Key result
T2 mapping was the most reproducible cardiac MR method to detect and quantify infarct myocardial edema (intraobserver variability 0.05), followed by EGE, ACUT2E, and T2-weighted STIR.
Why the study?
Which cardiac magnetic resonance imaging technique is most reproducible for detecting and quantifying myocardial edema after reperfused STEMI?
Observational (n=53)
Which cardiac magnetic resonance imaging technique is most reproducible for detecting and quantifying myocardial edema after reperfused STEMI?
T2 mapping is the most reproducible cardiac MR method for detecting and quantifying infarct myocardial edema after reperfused STEMI, outperforming EGE, ACUT2E, and T2-weighted STIR.
Answers are grounded in this paper and cite their sources.
T2 mapping may be prioritized for reproducible edema quantification post-reperfused STEMI; leaves open outcome correlation in prospective trials.
PURPOSE: To determine variability and agreement for detecting myocardial edema with T2-weighted short-tau inversion recovery (STIR), acquisition for cardiac unified T2 edema (ACUT2E), T2 mapping, and early gadolinium enhancement (EGE) after successfully reperfused ST-segment-elevation myocardial infarction (STEMI) and diagnostic accuracy of each sequence to predict infarct-related artery (IRA). MATERIALS AND METHODS: Local ethics committee approved the study, with patient informed written consent. On day 2 after successful primary angioplasty for STEMI, 53 patients were prospectively enrolled; 40 patients (mean age, 60 years) completed study. Two sets of cardiac magnetic resonance (MR) images were obtained on same day 6 hours apart. Basal, midcavity, and apical sections were obtained with each sequence. Interobserver, intraobserver, and interimage variability (1 minus intraclass correlation coefficient) and agreement (Bland-Altman method) were assessed. RESULTS: Size of myocardial edema significantly differed. Mean size of myocardium at risk was similar between T2-weighted STIR (18.2 g) and T2 mapping (17.3 g) (P = .54). Mean size differed between T2-weighted STIR (18.2 g) and ACUT2E (14.0 g) (P = .01) and between T2-weighted STIR (18.2 g) and EGE (14.2 g) (P = .003). T2 mapping and EGE had best agreement (interobserver bias: T2-weighted STIR, -0.9 [mean difference] ± 9.6 [standard deviation]; ACUT2E, -2.5 ± 6.9; T2 mapping, -3.8 ± 4.7; EGE, -5.3 ± 5.9; interimage bias: T2-weighted STIR, 1.5 ± 5.8; ACUT2E, -0.8 ± 4.9; T2 mapping, 3.1 ± 4.0; EGE, 1.1 ± 4.9; intraobserver bias: T2-weighted STIR, 1.4 ± 5.8; ACUT2E, 0.6 ± 4.7; T2 mapping, 2.2 ± 3.1; EGE, 1.7 ± 2.9). Variability was lowest for T2 mapping (intraobserver, 0.05; interobserver, 0.09; interimage, 0.1) followed by EGE (intraobserver, 0.03; interobserver, 0.14; interimage, 0.14), with improved detection of territory of IRA versus ACUT2E (intraobserver, 0.11; interobserver, 0.22; interimage, 0.12) and T2-weighted STIR (intraobserver, 0.1; interobserver, 0.32; interimage, 0.1). CONCLUSION: Cardiac MR methods to detect and quantify infarct myocardial edema are not interchangeable; T2 mapping is the most reproducible method, followed by EGE, ACUT2E, and T2-weighted STIR. Clinical trial registration no. NCT01468662
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McAlindon et al. (2014) conducted an observational in ST-segment-elevation myocardial infarction (STEMI) (n=53). T2 mapping vs. T2-weighted STIR, ACUT2E, and EGE was evaluated on Variability and agreement for detecting myocardial edema. T2 mapping was the most reproducible cardiac MR method to detect and quantify infarct myocardial edema (intraobserver variability 0.05), followed by EGE, ACUT2E, and T2-weighted STIR.
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