The MRI characteristics of the no-flow region are similar in reperfused and non-reperfused myocardial infarcts: an MRI and histopathology study in swine

Gabriel A. Elgavish, Tamas Simor, Rob J. van der Geest, Pal Suranyi, Pal P. Kiss, Zsofia Lenkey, Robert Kirschner, Dezhi Wang, Brigitta C. Brott, Akos Varga-Szemes

Research output: Contribution to journalArticle

Abstract

Background: The no-flow region (NF) visualised by magnetic resonance imaging (MRI) in myocardial infarction (MI) has been explained as the product of reperfusion-injury-induced microvascular obstruction. However, a similar MRI phenomenon occurs in non-reperfused MI. Accordingly, our purpose was to compare the MRI and histopathologic characteristics of the NF in reperfused and non-reperfused MIs. Methods: Reperfused (n = 7) and non-reperfused MIs (n = 7) were generated in swine by percutaneous balloon occlusion and microsphere embolisation techniques. Four days post-MI, animals underwent myocardial T2-mapping, early and serial late gadolinium enhancement MRI. MI and NF were compared between the models using the independent samples t test. Serial measurements were analysed using repeated measures analysis of variance. Triphenyltetrazolium chloride (TTC) macroscopic and microscopic histopathologic assessment was also performed. Results: The MI size in the reperfused and non-reperfused groups was 17.1 ± 3.4 ml and 19.4 ± 8.1 ml, respectively (p = 0.090), in agreement with TTC assessment (p = 0.216; p = 0.484), and the NF size was 7.7 ± 2.4 ml and 8.1 ± 1.9 ml, respectively (P = 0.211). Compared to the reference 2-min post-contrast measurement, the NF size was significantly reduced at 20 min in the reperfused group and at 25 min in the non-reperfused group (both p < 0.001). Nevertheless, the NF was still detectable at 45 min after injection. No significant T2 difference was observed between the groups (p > 0.326). Histopathologic assessment revealed extensive calcification and hemosiderin deposition in the NF of the reperfused MI, but not in the non-reperfused MI. Conclusions: The NF in non-reperfused and reperfused MIs have similar characteristics on MRI despite the different pathophysiologic and underlying histopathologic conditions, indicating that the presence of the NF alone cannot differentiate between these two types of MI.

Original languageEnglish
Article number2
JournalEuropean Radiology Experimental
Volume1
Issue number1
DOIs
Publication statusPublished - Dec 1 2017

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Swine
Myocardial Infarction
Magnetic Resonance Imaging
Hemosiderin
Balloon Occlusion
Gadolinium
Reperfusion Injury
Microspheres
Analysis of Variance

Keywords

  • Late gadolinium enhancement
  • Magnetic resonance imaging (MRI)
  • Microvascular obstruction
  • Myocardial infarction
  • No-flow region

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

The MRI characteristics of the no-flow region are similar in reperfused and non-reperfused myocardial infarcts : an MRI and histopathology study in swine. / Elgavish, Gabriel A.; Simor, Tamas; van der Geest, Rob J.; Suranyi, Pal; Kiss, Pal P.; Lenkey, Zsofia; Kirschner, Robert; Wang, Dezhi; Brott, Brigitta C.; Varga-Szemes, Akos.

In: European Radiology Experimental, Vol. 1, No. 1, 2, 01.12.2017.

Research output: Contribution to journalArticle

Elgavish, Gabriel A. ; Simor, Tamas ; van der Geest, Rob J. ; Suranyi, Pal ; Kiss, Pal P. ; Lenkey, Zsofia ; Kirschner, Robert ; Wang, Dezhi ; Brott, Brigitta C. ; Varga-Szemes, Akos. / The MRI characteristics of the no-flow region are similar in reperfused and non-reperfused myocardial infarcts : an MRI and histopathology study in swine. In: European Radiology Experimental. 2017 ; Vol. 1, No. 1.
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T1 - The MRI characteristics of the no-flow region are similar in reperfused and non-reperfused myocardial infarcts

T2 - an MRI and histopathology study in swine

AU - Elgavish, Gabriel A.

AU - Simor, Tamas

AU - van der Geest, Rob J.

AU - Suranyi, Pal

AU - Kiss, Pal P.

AU - Lenkey, Zsofia

AU - Kirschner, Robert

AU - Wang, Dezhi

AU - Brott, Brigitta C.

AU - Varga-Szemes, Akos

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background: The no-flow region (NF) visualised by magnetic resonance imaging (MRI) in myocardial infarction (MI) has been explained as the product of reperfusion-injury-induced microvascular obstruction. However, a similar MRI phenomenon occurs in non-reperfused MI. Accordingly, our purpose was to compare the MRI and histopathologic characteristics of the NF in reperfused and non-reperfused MIs. Methods: Reperfused (n = 7) and non-reperfused MIs (n = 7) were generated in swine by percutaneous balloon occlusion and microsphere embolisation techniques. Four days post-MI, animals underwent myocardial T2-mapping, early and serial late gadolinium enhancement MRI. MI and NF were compared between the models using the independent samples t test. Serial measurements were analysed using repeated measures analysis of variance. Triphenyltetrazolium chloride (TTC) macroscopic and microscopic histopathologic assessment was also performed. Results: The MI size in the reperfused and non-reperfused groups was 17.1 ± 3.4 ml and 19.4 ± 8.1 ml, respectively (p = 0.090), in agreement with TTC assessment (p = 0.216; p = 0.484), and the NF size was 7.7 ± 2.4 ml and 8.1 ± 1.9 ml, respectively (P = 0.211). Compared to the reference 2-min post-contrast measurement, the NF size was significantly reduced at 20 min in the reperfused group and at 25 min in the non-reperfused group (both p < 0.001). Nevertheless, the NF was still detectable at 45 min after injection. No significant T2 difference was observed between the groups (p > 0.326). Histopathologic assessment revealed extensive calcification and hemosiderin deposition in the NF of the reperfused MI, but not in the non-reperfused MI. Conclusions: The NF in non-reperfused and reperfused MIs have similar characteristics on MRI despite the different pathophysiologic and underlying histopathologic conditions, indicating that the presence of the NF alone cannot differentiate between these two types of MI.

AB - Background: The no-flow region (NF) visualised by magnetic resonance imaging (MRI) in myocardial infarction (MI) has been explained as the product of reperfusion-injury-induced microvascular obstruction. However, a similar MRI phenomenon occurs in non-reperfused MI. Accordingly, our purpose was to compare the MRI and histopathologic characteristics of the NF in reperfused and non-reperfused MIs. Methods: Reperfused (n = 7) and non-reperfused MIs (n = 7) were generated in swine by percutaneous balloon occlusion and microsphere embolisation techniques. Four days post-MI, animals underwent myocardial T2-mapping, early and serial late gadolinium enhancement MRI. MI and NF were compared between the models using the independent samples t test. Serial measurements were analysed using repeated measures analysis of variance. Triphenyltetrazolium chloride (TTC) macroscopic and microscopic histopathologic assessment was also performed. Results: The MI size in the reperfused and non-reperfused groups was 17.1 ± 3.4 ml and 19.4 ± 8.1 ml, respectively (p = 0.090), in agreement with TTC assessment (p = 0.216; p = 0.484), and the NF size was 7.7 ± 2.4 ml and 8.1 ± 1.9 ml, respectively (P = 0.211). Compared to the reference 2-min post-contrast measurement, the NF size was significantly reduced at 20 min in the reperfused group and at 25 min in the non-reperfused group (both p < 0.001). Nevertheless, the NF was still detectable at 45 min after injection. No significant T2 difference was observed between the groups (p > 0.326). Histopathologic assessment revealed extensive calcification and hemosiderin deposition in the NF of the reperfused MI, but not in the non-reperfused MI. Conclusions: The NF in non-reperfused and reperfused MIs have similar characteristics on MRI despite the different pathophysiologic and underlying histopathologic conditions, indicating that the presence of the NF alone cannot differentiate between these two types of MI.

KW - Late gadolinium enhancement

KW - Magnetic resonance imaging (MRI)

KW - Microvascular obstruction

KW - Myocardial infarction

KW - No-flow region

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