Fig 1.
CE-MRCVI findings in a patient with troponin positive ACS in the RCA.
Coronary MRA (A) of a 48-year-old male with troponin positive ACS showed decreased vessel lumen size of the mid RCA (red arrows). To highlight the relationship between CE-MRCVI (B) and morphology (A), images were fused in a way similar to PET/CT (C). CE-MRCVI displays high signal intensity (red arrows) within the mid RCA. Analysis of signal enhancement on CE-MRCVI (E, red) suggestive for culprit lesion yielded a contrast-to-noise ratio (CNR) of 12.7. Corresponding XCA (F) confirmed CE-MRCVI findings with mid RCA de-novo lesion (pre-treatment stenosis of 75–94%). MRA: magnetic resonance angiography, CE-MRCVI: contrast enhanced magnetic resonance coronary vessel wall imaging, PET/CT: positron emission tomography/computed tomography. CE-MRCVI:contrast enhanced magnetic resoance coronary vessel wall imaging, ACS: acute coronary syndrome, RCA: right coronary artery, MRA: magnetic resonance angiography, XCA: x-ray coronary angiography, PET/CT: positron emission tomography/computed tomography.
Table 1.
Baseline characteristics of patients with acute myocardial infarction.
Characteristics of patients with acute myocardial infarction, including patients with anterior and inferior STEMI. Characteristics include typical risk factors, laboratory findings, TIMI risk score and GRACE risk score.
Table 2.
Angiographic findings in patients with acute myocardial infarction.
Overview of patients with acute myocardial infarction, anterior STEMI, inferior STEMI and NSTEMI. Detailed description of angiographic findings including the degree of stenosis for the number of segments.
Table 3.
Diagnostic accuracy of CE-MRCVI culprit lesion location in comparison to XCA.
This table gives an overview about the angiographic findings, ECG findings as well as the absolute and relative CNR value for each of the investigated patients.
Fig 2.
CE-MRCVI findings with troponin positive ACS in the LCX.
Coronary MRA (A) with troponin positive ACS showed decreased vessel lumen size of the proximal LCX and first marginal branch (grey arrows). To highlight the relationship between and morphology (A) and CE-MRCVI, images were fused in a way similar to PET/CT (B). CE-MRCVI displays high signal intensity (red arrows) within the first marginal branch. Corresponding XCA (C) confirmed CE-MRCVI findings with mid LCX lesion. Short axis delayed enhancement scan shows predominantly transmural myocardial infarction of the mid-ventricular infero-lateral segment. MRA: magnetic resonance angiography, CE-MRCVI: contrast enhanced magnetic resonance coronary vessel wall imaging, PET/CT: positron emission tomography/computed tomography.
Fig 3.
Contrast-to-noise ratio of culprit lesion and coronary vessel wall.
Contrast to noise ratio (CNR) of segmented culprit lesion in comparison to segments with and without culprit lesion formation. Absolute CNR values of segmented culprit lesion area (Mean: 9.7, 95% CI: 7.6–11.9), segments with (Mean: 4.7, 95% CI: 3.4–6.0) and “normal” segments without visual apparent culprit lesion formation (Mean: 2.9, 95% CI: 2.5–3.3) were found to differ significantly (p<0.05).
Fig 4.
Relative contrast-to-noise ratio of culprit lesion and coronary vessel wall.
Relative CNR values were calculated as ratio between visually apparent culprit lesion area, the affected coronary segment (including culprit lesion formation) or “normal” segments without apparent culprit lesion formation and the averaged CNR of the corresponding entire left or right coronary system. Relative CNR values of segmented culprit lesion area (Mean: 329%, 95% CI: 249–409%), affected coronary segments with culprit lesion (Mean: 130%, 95% CI: 116–144%), and “normal” segments without visual apparent culprit lesion formation (Mean: 96%, 95% CI: 88.54–103.46) were found to differ significantly (p<0.05). A relative CNR threshold of 230 (red line) resulted in a true positive detection and localization in 11 out of 14 patients and true exclusion in 104 out of 105 coronary segments. The false positive classification of the left main stem (red dot) was observed in a patient without culprit lesion in XCA (inferior STEMI).