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128 Bright blood t2 weighted MRI has higher diagnostic precision and accuracy than dark blood stir MRI for assessment of the ischaemic area-at-risk and myocardial salvage in acute myocardial infarction
  1. A R Payne1,
  2. M Casey1,
  3. J McClure1,
  4. R McGeoch2,
  5. A Murphy2,
  6. R Woodward2,
  7. A Saul2,
  8. J Gilchrist2,
  9. C Clark2,
  10. K G Oldroyd2,
  11. N Tzemos1,
  12. C Berry1
  1. 1University of Glasgow, Glasgow, UK
  2. 2Golden Jubilee National Hospital, Glasgow, UK

Abstract

Background T2-weighted MRI reveals myocardial oedema and enables estimation of the ischaemic area-at-risk and myocardial salvage in patients with acute myocardial infarction (MI). We compared the diagnostic accuracy of a new bright blood T2-weighted with a standard black blood T2-weighted MRI in patients with acute MI.

Methods A breath hold bright blood T2-weighted ACUTE pulse sequence with normalisation for coil sensitivity and a breath hold T2 dark blood short τ inversion recovery (STIR) sequence were used to depict the area-at-risk in 54 consecutive acute MI patients. Infarct size was measured on gadolinium late contrast enhancement images.

Results Compared with dark blood T2-weighted MRI, consensus agreements between independent observers for identification of myocardial oedema were higher with bright blood T2 -weighted MRI when evaluated per patient (p<0.001) and per segment of left ventricle (p<0.001). Compared to bright blood T2-weighted MRI, dark blood T2-weighted MRI under-estimated the area-at-risk compared to infarct size (p<0.001). The 95% limits of agreement for inter-observer agreements for the ischaemic area-at-risk and myocardial salvage were wider with dark blood T2-weighted MRI than with bright blood T2-weighted MRI. Bright blood enabled more accurate identification of the culprit coronary artery with correct identification in 94% of cases compared to 61% for dark blood (p<0.001).

Conclusion Bright blood T2-weighted MRI has higher diagnostic accuracy than dark blood T2-weighted MRI. Additionally, dark blood T2-weighted MRI may underestimate area-at-risk and myocardial salvage.

  • Myocardial infarction
  • MRI
  • myocardial oedema

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