Science to practice: can the combination of resting first-pass myocardial perfusion and late gadolinium-enhanced cardiovascular MR imaging help identify myocardial infarction resulting from coronary microembolization?

Abstract

In this issue of Radiology, Carlsson and colleagues report on the use of acute (1 hour, n = 7) and subacute (1 week, n = 6) resting first-pass perfusion and late gadolinium-enhanced cardiovascular magnetic resonance (MR) imaging to detect myocardial hypoperfusion and microinfarction in a swine model of coronary microembolization. They found resting hypoperfusion at 1 hour that persisted at 1 week. Detection of microinfarction was not reliable at 1 hour, but microinfarction was detected and characterized at 1 week. The pattern on late gadolinium-enhanced images in their model was patchy, with small clusters randomly distributed across a large artery territory. This is distinct from the subendocardially based transmural extension patterns described with clinical myocardial infarction (MI). The degree of left ventricular (LV) systolic dysfunction did not correlate with the quantity of myonecrosis.