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Measurement of the Gadopentetate Dimeglumine Partition Coefficient in Human Myocardium in Vivo: Normal Distribution and Elevation in Acute and Chronic Infarction¹

¹ From the Cardiovascular Division, Barnes-Jewish Hospital at Washington University Medical Center, St Louis, Mo (S.J.F., S.E.F., C.H.L.); and Philips Medical Systems, Best, the Netherlands (S.E.F.). Received April 26, 2000; revision requested June 12; revision received June 28; accepted July 6. Supported in part by the Wolff Charitable Trust and Philips Medical Systems. S.J.F. supported by a grant from the Deutsche Forschungsgemeinschaft. Address correspondence to C.H.L., Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney St, London SW3 6NP, England (e-mail: chlorenz00@aol.com).

View larger version (135K): [in a new window]   Figure 1. Sample MR images obtained with the Look-Locker sequence (3,000/3.53; 10° flip angle, isotropic 2.5-mm in-plane resolution, and image spacing of 50 msec before and 30 msec after contrast material administration) in a patient with recent acute infarction in the right coronary artery distribution. A stent was placed in the distal right coronary artery, and the inferior basal wall of the left ventricle was hypokinetic. Sample images in a basal section that were obtained before contrast material administration (top row) and after bolus administration and a constant infusion of gadopentetate dimeglumine (bottom row) are shown. The images were obtained early after the 180° inversion pulse (left column), near the time of the blood zero crossing (middle column), and near the time of the myocardial zero crossing (right column). The early signal recovery of the pericardial fat (arrowheads) is noted. After administration of gadopentetate dimeglumine, the infarcted inferior basal myocardium (arrows) has a zero crossing that is earlier than that of the normal myocardium and similar to that of the blood pool in the left ventricle. The calculated was elevated to 0.87 mL/g, as compared with the normal value of 0.56 mL/g for this segment.

View larger version (35K): [in a new window]   Figure 2. Radial plot of the magnitude of in 12 healthy volunteers. The magnitude of varies from 0.42 to 0.75 mL/g, with slightly increased values at the intersection of the left and right ventricles (inferior-septal segment, P < .05) in each section.  = section 1,  = section 2,  = section 3,  = section 4.

View larger version (41K): [in a new window]   Figure 3a. (a) Graph compares the in acute and chronic infarctions and normal myocardium. The magnitude of the of nonviable segments in the patients with chronic myocardial infarction is plotted against the averaged values of the corresponding normal segments. Each patient is represented by a different symbol. In all but one segment, the value of the within the scar tissue is increased, as compared with that within the averaged normal values, and in only three of 37 segments, the increase of is less than 5%. The differences between corresponding segments in these two groups were highly significant (paired sample t test, P < .001). (b) Graph shows the magnitude of the in 15 acutely infarcted myocardial segments, as plotted against the averaged values of the corresponding normal segments. Each patient is represented by a different symbol. The minimal increase of the was 35%. The differences between corresponding segments in these two groups were highly significant (paired sample t test, P < .001).

View larger version (38K): [in a new window]   Figure 3b. (a) Graph compares the in acute and chronic infarctions and normal myocardium. The magnitude of the of nonviable segments in the patients with chronic myocardial infarction is plotted against the averaged values of the corresponding normal segments. Each patient is represented by a different symbol. In all but one segment, the value of the within the scar tissue is increased, as compared with that within the averaged normal values, and in only three of 37 segments, the increase of is less than 5%. The differences between corresponding segments in these two groups were highly significant (paired sample t test, P < .001). (b) Graph shows the magnitude of the in 15 acutely infarcted myocardial segments, as plotted against the averaged values of the corresponding normal segments. Each patient is represented by a different symbol. The minimal increase of the was 35%. The differences between corresponding segments in these two groups were highly significant (paired sample t test, P < .001).

View larger version (72K): [in a new window]   Figure 4. Bull’s-eye plot of the ratio of the patients’ and the normal mean value in a 61-year-old patient with a previous history of myocardial infarction and coronary artery bypass surgery 9 years prior to the current study. At examination, the patient’s left ventricular function was mildly depressed, with akinetic to dyskinetic and thinned septal-anterior (Sep-Ant) walls, including the apex and hypokinetic midlateral walls. Ratios of are displayed for each of the circumferential sectors by using a gray scale: Black represents a ratio of 1, and increased values of that result in a ratio greater than 1 are displayed in lighter shades of gray. The most basal section is displayed on the outside edge; the most apical section, on the inside edge. Increased ratios of the were detected in the anterior septal (Sep-Ant) wall, which extended from the apex to midventricular levels. However, the differences, as compared with those in normal segments, are less obvious than those in the acute infarctions (Fig 5). Two segments with normal wall motion and wall thickening under dobutamine stress in the anterior lateral (Ant-Lat) wall also showed an increased . This discrepancy between wall motion and the magnitude of the adjacent to the large infarction may be caused by an inhomogeneous mixture of viable and nonviable tissue at the border of the infarction. Ant = anterior, Inf = inferior, Inf-Sep = inferior septal, Lat = lateral, Lat-Inf = lateral inferior, Sep = septal.

View larger version (62K): [in a new window]   Figure 5. Bull’s-eye plot shows the ratio of the and the normal mean value in a 38-year-old patient with recent acute myocardial infarction. MR imaging was performed 7 days after symptom onset. Emergency angioplasty and stent placement were performed in the proximal left descending coronary artery. Ratios of the are displayed for each of the circumferential sectors by using a gray scale: Black represents a ratio of 1; increased values of , which result in a ratio greater than 1, are displayed in lighter shades of gray. The most apical section is displayed on the outside edge; the most apical section, on the inside edge. The infarction in the anterior wall at the midventricular level can be seen clearly. The reached values of 1.0 mL/g, and wall motion at rest was hypokinetic in the segments with an increased . Ant = anterior, Ant-Lat, anterior-lateral, Inf = inferior, Inf-Sep = inferior septal, Lat = lateral, Lat-Inf = lateral inferior, Sep = septal, Sep-Ant = septal anterior.