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Acute Myocardial Infarct

Case Study
Ms. Hermant, Aude Philips Healthcare
Borocco, Antoine, M.D. Pau, Centre Hospitalier de Pau

Patient background:

Fibrinolyse was administrated to a 40-year-old male patient, 2 hours after he suffered from chest pain. The patient had an angioplasty 2 days prior to the MRI examination, and the cardiologist found an inferior infarct, on the X-ray coronarography examination. The 3rd segment of the right coronary artery was occluded and two stents have been positioned.

MR images and interpretation:

T2 BB SA M2D sequence (7 mm thickness) covering the LV in short axis. An hypersignal on the inferior zone can already be seen.T2 BB STIR SA M2D sequence (7 mm thickness) covering the LV in short axis. It shows hyper intense signal on LV inferior zone in a more obvious way. Fat suppression enhance the oedema hyper signal.M2D cine BTFE SA M2D sequence (7mm slice thickness) covering the LV in short axis. It allows to assess the contractility of the LV, and volume quantification.
T2 BB SA
T2 BB STIR SA
M2D cine BTFE SA
M2D sequence (7 mm thickness) covering the LV in short axis. An hypersignal on the inferior zone can already be seen.
M2D sequence (7 mm thickness) covering the LV in short axis. It shows hyper intense signal on LV inferior zone in a more obvious way. Fat suppression enhance the oedema hyper signal.
M2D sequence (7mm slice thickness) covering the LV in short axis. It allows to assess the contractility of the LV, and volume quantification.
M2D cine BTFE LA M2D sequence (7mm slice thickness).  BTFE perfusion MS sequence with a saturation prepulse, using a T1 enhancing contrast agent.  Lack of perfusion can be seen in inferior area.Late enhancement IR TFE SA 3D sequence with an inversion prepulse and fat suppression. 20 slices can be obtained in one breathhold. The signal of normal myocardium is suppressed by inversion pulse set to null the signal of normal myocardium. On this picture we can see a
M2D cine BTFE LA
BTFE perfusion
Late enhancement IR TFE SA
M2D sequence (7mm slice thickness).
MS sequence with a saturation prepulse, using a T1 enhancing contrast agent. Lack of perfusion can be seen in inferior area.
3D sequence with an inversion prepulse and fat suppression. 20 slices can be obtained in one breathhold. The signal of normal myocardium is suppressed by inversion pulse set to null the signal of normal myocardium. On this picture we can see a "no reflow" area in the hyper enhanced zone.
Late enhancement IR TFE LA 3D sequence with an inversion prepulse and fat suppression. 20 slices can be obtained in one breathhold. The signal of normal myocardium is suppressed by inversion pulse set to null the signal of normal myocardium. On this picture we can see a Coronary flow territory The color coding shows the supplying coronary artery for each of the 17 segments of the heart.
Late enhancement IR TFE LA
Coronary flow territory
3D sequence with an inversion prepulse and fat suppression. 20 slices can be obtained in one breathhold. The signal of normal myocardium is suppressed by inversion pulse set to null the signal of normal myocardium. On this picture we can see a "no reflow" area in the hyper enhanced zone.
The color coding shows the supplying coronary artery for each of the 17 segments of the heart.

 

On the perfusion scan, the administration of a T1 enhancing contrast agent shows an enhancement of the normal myocardium that is absent in hypoperfused myocardial regions.

In the normal myocardium, there's a rapid wash-in and wash-out. Thus, the enhancement is early and brief and already substantially less 5 minutes after contrast administration.

 

In the infarcted myocardium, the phenomenon is opposite: the signal intensity is increasing in the infacted area during the first 20 minutes after contrast injection.

 

In the center of the infarct zone, a no reflow phenomenon can be observed, indicative of microvascular obstruction.

 

All the scans that were perfomed, demonstrated that, according to the coronary flow territories, the RCA suffered from occlusion.

 

In this clinical case, perfusion helps to evaluate the success of angioplasty and stenting.

The late enhancement is non-specific for ischemic heart disease. It is also seen in sarcoidosis, hypertrophy.


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May 24, 2005

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Case Study
Achieva 1.5T
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