Rapid detection of myocardial infarction by subsecond, free-breathing delayed contrast-enhancement cardiovascular magnetic resonance

• Published in: Circulation (New York, N.Y.) N.Y.), 2007-01, Vol.115 (2), p.236-244
• Main Authors: SIEVERS, Burkhard, ELLIOTT, Michael D, HURWITZ, Lynne M, ALBERT, Timothy S. E, KLEM, Igor, REHWALD, Wolfgang G, PARKER, Michele A, JUDD, Robert M, KIM, Raymond J
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cohort Studies; Contrast Media; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heart; Humans; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - diagnostic imaging; Neurology; Prospective Studies; Radiography; Respiration; Respiratory Mechanics - physiology; Time Factors; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.106.635409

An ultrafast, delayed contrast-enhancement cardiovascular magnetic resonance technique that can acquire subsecond, "snapshot" images during free breathing (subsecond) is becoming widely available. This technique provides myocardial infarction (MI) imaging with complete left ventricular coverage in < 30 seconds. However, the accuracy of this technique is unknown. We prospectively compared subsecond imaging with routine breath-hold delayed contrast-enhancement cardiovascular magnetic resonance (standard) in consecutive patients. Two cohorts with unambiguous standards of truth were prespecified: (1) patients with documented prior MI (n=135) and (2) patients without MI and with low likelihood of coronary disease (lowest Framingham risk category; n=103). Scans were scored masked to identity and clinical information. Sensitivity, specificity, and accuracy of subsecond imaging for MI diagnosis were 87%, 96%, and 91%, respectively. Compared with the standard technique (98%, 100%, 99%), the subsecond technique had modestly reduced sensitivity (P=0.0001), but specificity was excellent. Missed infarcts were generally small or subendocardial (87%). Overall, regional transmural extent of infarction scores were highly concordant (2083/2294; 91%); however, 51 of 337 regions (15%) considered predominantly infarcted (> 50% transmural extent of infarction) by the standard technique were considered viable (< or = 25% transmural extent of infarction) by the subsecond technique. Quantitative analysis demonstrated moderately reduced contrast-to-noise ratios for subsecond imaging between infarct and remote myocardium (12.0+/-7.2 versus 20.1+/-6.6; P