Multi-vendor, multicentre comparison of contrast-enhanced SSFP and T2-STIR CMR for determining myocardium at risk in ST-elevation myocardial infarction

Eur Heart J Cardiovasc Imaging. 2016 Jul;17(7):744-53. doi: 10.1093/ehjci/jew027. Epub 2016 Mar 21.


Aims: Myocardial salvage, determined by cardiac magnetic resonance imaging (CMR), is used as end point in cardioprotection trials. To calculate myocardial salvage, infarct size is related to myocardium at risk (MaR), which can be assessed by T2-short tau inversion recovery (T2-STIR) and contrast-enhanced steady-state free precession magnetic resonance imaging (CE-SSFP). We aimed to determine how T2-STIR and CE-SSFP perform in determining MaR when applied in multicentre, multi-vendor settings.

Methods and results: A total of 215 patients from 17 centres were included after percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction. CMR was performed within 1-8 days. These patients participated in the MITOCARE or CHILL-MI cardioprotection trials. Additionally, 8 patients from a previous study, imaged 1 day post-CMR, were included. Late gadolinium enhancement, T2-STIR, and CE-SSFP images were acquired on 1.5T MR scanners (Philips, Siemens, or GE). In 65% of the patients, T2-STIR was of diagnostic quality compared with 97% for CE-SSFP. In diagnostic quality images, there was no difference in MaR by T2-STIR and CE-SSFP (bias: 0.02 ± 6%, P = 0.96, r(2) = 0.71, P < 0.001), or between treatment and control arms. No change in size or quality of MaR nor ability to identify culprit artery was seen over the first week after the acute event (P = 0.44).

Conclusion: In diagnostic quality images, T2-STIR and CE-SSFP provide similar estimates of MaR, were constant over the first week, and were not affected by treatment. CE-SSFP had a higher degree of diagnostic quality images compared with T2 imaging for sequences from two out of three vendors. Therefore, CE-SSFP is currently more suitable for implementation in multicentre, multi-vendor clinical trials.

Keywords: AAR; area at risk; ischaemia; magnetic resonance imaging; myocardium at risk.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Analysis of Variance
  • Angioplasty, Balloon, Coronary / methods*
  • Case-Control Studies
  • Contrast Media
  • Coronary Angiography / methods*
  • Databases, Factual
  • Female
  • Gadolinium DTPA
  • Humans
  • Hypothermia, Induced / methods
  • Magnetic Resonance Imaging, Cine / methods*
  • Male
  • Middle Aged
  • Oximes / therapeutic use
  • Prognosis
  • Radiographic Image Enhancement*
  • Reference Values
  • Retrospective Studies
  • Risk Assessment
  • ST Elevation Myocardial Infarction / diagnostic imaging*
  • ST Elevation Myocardial Infarction / mortality
  • ST Elevation Myocardial Infarction / therapy*
  • Secosteroids / therapeutic use
  • Statistics, Nonparametric
  • Treatment Outcome


  • Contrast Media
  • Oximes
  • Secosteroids
  • 3,5-seco-4-norcholestan-5-one oxime-3-ol
  • Gadolinium DTPA