Department of Radiology, Versilia Hospital, Via Aurelia 335, 55041, Lido di Camaiore, Italy.
Department of Cardiology, Versilia Hospital, Via Aurelia 335, 55041, Lido di Camaiore, Italy.
Radiol Med. 2018 Dec;123(12):926-934. doi: 10.1007/s11547-018-0931-2. Epub 2018 Aug 21.
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.
Forty-seven patients with acute NSTEMI underwent cardiac magnetic resonance (CMR) at 1.5 T, including T1 and T2 mapping.
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.
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.
在接受血运重建之前，评估非 ST 段抬高型心肌梗死（NSTEMI）患者的 T1 和 T2 映射，以检测急性心肌损伤。
47 名急性 NSTEMI 患者在 1.5T 下进行心脏磁共振（CMR）检查，包括 T1 和 T2 映射。
冠状动脉造影（CA）显示 36 例（80%）患者存在阻塞性冠状动脉疾病（CAD），11 例（20%）患者存在非阻塞性 CAD。T1/T2 图中分别有 51.1%/65.9%的患者存在水肿。这种差异是由于 T1 图中的伪影造成的。与远程心肌（RM）相比，梗死心肌（IM）的 T1/T2 值明显更高（T1：1151.6±53.5ms 比 958.2±38.6ms；T2：69±6ms 比 51.9±2.9ms；均 p<0.0001）。我们在 53.2%的患者中同时发现 CA 中的阻塞性 CAD 和 CMR 中的心肌水肿，而 8.5%的患者存在非阻塞性 CAD 但无水肿。然而，25.5%的患者存在阻塞性 CAD 但无水肿，而 12.8%的患者存在非阻塞性 CAD 但有水肿。此外，在 6 名多血管阻塞性 CAD 且水肿阳性的患者中，CMR 在与 CA 中假定为罪犯病变的血管区域不同的血管区域识别出心肌水肿。
在非小比例的 NSTEMI 患者中，T1 和 T2 映射可检测到 CA 无明显狭窄但存在心肌水肿，反之亦然。因此，CA 和 CMR 水肿成像可能在 NSTEMI 的评估中提供互补信息。
