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

Hiroaki Mori; Satoshi Isobe; Shinichi Sakai; Takashi Yamada; Naoki Watanabe; Manabu Miura; Yasuhiro Uchida; Masaaki Kanashiro; Satoshi Ichimiya; Takahiro Okumura; Toyoaki Murohara

doi:10.1016/j.ejrad.2015.05.002

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

Eur J Radiol. 2015 Aug;84(8):1516-1524. doi: 10.1016/j.ejrad.2015.05.002. Epub 2015 May 15.

Authors

Affiliations

¹ Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Kainan Hospital, Yatomi, Japan.
² Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: [email protected].
³ Department of Cardiology, Kainan Hospital, Yatomi, Japan.
⁴ Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
⁵ Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Japan.

PMID: 26022521
DOI: 10.1016/j.ejrad.2015.05.002

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.

Keywords: (201)Tl and (123)I-BMIPP dual SPECT; Acute myocardial infarction; Magnetic resonance imaging; Microvascular obstruction.

Publication types

Comparative Study

MeSH terms

Acute Disease
Adult
Aged
Aged, 80 and over
Contrast Media
Fatty Acids*
Female
Humans
Image Enhancement
Iodine Radioisotopes*
Iodobenzenes*
Magnetic Resonance Imaging / methods*
Male
Microvessels / diagnostic imaging
Microvessels / pathology
Middle Aged
Myocardial Infarction / complications*
Myocardial Infarction / diagnosis
Radiopharmaceuticals
Thallium Radioisotopes*
Tomography, Emission-Computed, Single-Photon / methods*
Vascular Diseases / complications
Vascular Diseases / diagnosis*

Substances

Contrast Media
Fatty Acids
Iodine Radioisotopes
Iodobenzenes
Radiopharmaceuticals
Thallium Radioisotopes
iodofiltic acid