 1.08 ms, TI 180 - 280 ms, FA 50 degrees) covering the entire left ventricle was acquired. Areas of MO and myocardial infarction were measured for all times after contrast injection (p. i.).
MO was detected in 32 of 50 patients two minutes p. i., while 23 patients showed evidence of MO (p = 0.002) 20 min. p. i. In all patients with MO, the extent of MO decreased over time (7.4 +/- 9.0 % of the LV myocardium 2 min. p. i. vs. 2.4 +/- 4.6 % 20 min. p. i. p < 0.0001). The area of myocardial infarction increased from 13.9 +/- 13.5 % 2 min. p. i. to 18.6 +/- 14.2 % 10 min. p. i. (p < 0.0001), and then remained unchanged (18.7 +/- 14.3 % at 20 min. p = 0.57).
Our study shows that the time delay between contrast media injection and image acquisition has a significant impact on the delimitable extent of MO and infarct size.
微血管阻塞（MO）和梗死范围是急性心肌梗死重要的预后因素。我们的研究旨在探讨造影剂注射与图像采集之间的时间间隔对微血管阻塞和心肌梗死定量分析的影响。
连续纳入50例急性心肌梗死患者（40例男性，平均年龄58.1±11.7岁），这些患者接受经皮冠状动脉血运重建治疗，根据心肌梗死溶栓血流分级达到3级血流，在梗死后的前5天内于1.5T磁共振成像扫描仪上进行检查。静脉注射每千克体重0.2mmol/kg的钆双胺（欧乃影，德国通用电气医疗集团布赫勒公司）后2、5、10和20分钟，采集覆盖整个左心室的单次激发IR-SSFP序列（重复时间2.4ms，回波时间1.08ms，反转时间180 - 280ms，翻转角50°）。在造影剂注射后（p.i.）的所有时间点测量MO和心肌梗死的面积。
50例患者中有32例在注射造影剂后2分钟检测到MO，而23例患者在注射造影剂后20分钟显示有MO证据（p = 0.002）。在所有有MO的患者中，MO范围随时间减小（注射造影剂后2分钟时为左心室心肌的7.4±9.0%，注射造影剂后20分钟时为2.4±4.6%，p < 0.0001）。心肌梗死面积从注射造影剂后2分钟时的13.9±13.5%增加到注射造影剂后10分钟时的18.6±14.2%（p < 0.0001），然后保持不变（注射造影剂后20分钟时为18.7±14.3%，p = 0.57）。
我们的研究表明，造影剂注射与图像采集之间的时间延迟对可界定的MO范围和梗死大小有显著影响。
