Download PDF
Rofo 1999; 171(5): 349-358
DOI: 10.1055/s-1999-265
ÜBERSICHT
Georg Thieme Verlag Stuttgart · New York

Bildgebung nach Myokardinfarkt: Was leistet die Magnetresonanztomographie?

Diagnostic assessment of the heart after infarction: What is the role of magnetic resonance imaging?D. E. Kivelitz, M. Taupitz, B. Hamm
  • Institut für Radiologie, Universitätsklinikum Charité der Humboldt-Universität zu Berlin
Further Information

Publication History

Publication Date:
31 December 1999 (online)

Also available at
    Permissions and Reprints

Zusammenfassung.

Die Magnetresonanztomographie (MRT) hat in den letzten Jahren erhebliche Fortschritte auf dem Gebiet der bildgebenden Diagnostik des Herzens erzielt. Dadurch kann eine umfassende nichtinvasive Evaluierung der koronaren Herzkrankheit und des Myokardinfarktes in naher Zukunft Realität werden. Diese Arbeit gibt einen Überblick über derzeitige Möglichkeiten und das zukünftige Potential, die myokardiale Anatomie, Funktion, Perfusion und Koronaranatomie nach Myokardinfarkt zu evaluieren. Die Cine MR erlaubt mit hoher zeitlicher und räumlicher Auflösung eine zuverlässige Analyse regionaler und globaler myokardialer Wandbewegungsstörungen. Darüber hinaus ermöglichen Tagging-Techniken, nichtinvasiv Anteile des Myokards zu markieren und dreidimensionale Kontraktionsmuster zu erkennen. Die Bestimmung der myokardialen Perfusion und eine Beurteilung von Wandbewegungsstörungen unter pharmokologischer Belastung können auch zuverlässig im MRT durchgeführt werden. Einzigartig ist die Darstellung des myokardialen Ödems aufgrund der hohen Weichteilkontrastauflösung. Die derzeit noch begrenzten Möglichkeiten, die Koronararterien und Koronarbypasses darzustellen, werden diskutiert.

There have been considerable advances in the diagnostic assessment of the heart by magnetic resonance imaging (MRI) in recent years. Thus MRI as a one-stop shop modality for the comprehensive noninvasive evaluation of coronary heart disease and myocardial infarction may soon become a reality. This article presents an overview of the present possibilities and future potential of evaluating myocardial anatomy, function, perfusion, and coronary anatomy after myocardial infarction. Cine MRI provides a reliable analysis of regional and global disturbances of cardiac wall motion with a high temporal and spatial resolution. Tagging techniques permit the noninvasive labelling of parts of the myocardium and the identification of three-dimensional patterns of contraction. Myocardial perfusion and disturbed wall motion under pharmacologic stress can be reliably assessed by MRI as well. What is unique is the visualization of myocardial edema, which is made possible by the high soft-tissue contrast resolution. The as yet limited potential to assess coronary arteries and coronary bypasses is likewise discussed.

Schlüsselwörter:

Myokardinfarkt - Koronare Herzkrankheit - MRT - Perfusion - Cine MRT

Key words:

Myocardial infarction - Coronary heart disease - MRI - Perfusion - Cine MRI

Literatur

  • 1 . WHO-MONICA Project: geographic variation in mortality from cardiovascular mortality.  World Health Stat Q. 1987;  40 171-184
    PubMedGoogle Scholar
  • 2 . Schriftenreihe des Bundesgesundheitsministeriums für Gesundheit.  Baden-Baden; Nomos 1985 51: 150-151
  • 3 Elefteriades J A, Tolis Jr G, Levi E, Mills L K, Zaret B L. Coronary artery bypass grafting in severe left ventricular dysfunction: excellent survival with improved ejection fraction and functional state.  J Am Coll Cardiol. 1993;  22 1411-1417
    CrossrefPubMedGoogle Scholar
  • 4 Nesto R W, Kowalchuk G J. The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia.  Am J Cardiol. 1987;  57 23
    PubMedGoogle Scholar
  • 5 . Reperfusion in acute myocardial infarction.  Circulation. 1994;  90 2091-2102
    PubMedGoogle Scholar
  • 6 Braunwald E, Kloner R A. The stunned myocardium: prolonged, postischemic ventricular dysfunction.  Circulation. 1982;  66 1146-1149
    PubMedGoogle Scholar
  • 7 Rahimtoola S H. A perspective on the three large multicenter randomized clinical trials of coronary bypass surgery for chronic stable angina.  Circulation. 1985;  72 135
    PubMedGoogle Scholar
  • 8 von Schulthess G K, Davis C P, Debatin J F, McKinnon G C. Schnelle und ultraschnelle Bildgebung des Herzens.  Radiologe. 1995;  35 952-953
    PubMedGoogle Scholar
  • 9 Krahe T H, Landwehr P, Leibold G, Lackner K. Myokardmassenbestimmung mit der Kardio-Magnetresonanztomographie.  Fortschr Röntgenstr. 1992;  157 439-446
    PubMedGoogle Scholar
  • 10 Caputo G R, Tscholakoff D, Sechtem U, Higgins C B. Measurements of canine left ventricular mass by using MR imaging.  Am J Roentgenol. 1997;  14 33-38
    PubMedGoogle Scholar
  • 11 Shapiro E P, Rogers W J, Beyar R, Soulen R L, Zerhouni E A, Lima J AC, Weiss J L. Determination of left ventricular mass by magnetic resonance imaging in hearts deformed by acute infarction.  Circulation. 1989;  79 706-711
    PubMedGoogle Scholar
  • 12 Katz J, Milliken M C, Stray-Gundersen J, Buja L M, Parkey R W, Mitchell J H, Peshock R M. Estimation of human myocardial mass with MR imaging.  Radiology. 1988;  169 495-498
    PubMedGoogle Scholar
  • 13 Matsumura K, Nakase E, Haiyama T, Takeo K, Shimizu K, Yamasaki K, Kohno K. Determination of cardiac ejection fraction and left ventricular volume: contrast-enhanced ultrafast cine MR imaging vs. i.v. digital subtraction ventriculography.  Am J Roentgenol. 1993;  160 979-985
    PubMedGoogle Scholar
  • 14 Pattynama P MT, Lamb H J, van der Velde E A, van der Wall E E, de Roos A. Left ventricular measurements with cine and spin-echo MR imaging: A study of reproducibility with variance component analysis.  Radiology. 1993;  187 261-268
    PubMedGoogle Scholar
  • 15 Fedele F, Scopinaro F, Di Cesare E, Di Renzi P, Vitarelli A, Dagianti Jr A. Characterization of reversible myocardial dysfunction by magnetic resonance imaging.  Herz. 1994;  19 210-220
    PubMedGoogle Scholar
  • 16 Dendale P AC, Franken P R, Waldmann G-J, De Moor D GE, Tombeur D AM, Block P FC, de Roos A. Low-dosage dobutamine magnetic resonance imaging as an alternative to echocardiography in the detection of viable myocardium after acute infarction.  Am Heart J. 1995;  130 134-140
    CrossrefPubMedGoogle Scholar
  • 17 Baer F M, Voth E, Schneider C A, Theissen P, Schicha H, Sechtem U. Comparison of low-dose dobutamine-gradient-echo magnetic resonance imaging and positron emission tomography with (18F)Fluorodeoxyglucose in patients with chronic coronary artery disease.  Circulation. 1995;  91 1006-1015
    PubMedGoogle Scholar
  • 18 Zerhouni E A, Parish D M, Rogers W J, Yang A, Shapiro E P. Human heart: Tagging with MR imaging - a method for noninvasive assessment of myocardial motion.  Radiology. 1988;  169 59-63
    PubMedGoogle Scholar
  • 19 Axel L, Dougherty L. MR imaging of motion with spatial modulation of magnetization.  Radiology. 1989;  171 841-845
    PubMedGoogle Scholar
  • 20 Young A A, Axel L. Three-dimensional motion of the heart wall: estimation with spatial modulation of magnetization - a model-based approach.  Radiology. 1992;  185 241-247
    PubMedGoogle Scholar
  • 21 Matter C, Mandinov L, Kaufmann P, Nagel E, Boesiger F, Hess O M. Funktion des Restmyokards nach Infarkt und dessen prognostische Bedeutung.  Z Kardiol. 1997;  86 684-690
    CrossrefPubMedGoogle Scholar
  • 22 Tsekos N V, Zhang Y, Merkle H, Wilke N, Jerosch-Herold M, Stillman A, Ugurbil K. Fast anatomical imaging of the heart and assessment of myocardial perfusion with arrhythmia insensitive magnetization preparation.  Magn Res Med. 1995;  34 530-536
    PubMedGoogle Scholar
  • 23 Wendlandt M F, Saeed M, Masui T, Derugin N, Moseley M E, Higgins C B. Echo-planar MR imaging of normal and ischemic myocardium with gadodiamide injection.  Radiology. 1993;  186 535-542
    PubMedGoogle Scholar
  • 24 Atkinson D J, Burstein D, Edelman R R. First-pass cardiac perfusion: evaluation with ultrafast MR imaging.  Radiology. 1990;  174 757-762
    PubMedGoogle Scholar
  • 25 Saeed M, Wendland M F, Tomei E, Rocklage S M, Quay S C, Moseley M E, Wolfe C, Higgins C B. Demarcation of myocardial ischemia: magnetic susceptibility effect of contrast medium in MR imaging.  Radiology. 1989;  173 763-767
    PubMedGoogle Scholar
  • 26 Wilke N, Jerosch-Herold M. Assessing myocardial perfusion in coronary artery disease with magnetic resonance imaging.  Cardiology Clinics. 1998;  16 227-246
    PubMedGoogle Scholar
  • 27 Wilke N, Jerosch-Herold M, Wang Y, Huang Y, Christensen B V, Stillman A, Ugurbil K, McDonald K, Wilson R F. Myocardial perfusion reserve: Assessment with multisection, quantitative, first-pass MR imaging.  Radiology. 1997;  204 373-384
    PubMedGoogle Scholar
  • 28 Lima J AC, Judd R M, Bazille A, Schulman S P, Atalar E, Zerhouni E A. Regional heterogeneity of human myocardial infarcts demonstrated by contrast-enhanced MRI.  Circulation. 1995;  92 1117-1125
    PubMedGoogle Scholar
  • 29 Szolar D H, Saeed M, Wendland M F, Sakuma H, Roberts T PL, Stiskal M A, Derugin N, Higgins C B. MR imaging characterization of postischemic myocardial dysfunction (stunned myocardium): relationship between functional and perfusion abnormalities.  J Magn Reson Imaging. 1996;  6 615-624
    PubMedGoogle Scholar
  • 30 Kivelitz D E, Bis K G, Wilke N M, Jerosch-Herold M, Juni J E, Hamm B. Quantitative MR first pass perfusion imaging demonstrates coronary artery patency post intervention.  Radiology. 1997;  205 254
    PubMedGoogle Scholar
  • 31 Manning W J, Atkinson D J, Grossman W, Paulin S, Edelman R R. First-pass nuclear magnetic resonance imaging studies using gadolinium-DTPA in patients with coronary artery disease.  J Am Coll Cardiol. 1991;  18 959-965
    PubMedGoogle Scholar
  • 32 Fung A Y, Gallagher K P, Buda A J. The physiologic basis of dobutamine as compared with dipyridamole stress interventions in the assessment of critical coronary stenosis.  Circulation. 1987;  76 943-951
    PubMedGoogle Scholar
  • 33 Schaefer S, van Tyen R, Salomer D. Evaluation of myocardial perfusion abnormalities with gadolinium-enhanced snapshot MR imaging in humans.  Radiology. 1992;  185 795-801
    PubMedGoogle Scholar
  • 34 Hartnell G, Cerel A, Kamalesh M, Finn J P, Hill T, Cohen M, Tello R, Lewis S. Detection of myocardial ischemia: Value of combined myocardial perfusion and cineangiographic MR imaging.  Am J Roentgenol. 1994;  163 1061-1067
    PubMedGoogle Scholar
  • 35 Bremerich J, Buser P, Bongartz G, Müller-Brand J, Grädel Ch, Pfisterer M, Steinbrich W. Noninvasive stress testing of myocardial ischemia: comparison of GRE-MRI perfusion and wall motion analysis to 99mTc-MIBI-SPECT, relation to coronary angiography.  Eur Radiol. 1997;  7 990-995
    CrossrefPubMedGoogle Scholar
  • 36 Matheijssen N AA, Louwerenburg H W, van Rugge F P, Arens R PJH, Kauer B, de Roos A, van der Wall E E. Comparison of ultrafast dipyridamole magnetic resonance imaging with dipyridamole SestaMIBI SPECT for detection of perfusion abnormalities in patients with one-vessel coronary artery disease: assessment by quantitative model fitting.  Magn Res Med. 1996;  35 221-228
    PubMedGoogle Scholar
  • 37 Klein M A, Collier B D, Hellman R S, Bamrah V S. Detection of chronic coronary artery disease: value of pharmacologically stressed, dynamically enhanced turbo-fast-low-angle shot MR images.  Am J Roentgenol. 1993;  161 257-263
    PubMedGoogle Scholar
  • 38 Lauerma K, Virtanen K S, Sipilä L M, Hekali P, Aronen H. Multislice MRI In assessment of myocardial perfusion in patients with single-vessel proximal left anterior descending coronary artery diseease before and after revascularization.  Circulation. 1997;  96 2859-2867
    PubMedGoogle Scholar
  • 39 Higgins C B, Herfkens R, Lipton M J, Sievers R, Sheldon P, Kaufman L, Crooks L E. Nuclear magnetic resonance imaging of acute myocardial infarction in dogs: alterations in magnetic relaxation times.  Am J Cardiol. 1983;  52 184-188
    CrossrefPubMedGoogle Scholar
  • 40 Ratner A V, Okada R D, Newell J B, Pohost G M. The relationship between proton nuclear magnetic resonance relaxation parameters and myocardial perfusion with acute coronary arterial occlusion and reperfusion.  Circulation. 1985;  71 823-828
    PubMedGoogle Scholar
  • 41 Wesbey G, Higgins C B, Lancer P, Botvinick E, Lipton M J. Imaging and characterization of acute myocardial infarction in vivo by gated nuclear magnetic resonance.  Circulation. 1984;  69 125-130
    PubMedGoogle Scholar
  • 42 Johnston D L, Homma S, Liu P, Weilbaecher D G, Rokey R, Brady T J, Okada R D. Serial changes in nuclear magnetic resonance times after myocardial infarction in the rabbit: relationship to water content, severity of ischemia, and histopathology over a six-month period.  Magn Res Med. 1988;  8 363-379
    PubMedGoogle Scholar
  • 43 Lim T-H, Hong M-K, Lee J S, Mun C W, Park S-J, Park S-W, Ryu J S, Lee J H, Chien D, Laub G. Novel application of breath-hold turbo spin echo T2 MRI for detection of acute myocardial infarction.  J Magn Reson Imaging. 1997;  7 996-1001
    PubMedGoogle Scholar
  • 44 Simonetti O P, Finn J P, White R D, Laub G, Henry D A. „Black blood” T2-weighted inversion recovery MR imaging of the heart.  Radiology. 1996;  199 49-57
    PubMedGoogle Scholar
  • 45 Hofman M BM, Wickline S A, Lorenz C H. Quantification of in-plane motion of the coronary arteries during the cardiac cycle: implications for acquisition window duration for MR flow quantification.  Magn Reson Imaging. 1998;  8 568-576
    PubMedGoogle Scholar
  • 46 Wang Y, Riederer S J, Ehmann R L. Respiratory motion of the heart: kinematics and the implication for the spatial resolution in coronary imaging.  Magn Res Med. 1995;  33 713-719
    PubMedGoogle Scholar
  • 47 Paschal C B, Haacke E M, Adler L P, Finelli D A. Magnetic resonance coronary artery imaging.  Cardiovasc Intervent Radiol. 1992;  15 23-31
    PubMedGoogle Scholar
  • 48 Edelmann R R, Manning W J, Pearlman J, Li W. Human coronary arteries: projection angiograms reconstructed from breath-hold two-dimensional MR images.  Radiology. 1993;  187 719-722
    PubMedGoogle Scholar
  • 49 Manning W J, Li W, Edelman R R. A preliminary report comparing magnetic resonance coronary angiography with conventional angiography.  N Engl J Med. 1993;  328 828-832
    CrossrefPubMedGoogle Scholar
  • 50 Duerinckx A J, Urman M K. Two-dimensional coronary MR angiography: Analysis of initial clinical results.  Radiology. 1994;  193 731-738
    PubMedGoogle Scholar
  • 51 Pennell D J, Bogren H G, Keegan J, Firmin D N, Underwood S R. Assessment of coronary artery stenosis by magnetic resonance imaging.  Heart. 1996;  75 127-133
    PubMedGoogle Scholar
  • 52 Post J C, van Rossum A C, Hofman M BM, Valk J, Visser C A. Three-dimensional respiratory gated MR angiography of coronary arteries: comparison with conventional coronary angiography.  Am J Roentgenol. 1996;  166 1399-1404
    PubMedGoogle Scholar
  • 53 Sandstede J JW, Pabst T, Beer M, Geis N, Kenn W, Neubauer S, Hahn D. Three-dimensional MR coronary angiography using the navigator technique compared with conventional coronary angiography.  Am J Roentgenol. 1999;  172 135-139
    PubMedGoogle Scholar
  • 54 Sandstede J, Pabst T, Kenn W, Beer M, Neubauer S, Hahn D. Dreidimensionale MR-Koronarangiographie in Navigator-Technik zur Primärdiagnostik der koronaren Herzkrankheit: Vergleich zur konventionellen Koronarangiographie.  Fortschr Röntgenstr. 1999;  170 269-274
    PubMedGoogle Scholar
  • 55 Hofman M BM, Paschal C B, Li D, Haacke E M, van Rossum A C, Sprenger M. MRI of coronary arteries: 2D breath-hold vs. 3D respiratory-gated acquisition.  J Comput Assist Tomogr. 1995;  19 56-62
    PubMedGoogle Scholar
  • 56 Wielopolski P A, Manning W J, Edelman R R. Single breath-hold volumetric imaging of the heart using magnetization prepared 3-dimensional segmented echo planar imaging.  J Magn Reson Imaging. 1995;  4 403-409
    PubMedGoogle Scholar
  • 57 Goldfarb J W, Edelman R R. Coronary arteries: breath-hold, gadolinium-enhanced, three-dimensional MR angiography. .  Radiology. 1998;  206 830-834
    PubMedGoogle Scholar
  • 58 White R D, Caputo G R, Mark A S, Modin G W, Higgins C B. Coronary artery bypass graft patency: noninvasive evaluation with MR imaging.  Radiology. 1987;  164 681-686
    PubMedGoogle Scholar
  • 59 Galjee M A, van Rossum A C, Doesburg T, van Eenige M J, Visser C A. Value of magnetic resonance imaging in assessing patency and function of coronary artery bypass grafts.  Circulation. 1996;  93 660-666
    PubMedGoogle Scholar
  • 60 Vrachliotis T G, Bis K G, Aliabadi D, Shetty A N, Safian R, Simonetti O. Contrast-enhanced breath-hold MR angiography for evaluating patency of coronary artery bypass grafts.  Am J Roentgenol. 1997;  168 1073-1080
    PubMedGoogle Scholar
  • 61 Wintersperger B J, von Smekal A, Engelmann M G, Knez A, Penzkofer H V, Laub G, Reiser M. Kontrastmittelverstärkte Magnetresonanzangiographie zur Überprüfung der Durchgängigkeit koronarer Bypasses.  Fortschr Röntgenstr. 1997;  167 572-578
    PubMedGoogle Scholar
  • 62 Opie L H. Stunning, hibernation, and calcium in myocardial ischemia and reperfusion. (ed) Boston; Kluwer Academic Publishers 1992: 2

Dr. D. E. Kivelitz

Institut für Radiologie Universitätsklinikum Charité Humboldt-Universität zu Berlin

Schumannstraße 20 - 21

D-10098 Berlin

Phone: + 30-2802-3330

Fax: + 30-2802-5042

Email: dietmar.kivelitz@charite.de

      >