Quantification of myocardial area at risk with T2-weighted CMR: comparison with contrast-enhanced CMR and coronary angiography

JACC Cardiovasc Imaging. 2009 Jul;2(7):825-31. doi: 10.1016/j.jcmg.2009.02.011.


Objectives: We sought to quantify the myocardium at risk in reperfused acute myocardial infarction (AMI) in man with T2-weighted (T2W) cardiac magnetic resonance (CMR).

Background: The myocardial area at risk (AAR) is defined as the myocardial tissue within the perfusion bed distally to the culprit lesion of the infarct-related coronary artery. T2W CMR is appealing to retrospectively determine the myocardial AAR after reperfused AMI. Data on the utility of this technique in humans are limited.

Methods: One hundred eight patients with successfully reperfused ST-segment elevation AMI were studied between 1 and 20 days after percutaneous coronary intervention (PCI). We compared the volume of hyperintense myocardium on T2W CMR with the myocardial AAR determined by contrast-enhanced CMR with infarct endocardial surface length (ESL) and AAR estimated by conventional coronary angiography with the BARI (Bypass Angioplasty Revascularization Investigation) risk score.

Results: The volume of hyperintense myocardium on T2W CMR (mean 32 +/- 16%, range 3% to 67%) was consistently larger than the volume of myocardial infarction measured with contrast-enhanced images (mean 17 +/- 12%, range 0% to 55%) (p < 0.001). Myocardial salvage ranged from -4% to 45% of the left ventricular myocardium (mean 14 +/- 10%). The AAR determined by T2W CMR compared favorably with the infarct ESL (r = 0.77) with contrast-enhanced CMR, and there was moderate correlation between the BARI angiographic risk score and infarct ESL (r = 0.42). The time between PCI and CMR did not cause a significant difference in the volume of T2W hyperintense myocardium (r = 0.11, p = 0.27) or the calculated volume of salvaged myocardium (r = 0.12, p = 0.23).

Conclusions: T2W CMR performed early after successfully reperfused AMI in humans enables retrospective quantification of the myocardial AAR and salvaged myocardium.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary*
  • Contrast Media*
  • Coronary Angiography*
  • Edema, Cardiac / diagnosis*
  • Edema, Cardiac / diagnostic imaging
  • Edema, Cardiac / pathology
  • Female
  • Gadolinium DTPA*
  • Humans
  • Imaging, Three-Dimensional
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / pathology
  • Myocardial Infarction / therapy
  • Myocardium / pathology*
  • Predictive Value of Tests
  • Prospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome


  • Contrast Media
  • Gadolinium DTPA