Cardiac MRI to Visualize Myocardial Damage after ST-Segment Elevation Myocardial Infarction: A Review of Its Histologic Validation

C.W.H. Beijnink, N.W. van der Hoeven, L.S.F. Konijnenberg, R.J. Kim, S.C.A.M. Bekkers, R.A. Kloner, H. Everaars, S. El Messaoudi, A.C. van Rossum, N. van Royen, R. Nijveldt*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

2 Citations (Web of Science)

Abstract

Cardiac MRI is a noninvasive diagnostic tool using nonionizing radiation that is widely used in patients with ST-segment elevation myocardial infarction (STEMI). Cardiac MRI depicts different prognosticating components of myocardial damage such as edema, intramyocardial hemorrhage (IMH), microvascular obstruction (MVO), and fibrosis. But how do cardiac MRI findings correlate to histologic findings? Shortly after STEMI, T2-weighted imaging and T2* mapping cardiac MRI depict, respectively, edema and IMH. The acute infarct size can be determined with late gadolinium enhancement (LGE) cardiac MRI. T2-weighted MRI should not be used for area-at-risk delineation because T2 values change dynamically over the first few days after STEMI and the severity of T2 abnormalities can be modulated with treatment. Furthermore, LGE cardiac MRI is the most accurate method to visualize MVO, which is characterized by hemorrhage, microvascular injury, and necrosis in histologic samples. In the chronic setting post-STEMI, LGE cardiac MRI is best used to detect replacement fibrosis (ie, final infarct size after injury healing). Finally, native T1 mapping has recently emerged as a contrast material-free method to measure infarct size that, however, remains inferior to LGE cardiac MRI. Especially LGE cardiac MRI-defined infarct size and the presence and extent of MVO may be used to monitor the effect of new therapeutic interventions in the treatment of reperfusion injury and infarct size reduction. (C) RSNA, 2021
Original languageEnglish
Pages (from-to)4-18
Number of pages15
JournalRadiology
Volume301
Issue number1
DOIs
Publication statusPublished - 1 Oct 2021

Keywords

  • CARDIOVASCULAR MAGNETIC-RESONANCE
  • PERCUTANEOUS CORONARY INTERVENTION
  • LATE GADOLINIUM-ENHANCEMENT
  • MICROVASCULAR OBSTRUCTION
  • INTRAMYOCARDIAL HEMORRHAGE
  • PROGNOSTIC VALUE
  • QUANTITATIVE ASSESSMENT
  • CONTRAST ENHANCEMENT
  • SIGNAL INTENSITY
  • PORCINE MODEL

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