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Area at risk in acute myocardial infarction: oedema imaging and species-specific findings.

Norlund et al. 1 from Lund University addressed two distinctly different aims in this edition of the European Heart Journal Cardiovascular Imaging. Their primary aim was to compare the diagnostic accuracy and image quality of T 2-STIR ( T 2-weighted Short Tau Inversion Recovery) oedema imaging and CE-SSFP (contrast enhanced steady-state free precession cine MRI) with respect to determining myocardium at risk (MaR). Their second aim was to determine whether there is a bimodal temporal response to oedema or MaR imaging in humans as recently described in swine and possibly also present in dogs.

They used data from three separate studies to have multi-centre and multi-vendor representation of CMR MaR methodologies. They picked two clinical trials that used CMR to determine myocardial salvage: the CHILL-MI trial2 and the MITOCARE study.3 These studies provided real world experience in clinical trials aimed at measuring myocardial salvage. To address the second aim of the study, they also included patients from a third study4 to ensure that they had data on Day 1 after myocardial infarction.

With respect to their first aim on image quality, Norlund et al. 1 found that T 2-STIR performs poorly for imaging MaR; only 65% of T 2-STIR datasets were considered of diagnostic …