Retrospective assessment of at-risk myocardium in reperfused acute myocardial infarction patients using contrast-enhanced balanced steady-state free-precession cardiovascular magnetic resonance at 3T with SPECT validation

Background Contrast-enhanced (CE) steady-state free precession (SSFP) CMR at 1.5T has been shown to be a valuable alternative to T2-based methods for the detection and quantifications of area-at-risk (AAR) in acute myocardial infarction (AMI) patients. However, CE-SSFP's capacity for assessment of AAR at 3T has not been investigated. We examined the clinical utility of CE-SSFP and T2-STIR for the retrospective assessment of AAR at 3T with single-photon-emission-computed tomography (SPECT) validation. Materials and methodsA total of 60 AMI patients (ST-elevation AMI, n = 44; non-ST-elevation AMI, n = 16) were recruited into the CMR study between 3 and 7 days post revascularization. All patients underwent T2-STIR, CE-bSSFP and late-gadolinium-enhancement CMR. For validation, SPECT images were acquired in a subgroup of patients (n=30). Results In 53 of 60 patients (88%), T2-STIR was of diagnostic quality compared with 54 of 60 (90%) with CE-SSFP. In a head-to-head per-slice comparison (n=365), there was no difference in AAR quantified using T2-STIR and CE-SSFP (R-2=0.92, p < 0.001; bias:-0.4 +/- 0.8 cm(2), p=0.46). On a per-patient basis, there was good agreement between CE-SSFP (n=29) and SPECT (R-2=0.86, p < 0.001; bias: - 1.3 +/- 7.8%LV, p=0.39) for AAR determination. T2-STIR also showed good agreement with SPECT for AAR measurement (R-2=0.81, p < 0.001, bias: 0.5 +/- 11.1%LV, p=0.81). There was also a strong agreement between CE-SSFP and T2-STIR with respect to the assessment of AAR on per-patient analysis (R-2=0.84, p < 0.001, bias: - 2.1 +/- 10.1%LV, p=0.31). Conclusions At 3T, both CE-SSFP and T2-STIR can retrospectively quantify the at-risk myocardium with high accuracy.