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Contrast enhanced magnetic resonance imaging of culprit lesions in patients with acute coronary syndrome
Journal of Cardiovascular Magnetic Resonance volume 12, Article number: P39 (2010)
X-Ray Angiography (XRA) is the gold standard for the assessment of lumen encroaching coronary stenosis, which typically underlies stable coronary artery disease. However, XRA cannot distinguish between stable and vulnerable plaques, which are thought to be the precursor lesions of most acute myocardial infarctions (MI) and death. The development of a non-invasive technique that can detect culprit lesions immediately after MI may eventually prove useful for prospective identification of vulnerable plaque.
The aim of the study was to evaluate whether contrast-enhanced magnetic resonance imaging (CE-MRI) could detect culprit lesions in patients with a recent ACS (troponin T >1.0).
16 patients (14 male, age 62.7 ± 8.7) were imaged within 24-72 h after presenting with ACS prior to XRA. Following coronary lumen imaging and contrast injection, CE-MRI of the coronary artery wall was performed using a T1-weighted 3D gradient echo inversion recovery sequence (3D IR TFE).
In 13 patients culprit lesions (6 × LAD, 2 × LCX, 5 × RCA) were identified by XRA (Fig. 1e+j) +/- intravascular ultrasound (IVUS). CE-MRI (fused with magnetic resonance angiography, Fig. 1c+h) correctly identified culprit lesions in 11 of 13 patients (sensitivity: 85%) and correctly classified the 3 patients without culprit lesions (specificity 100%). Contrast uptake in culprit lesions (Fig. 2a) as compared to overall vessel wall contrast uptake was 4-fold increased (50.7 ± 24.2 vs. 12.1 ± 7.7, p < 0.01) and 2-fold increased as compared to affected segments (19.2 ± 14.2, p < 0.01). Intra pair analysis (Fig. 2b) of the culprit lesion showed a 4-fold increase of the CNR as compared to the overall vessel wall contrast uptake (Ratio: 406 ± 123%), a 3-fold increase for the segments of the affected vessel (356 ± 155%) and a 2-fold increase for the affected segments (262 ± 92%). Subgroup analysis (Fig. 2c+d) revealed a significant higher contrast uptake of the culprit lesion (69.4 ± 20.5 vs. 31.2 ± 5.6, p = 0.01) and adjacent segments (30.7 ± 15.1 vs. 12.8 ± 5.1, p = 0.04) in the left coronary system (Fig. 2c) as compared to the right system (Fig. 2d). Non-affected segments showed no significant difference between the left and right system (3.5 ± 1.5 vs. 4.1 ± 1.3, p = 0.50). These findings are in concordance with a trend towards a higher TIMI Risk Score in patients with anterior MI (median: 21.5 (Range 16.1-35.9) vs. 1.6 (0.8-23.4), p = 0.06).
CE-MRI allows selective visualization of culprit lesions in patients after MI. This technique may be useful for prospective detection of vulnerable plaque.
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Jansen, C.H., Perera, D., Makowski, M. et al. Contrast enhanced magnetic resonance imaging of culprit lesions in patients with acute coronary syndrome. J Cardiovasc Magn Reson 12, P39 (2010). https://doi.org/10.1186/1532-429X-12-S1-P39
- Magnetic Resonance Angiography
- Coronary Stenosis
- Vulnerable Plaque
- Stable Coronary Artery Disease
- Culprit Lesion