Gadolinium pharmacokinetics of chronic myocardial infarcts: Implications for late gadolinium-enhanced infarct imaging.

PURPOSE: To monitor gadolinium pharmacokinetics in the hearts of patients with chronic myocardial infarcts and to determine the variability of contrast agent concentrations and accuracy of infarct detection over an hour time period. MATERIALS AND METHODS: Twenty-five patients with chronic myocardial infarcts were examined. T1 measurements were performed every 2 minutes using an inversion recovery CINE balanced steady-state free precession technique. Paired differences in T1 values over time for the discrimination between the left ventricular (LV) bloodpool, viable, and infarct myocardium were statistically evaluated. The average change per 1, 5, and 10 minutes of the inversion time parameter for optimal nulling of viable myocardium was calculated. Receiver operator characteristic (ROC) curve analysis was performed to compare the performance of late gadolinium-enhanced infarct imaging at increasing delays after contrast agent administration. RESULTS: Significantly different T1 values were reached after 10 minutes between the LV bloodpool, infarcted, and viable myocardium. The T1 difference between myocardial infarcts and the LV bloodpool increased over time, while the difference between viable myocardium and the LV bloodpool decreased. ROC curve analysis showed a decrease in performance of a fixed T1 value to discriminate between the LV bloodpool and viable myocardium over time, while there was a marked increase in the discrimination between the LV bloodpool and infarcted myocardium. CONCLUSION: The ability to discriminate between infarcted myocardium and the LV bloodpool improves with an increasing delay after contrast agent administration while discrimination between viable myocardium and the LV bloodpool decreases.

Recent myocardial infarction: assessment with unenhanced T1-weighted MR imaging.

The purpose of the study was to prospectively evaluate a T1-weighted technique for detection of myocardial edema resulting from recent myocardial infarction (MI) or intervention. This study was HIPAA compliant and institutional review board approved. Fifteen men and one woman (mean age, 57.8 years+/-11.5 [standard deviation]) were examined with T1-weighted magnetic resonance (MR) imaging and inversion-recovery cine pulse sequence in two groups, recent MI and chronic MI, and gave informed consent. T1 relaxation times of MI and adjacent myocardium were compared (Student t test and correlation analysis). In patients with recent MI, areas of myocardial edema were well depicted with T1-weighted MR imaging. T1 relaxation times of recent infarcts were longer than those of older MIs (925 msec+/-169 vs 551 msec+/-107, P<.001). From local edema, T1 relaxation time of infarcted myocardium is increased, may remain elevated for 2 months, and enables imaging with T1-weighted techniques.

T1-weighted magnetic resonance imaging shows fatty deposition after myocardial infarction.

Pathologic studies have shown an increased lipid content in areas of myocardial infarction (MI). We sought to show the ability of precontrast T1-weighted MRI to noninvasively detect fat deposition in MI and show its association with infarct age. Thirty-two patients with MI were studied. Precontrast inversion-recovery (IR) cine steady-state free precession (SSFP) imaging was used to generate both fat- and muscle-nulled images to locate areas of fat deposition in the left ventricular (LV) myocardium. Postcontrast delayed hyperenhanced (DHE) imaging was also performed. Image contrast in regions of MI on precontrast images and postcontrast DHE images was measured. The association of image contrast with infarct age was determined by means of correlations and Student's t-test. We found a significant association between infarct age and image contrast in both fat- and muscle-nulled images. Precontrast T1-weighted MRI is a promising method for detecting myocardial fat deposition in chronic MI, and can be used to assess myocardial infarct age.

On the cause of spatial displacement of long T1 species in segmented inversion recovery prepared imaging.

Using inversion recovery steady-state free precession segmented k-space imaging for the detection of myocardial infarction, we noticed that some structures appeared in the wrong locations of the image. In this work, the spatial displacement is demonstrated and explained from both theoretical and experimental points of view. The effect is due to a change in phase from segment to segment of the detected magnetization from species with long T1's such as cysts, fluid collections, and cerebrospinal fluid. Depending on the number of k-space segments and view ordering, structures can be replicated throughout the image or displaced by half of the phase-encoding field of view.

Adaptation of the attention network in human immunodeficiency virus brain injury.

Human immunodeficiency virus (HIV)-positive patients commonly have attention and concentration problems. However, it remains unclear how HIV infection affects the attention network. Therefore, blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI) was performed in 36 subjects (18 HIV and 18 seronegative [SN] controls) during a set of visual attention tasks with increasing levels of attentional load. Compared with SN controls, HIV subjects showed similar task performance (accuracies and reaction times) but decreased activation in the normal visual attention network (dorsal parietal, bilateral prefrontal, and cerebellar regions) and increased activation in adjacent or contralateral brain regions. Cognitive performance (assessed with NPZ-8), CD4, and viral load all correlated with activated BOLD signals in brain regions that activated more in HIV subjects. Furthermore, HIV subjects activated more than SN controls in brain regions that showed load-dependent increase in activation (right prefrontal and right parietal regions) but less in regions that showed a saturation effect with increasing load. These findings suggest that HIV-associated brain injury leads to reduced efficiency in the normal attention network, thus requiring reorganization and increased usage of neural reserves to maintain performance during attention-requiring tasks. Exceeding the brain reserve capacity may lead to attention deficits and cognitive impairment in HIV patients.

k-Space based summary motion detection for functional magnetic resonance imaging.

Functional MRI studies are very sensitive to motion; head movements of as little as 1-mm translations or 1 degrees rotations may cause spurious signals. An algorithm was developed that uses k-space MRI data to monitor subject motion during functional MRI time series. A k-space weighted average of squared difference between the initial scan and subsequent scans is calculated, which summarizes subject motion in a single quality parameter; however, the quality parameter cannot be used for motion correction. The evolution of this quality parameter throughout a time series indicates whether head motion is within a predetermined limit. Fifty functional MRI studies were used to calibrate the sensitivity of the algorithm, using the six rigid-body registration parameters (three translations and three rotations) from the statistical parametric mapping (SPM99) package as a reference. The average correlation coefficient between the new quality parameter and the reference value from SPM was 0.84. The simple algorithm correctly classified acceptable or excessive motion with 90% accuracy, with the remaining 10% being borderline cases. This method makes it possible to evaluate brain motion within seconds after a scan and to decide whether a study needs to be repeated.