Case Report: Myocardial Infarction
Courtesy of Jens Bremerich, M.D., P. Buser, M.D., Georg Bongartz, M.D., Department of Radiology, Department of Cardiology, University Hospital Basel, Basel, Switzerland
67-year-old man with myocardial infarction. Specific question was the extent of myocardial necrosis and scarring.
Figure 1: Parasagittal long axis 2 chamber view shows dilated left atrium (LA) and ventricle (LV) with marked thinning of the myocardium in the apex and anterior wall (arrows). TrueFISP images were acquired on a MAGNETOM Espree scanner with a PAT factor of 2, antegrade ECG gating (RR interval 1155 ms) and retrograde arrhythmia detection.
Figure 2: Short axis view of the heart with the same sequence as figure one. Consecutive 6 mm thick slices of the entire heart were acquired enabling gold standard calculation of the ejection fraction which was markedly reduced (23 %). Moreover, wall thinning was observed in the anterior wall (arrows) of the left ventricle (LV) as already seen on 2 chamber view.
Figure 3: Late enhancement* image acquired in the short axis 15 min after injection of 0.1 mmol Gadolinium with the following parameters: slice thickness = 8 mm, TI = 250 ms, TR = 700 ms, TE = 4.2. The phase sensitive reconstructions of Turbo FLASH images (PSIF) show transmural infarction in the anterior wall (arrowheads)
Results & Discussion
The protocol for imaging myocardial infarction and viability* is comprised of cine TrueFISP and late enhancement* Turbo FLASH with phase sensitive reconstruction (PSIR) in three axis: Short axis, long axis 2-chamber view, and long axis 4-chamber view. This protocol enables assessment of wall motion abnormalities, definition of location and transmurality of infarcts, and gold standard calculation of ventricular function.