Microvascular obstruction on delayed enhancement cardiac magnetic resonance imaging after acute myocardial infarction, compared with myocardial 201Tl and 123I-BMIPP dual SPECT findings. Issue 8 (August 2015)

• Record Type: Journal Article
• Authors: Mori, Hiroaki; Isobe, Satoshi; Sakai, Shinichi; Yamada, Takashi; Watanabe, Naoki; Miura, Manabu; Uchida, Yasuhiro; Kanashiro, Masaaki; Ichimiya, Satoshi; Okumura, Takahiro; Murohara, Toyoaki
• Is Part Of: European journal of radiology. Volume 84:Issue 8(2015)
• Page Start: 1516
• Page End: 1524
• Publication Date: 2015-08
• Subjects: AMI acute myocardial infarction -- 123I-BMIPP iodine-123-15-(p-iodophenyl)-3-(R, S)-methylpentadecanoic acid -- CMR cardiac magnetic resonance -- IS infarct size -- LGE late gadolinium enhancement -- LV left ventricular -- MMS mismatch score -- MO microvascular obstruction -- PCI percutaneous coronary intervention -- SPECT single-photon emission computed tomography -- 201Tl thallium-201; Microvascular obstruction -- Magnetic resonance imaging -- 201Tl and 123I-BMIPP dual SPECT -- Acute myocardial infarction; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2015.05.002
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: The percentage infarct size (%IS) was significantly greater in the microvascular obstruction (MO) group than in the non-MO group. The percentage mismatch score (%MMS) on dual scintigraphy significantly correlated with the %IS and the percentage MO. The %MMS was significantly greater in the non-MO group than in the MO group, and was an independent predictor for MO. Abstract: Background: The hypo-enhanced regions within the hyper-enhanced infarct areas detected by cardiac magnetic resonance (CMR) imaging reflect microvascular obstruction (MO) after acute myocardial infarction (AMI). The combined myocardial thallium-201 ( 201 Tl)/iodine-123-15-(p-iodophenyl)-3-(R, S)-methylpentadecanoic acid ( 123 I-BMIPP) dual single-photon emission computed tomography (SPECT) is a useful tool for detecting myocardial reversibility after AMI. We evaluated whether MO could be an early predictor of irreversible myocardial damage in comparison with 201 Tl and 123 I-BMIPP dual SPECT findings in AMI patients. Methods: Sixty-two patients with initial AMI who successfully underwent coronary revascularization were enrolled. MO was defined by CMR imaging. Patients were divided into 2 groups as follows: MO group ( n = 32) and non-MO group ( n = 30). Scintigraphic defect scores were calculated using a 17-segment model with a 5-point scoring system. The mismatch score (MMS) was calculated as follows: the total sum of (Σ) 123 I-BMIPP defect score minus Σ 201 Tl defect score. The percentage mismatch score (%MMS) was calculated as follows: MMS/(Σ 123 I-BMIPP score) × 100 (%). Results: The percentage infarct size (%IS) was significantly greater in the MO group than in the non-MO group (32.2 ± 13.8% vs. 18.3 ± 12.1%, p < 0.001). The %MMS significantly correlated with the %IS and the percentage MO ( r = −0.26, p = 0.03; r = −0.45, p < 0.001, respectively). The %MMS was significantly greater in the non-MO group than in the MO group (45.4 ± 42.4% vs. 13.3 ± 28.0%, p = 0.001), and was an independent predictor for MO (OR 0.97, 95%CI 0.94–0.99, p = 0.02). Conclusions: Our results reconfirm that, in comparison with myocardial dual scintigraphy, MO is an important structural abnormality. CMR imaging is useful for the early detection of irreversible myocardial damage after AMI.