• Christoph Klein, Thaiz R Schmal, Stephan G Nekolla, Bernhard Schnackenburg, Eckart Fleck, and Eike Nagel.
• German Heart Institute Berlin, Berlin, Germany. klein@dhzb.de
• J Cardiovasc Magn Reson. 2007 Jan 1; 9 (4): 653-8.

PurposeTo investigate the mechanism of late gadolinium enhancement in irreversibly damaged myocardium in patients with acute myocardial infarct by determining kinetics of Gd-DTPA over time.MethodsTwenty-nine patients (24 men; 64 +/- 9 years) with acute myocardial infarction were imaged with functional and gadolinium enhanced cardiovascular magnetic resonance (CMR) 18 minutes post 0.2 mmol/kg Gd-DTPA. T1 of blood, remote and enhanced myocardium, as well as microvascular obstruction (MVO) was determined before and 5-40 minutes post contrast injection (Look-Locker), and the partition coefficient (lambda) was calculated.ResultsT1 and lambda were significantly different from 5-40 minutes post contrast in enhanced (lambda = 0.90 +/- 0.09, p < 0.001) compared to remote myocardium (lambda = 0.40 +/- 0.07). lambda achieved a steady state in remote but increased continuously in infarcted myocardium and to an even greater extent in MVO. T1 of enhanced myocardium was higher from 5-15 minutes, equal at 20 minutes and lower 25-40 minutes post contrast compared to blood, indicating a changing contrast between blood and late gadolinium enhancement over time.ConclusionEnhancement in patients with acute infarction is mainly due to an increased lambda, although reduced wash-in-wash-out adds to the effect. Differentiation between blood and enhanced myocardium may be difficult to achieve, if only little differences of T1 are available. Imaging at a later point will restore the contrast.

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