Detection of scarred and viable myocardium using a new magnetic resonance imaging technique: Blood Oxygen Level Dependent (BOLD) MRI

M. Egred, A. Al-Mohammad, Gordon David Waiter, Thomas William Redpath, Scott Ian Kay Semple, Murdoch Young Norton, Andrew Welch, S. Walton

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: The identification of viable myocardium in patients with impaired left ventricular contraction secondary to coronary heart disease is important clinically as such myocardium is likely to benefit from revascularisation. Blood oxygen level dependent (BOLD) magnetic resonance imaging (MRI) relies on changes in deoxyhaemoglobin concentration under stress for signal generation and could be used for the differentiation between scarred and viable myocardium.

Aim: To assess the signal change on BOLD MRI in viable and scarred myocardium as identified by positron emission tomography (PET).

Method: 19 patients with impaired left ventricular contraction and at least one akinetic area were enrolled. They underwent rest and dipyridamole stress MRI, using a double breath hold T2* weighted, ECG gated sequence to produce BOLD contrast images, and cine-MRI for wall thickening assessment. Dynamic perfusion and metabolic PET images followed the MRI. Signal change on BOLD MRI and the wall thickening were compared between rest and stress images in hibernating and scarred segments identified by PET on two short axis slices of mid ventricle, with eight segments each.

Results: Using PET, 68 segments were identified as hibernating and 42 as scarred. The hibernating segments were found on BOLD MRI to have an average signal change between rest and stress of -9.53%, compared with -2.15% in the scarred segments (p=0.008). The average wall thickening was 8.7 mm in the hibernating segments compared with 5.9 mm in the scarred segments (P<0.0001).

Conclusions: BOLD MRI with wall thickening may differentiate scarred and viable myocardium and help identify suitable patients for revascularisation. Further larger studies are needed to establish a threshold for detection, sensitivity, and specificity.

Original languageEnglish
Pages (from-to)738-744
Number of pages6
JournalHeart
Volume89
Issue number7
DOIs
Publication statusPublished - Jul 2003

Keywords

  • POSITRON EMISSION TOMOGRAPHY
  • CORONARY-ARTERY-DISEASE
  • LEFT-VENTRICULAR DYSFUNCTION
  • HIBERNATING MYOCARDIUM
  • N-13 AMMONIA
  • DOBUTAMINE ECHOCARDIOGRAPHY
  • SURGICAL REVASCULARIZATION
  • COMPUTED-TOMOGRAPHY
  • REGIONAL PERFUSION
  • WALL-MOTION

Cite this

Detection of scarred and viable myocardium using a new magnetic resonance imaging technique: Blood Oxygen Level Dependent (BOLD) MRI. / Egred, M.; Al-Mohammad, A.; Waiter, Gordon David; Redpath, Thomas William; Semple, Scott Ian Kay; Norton, Murdoch Young; Welch, Andrew; Walton, S.

In: Heart, Vol. 89, No. 7, 07.2003, p. 738-744.

Research output: Contribution to journalArticle

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title = "Detection of scarred and viable myocardium using a new magnetic resonance imaging technique: Blood Oxygen Level Dependent (BOLD) MRI",
abstract = "Background: The identification of viable myocardium in patients with impaired left ventricular contraction secondary to coronary heart disease is important clinically as such myocardium is likely to benefit from revascularisation. Blood oxygen level dependent (BOLD) magnetic resonance imaging (MRI) relies on changes in deoxyhaemoglobin concentration under stress for signal generation and could be used for the differentiation between scarred and viable myocardium.Aim: To assess the signal change on BOLD MRI in viable and scarred myocardium as identified by positron emission tomography (PET).Method: 19 patients with impaired left ventricular contraction and at least one akinetic area were enrolled. They underwent rest and dipyridamole stress MRI, using a double breath hold T2* weighted, ECG gated sequence to produce BOLD contrast images, and cine-MRI for wall thickening assessment. Dynamic perfusion and metabolic PET images followed the MRI. Signal change on BOLD MRI and the wall thickening were compared between rest and stress images in hibernating and scarred segments identified by PET on two short axis slices of mid ventricle, with eight segments each.Results: Using PET, 68 segments were identified as hibernating and 42 as scarred. The hibernating segments were found on BOLD MRI to have an average signal change between rest and stress of -9.53{\%}, compared with -2.15{\%} in the scarred segments (p=0.008). The average wall thickening was 8.7 mm in the hibernating segments compared with 5.9 mm in the scarred segments (P<0.0001).Conclusions: BOLD MRI with wall thickening may differentiate scarred and viable myocardium and help identify suitable patients for revascularisation. Further larger studies are needed to establish a threshold for detection, sensitivity, and specificity.",
keywords = "POSITRON EMISSION TOMOGRAPHY, CORONARY-ARTERY-DISEASE, LEFT-VENTRICULAR DYSFUNCTION, HIBERNATING MYOCARDIUM, N-13 AMMONIA, DOBUTAMINE ECHOCARDIOGRAPHY, SURGICAL REVASCULARIZATION, COMPUTED-TOMOGRAPHY, REGIONAL PERFUSION, WALL-MOTION",
author = "M. Egred and A. Al-Mohammad and Waiter, {Gordon David} and Redpath, {Thomas William} and Semple, {Scott Ian Kay} and Norton, {Murdoch Young} and Andrew Welch and S. Walton",
year = "2003",
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doi = "DOI:10.1136/HEART.89.7.738",
language = "English",
volume = "89",
pages = "738--744",
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TY - JOUR

T1 - Detection of scarred and viable myocardium using a new magnetic resonance imaging technique: Blood Oxygen Level Dependent (BOLD) MRI

AU - Egred, M.

AU - Al-Mohammad, A.

AU - Waiter, Gordon David

AU - Redpath, Thomas William

AU - Semple, Scott Ian Kay

AU - Norton, Murdoch Young

AU - Welch, Andrew

AU - Walton, S.

PY - 2003/7

Y1 - 2003/7

N2 - Background: The identification of viable myocardium in patients with impaired left ventricular contraction secondary to coronary heart disease is important clinically as such myocardium is likely to benefit from revascularisation. Blood oxygen level dependent (BOLD) magnetic resonance imaging (MRI) relies on changes in deoxyhaemoglobin concentration under stress for signal generation and could be used for the differentiation between scarred and viable myocardium.Aim: To assess the signal change on BOLD MRI in viable and scarred myocardium as identified by positron emission tomography (PET).Method: 19 patients with impaired left ventricular contraction and at least one akinetic area were enrolled. They underwent rest and dipyridamole stress MRI, using a double breath hold T2* weighted, ECG gated sequence to produce BOLD contrast images, and cine-MRI for wall thickening assessment. Dynamic perfusion and metabolic PET images followed the MRI. Signal change on BOLD MRI and the wall thickening were compared between rest and stress images in hibernating and scarred segments identified by PET on two short axis slices of mid ventricle, with eight segments each.Results: Using PET, 68 segments were identified as hibernating and 42 as scarred. The hibernating segments were found on BOLD MRI to have an average signal change between rest and stress of -9.53%, compared with -2.15% in the scarred segments (p=0.008). The average wall thickening was 8.7 mm in the hibernating segments compared with 5.9 mm in the scarred segments (P<0.0001).Conclusions: BOLD MRI with wall thickening may differentiate scarred and viable myocardium and help identify suitable patients for revascularisation. Further larger studies are needed to establish a threshold for detection, sensitivity, and specificity.

AB - Background: The identification of viable myocardium in patients with impaired left ventricular contraction secondary to coronary heart disease is important clinically as such myocardium is likely to benefit from revascularisation. Blood oxygen level dependent (BOLD) magnetic resonance imaging (MRI) relies on changes in deoxyhaemoglobin concentration under stress for signal generation and could be used for the differentiation between scarred and viable myocardium.Aim: To assess the signal change on BOLD MRI in viable and scarred myocardium as identified by positron emission tomography (PET).Method: 19 patients with impaired left ventricular contraction and at least one akinetic area were enrolled. They underwent rest and dipyridamole stress MRI, using a double breath hold T2* weighted, ECG gated sequence to produce BOLD contrast images, and cine-MRI for wall thickening assessment. Dynamic perfusion and metabolic PET images followed the MRI. Signal change on BOLD MRI and the wall thickening were compared between rest and stress images in hibernating and scarred segments identified by PET on two short axis slices of mid ventricle, with eight segments each.Results: Using PET, 68 segments were identified as hibernating and 42 as scarred. The hibernating segments were found on BOLD MRI to have an average signal change between rest and stress of -9.53%, compared with -2.15% in the scarred segments (p=0.008). The average wall thickening was 8.7 mm in the hibernating segments compared with 5.9 mm in the scarred segments (P<0.0001).Conclusions: BOLD MRI with wall thickening may differentiate scarred and viable myocardium and help identify suitable patients for revascularisation. Further larger studies are needed to establish a threshold for detection, sensitivity, and specificity.

KW - POSITRON EMISSION TOMOGRAPHY

KW - CORONARY-ARTERY-DISEASE

KW - LEFT-VENTRICULAR DYSFUNCTION

KW - HIBERNATING MYOCARDIUM

KW - N-13 AMMONIA

KW - DOBUTAMINE ECHOCARDIOGRAPHY

KW - SURGICAL REVASCULARIZATION

KW - COMPUTED-TOMOGRAPHY

KW - REGIONAL PERFUSION

KW - WALL-MOTION

U2 - DOI:10.1136/HEART.89.7.738

DO - DOI:10.1136/HEART.89.7.738

M3 - Article

VL - 89

SP - 738

EP - 744

JO - Heart

JF - Heart

SN - 1355-6037

IS - 7

ER -