PMID- 23192160
OWN - NLM
STAT- MEDLINE
DCOM- 20130520
LR  - 20151119
IS  - 1536-0210 (Electronic)
IS  - 0020-9996 (Linking)
VI  - 48
IP  - 1
DP  - 2013 Jan
TI  - Diagnostic performance of dark-blood T2-weighted CMR for evaluation of acute 
      myocardial injury.
PG  - 24-31
LID - 10.1097/RLI.0b013e3182718672 [doi]
AB  - OBJECTIVES: We compared the image quality and diagnostic performance of 2 
      fat-suppression methods for black-blood T2-weighted fast spin-echo (FSE), which 
      are as follows: (a) short T1 inversion recovery (STIR; FSE-STIR) and (b) spectral 
      adiabatic inversion recovery (SPAIR; FSE-SPAIR), for detection of acute 
      myocardial injury. BACKGROUND: Edema-sensitive T2-weighted FSE cardiac magnetic 
      resonance (CMR) imaging is useful in detecting acute myocardial injury but may 
      experience reduced myocardial signal and signal dropout. The SPAIR pulse aims to 
      eliminate artifacts associated with the STIR pulse. MATERIALS AND METHODS: A 
      total of 65 consecutive patients referred for CMR evaluation of myocardial 
      structure and function underwent FSE-STIR and FSE-SPAIR, in addition to cine and 
      late gadolinium enhancement (LGE) CMR. T2-weighted FSE images were independently 
      evaluated by 2 readers for image quality and artifacts (Likert scale of 1-5; 
      best-worst) and presence of increased myocardial signal suggestive of edema. In 
      addition, clinical CMR interpretation, incorporating all CMR sequences available, 
      was recorded for comparison. Diagnostic performance of each T2-weighted sequence 
      was measured using recent (<30 days) troponin elevation greater than 2 times the 
      upper limit of normal as the reference standard for acute myocardial injury. 
      RESULTS: Of the 65 patients, there were 21 (32%) with acute myocardial injury. 
      Image quality and artifact scores were significantly better with FSE-SPAIR 
      compared with FSE-STIR (2.15 vs 2.68, P < 0.01; 2.62 vs 3.05, P < 0.01, 
      respectively). The sensitivity, specificity, positive predictive value, and 
      negative predictive value for acute myocardial injury were as follows: 29%, 93%, 
      67%, and 73% for FSE-SPAIR; 38%, 91%, 67%, and 75% for FSE-STIR; 71%, 98%, 94%, 
      and 88% for clinical interpretation including LGE, T2, and wall motion. There was 
      a statistically significant difference in sensitivity between the clinical 
      interpretation and each of the T2-weighted sequences but not between each 
      T2-weighted sequence. CONCLUSIONS: Although FSE-SPAIR demonstrated significantly 
      improved image quality and decreased artifacts, isolated interpretations of each 
      T2-weighted technique demonstrated high specificity but overall low sensitivity 
      for the detection of myocardial injury, with no difference in accuracy between 
      the techniques. However, real-world interpretation in combination with cine and 
      LGE CMR methods significantly improves the overall sensitivity and diagnostic 
      performance.
FAU - Srichai, Monvadi B
AU  - Srichai MB
AD  - Department of Radiology, New York University School of Medicine, NY, USA. 
      srichai@alum.mit.edu
FAU - Lim, Ruth P
AU  - Lim RP
FAU - Lath, Narayan
AU  - Lath N
FAU - Babb, James
AU  - Babb J
FAU - Axel, Leon
AU  - Axel L
FAU - Kim, Daniel
AU  - Kim D
LA  - eng
GR  - K12HS019473/HS/AHRQ HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Invest Radiol
JT  - Investigative radiology
JID - 0045377
RN  - 0 (Biomarkers)
RN  - 0 (Troponin)
SB  - IM
MH  - Artifacts
MH  - Biomarkers/blood
MH  - Blood
MH  - Female
MH  - Humans
MH  - *Magnetic Resonance Imaging/methods
MH  - Magnetic Resonance Imaging, Cine
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*diagnosis
MH  - Predictive Value of Tests
MH  - Sensitivity and Specificity
MH  - Troponin/blood
EDAT- 2012/11/30 06:00
MHDA- 2013/05/22 06:00
CRDT- 2012/11/30 06:00
PHST- 2012/11/30 06:00 [entrez]
PHST- 2012/11/30 06:00 [pubmed]
PHST- 2013/05/22 06:00 [medline]
AID - 10.1097/RLI.0b013e3182718672 [doi]
PST - ppublish
SO  - Invest Radiol. 2013 Jan;48(1):24-31. doi: 10.1097/RLI.0b013e3182718672.