Zusammenfassung
Ziel: Vergleich der flüssigkeitssensitiven HASTE-TIRM-Sequenz mit der späten Kontrastmittel
(KM)-Anreicherung in der MRT bei Patienten mit akutem Myokardinfarkt (AMI). Material und Methoden: 32 Patienten mit AMI wurden 7 ± 4 Tage post Infarkt mittels T2 -HASTE-TIRM und einer kontrastmittelverstärkten T1 - turbo-FLASH bei 1,5 Tesla untersucht. Mit der Schwellenwert-Methode (> 2 SD im Vergleich
zu normalem Myokard) wurden die hyperintensen Areale in beiden Sequenzen vermessen
sowie die Transmuralität auf segmentaler Ebene bestimmt. Ergebnisse: Die hyperintensen Flächen in der HASTE-TIRM (29,6 ± 13,2 % der linksventrikulären
(LV)-Fläche) waren größer als die in der KM-MRT (19,2 ± 10 % der LV-Fläche; p < 0,0001).
Die transmurale Ausdehnung der hyperintensen Regionen wurde in der HASTE-TIRM deutlich
höher bemessen als in der KM-MRT (p < 0,0001). Während die KM-MRT mit dem maximalen
Creatinkinasewert (CK max.) korrelierte (r = 0,59, p < 0,001), besteht keine Korrelation
zwischen HASTE-TIRM und CK max. (r = 0,29, p = ns). Schlussfolgerungen: Mit der HASTE-TIRM kann zusätzlich zum avitalen Areal das periinfarzielle Ödem dargestellt
werden. Die HASTE-TIRM zeigt eine größere Transmuralität der Infarkte im Vergleich
zur KM-MRT an. Die zusätzlich mit der HATSE-TIRM dargestellte Fläche könnte funktionell
gestörtes aber vitales Myokard darstellen.
Abstract
Goal: Comparison between a fluid-sensitive (HASTE-TIRM)-sequence and delayed contrast-enhancement
in patients with acute myocardial infarct (AMI) in MRI. Material and Methods: 32 patients with AMI were imaged 7 ± 4 days after the time of infarction with a 1.5
T unit using a T2 HASTE-TIRM and a contrast-enhanced (CE) T1 turbo FLASH sequence. A threshold method (>2 SD in comparison with normal myocardium)
was used to quantify the hyperintense zones in both sequences. The transmurality of
the hyperintense regions was measured on a segmental basis. Results: The hyperintense areas were larger on the HASTE-TIRM sequence with 29.6 ± 13.2 % of
the left ventricular (LV) area as compared to the CE-MRI with 19.2 ± 10
% of the LV area (p < 0.0001). The measured transmurality was higher with the
HASTE-TIRM sequence than with the CE-MRI (p < 0.0001). While the correlation between
CE-MRI and peak creatine kinase (CK max) was good (r = 0.59, p < 0.001), no correlation
was found between the HASTE-TIRM sequence and CK max (r = 0.29, p = ns). Conclusions: The peri-infarct edema can be depicted with a HASTE-TIRM sequence in addition to the
non-viable infarct zone. The HASTE-TIRM sequence shows a higher transmurality of the
hyperintense regions than the CE-MRI. The additional area depicted by the HASTE-TIRM
sequence could represent functionally impaired but viable myocardium).
Schlüsselwörter
MRT - Myokardinfarkt - Kontrastmittel - Ödem - HASTE-TIRM
Key words
MRI - myocardial infarct - contrast media - edema - HASTE-TIRM
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Dr. A. Stork
Universitätsklinikum Eppendorf
Martinistraße 52
20246 Hamburg
Phone: + 040 428034010
Fax: + 040 428036799
Email: astork@uke.uni-hamburg.de