GADOLINIUM-ENHANCED MAGNETIC-RESONANCE-IMAGING IN ACUTE MYOCARDIAL-INFARCTION

To investigate the clinical application of gadolinium diethylenetriami nepentaacetic acid (Gd-DTPA)-enhanced magnetic resonance imaging (MRI) in the management of acute myocardial infarction (AMI), we examined 4 4 patients with AMI within 1 month after onset. Enhanced Images were c lassified into 4 types: nontransmural (type 1), transmural and homogen eous (type 2), transmural and marginal (type 3), and no enhancement (t ype 4). Each enhancement pattern was correlated with angiographic and thallium-201 imaging results. The redistribution images of thallium we re graded on a 4-point scale from 0 (normal) to 3 (markedly activity). The percentage of the perimeter affected by asynergy was obtained fro m the left ventriculogram. Peak creatine kinase and the percentage of asynergic perimeter were significantly higher in type 3 than in other type patients. End-diastolic volume index was significantly higher in type 3 than in type 2 patients. Left ventricular ejection fraction was lowest, and end-systolic volume index, thallium-201 score, and incide nce of wall thinning on MRI were highest in type 3 patients. Therefore , the transmural and marginal enhancement pattern (type 3) was compati ble with extensive myocardial infarction with infarct expansion and le ss viable myocardium. In the other types, the infarction was small to moderate in size and left ventricular function was well preserved. Thu s, Gd-DTPA-enhanced MRI may be useful in the evaluation of left ventri cular function: and myocardial viability of the infarct region after A MI.