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World J Radiol. Jan 28, 2010; 2(1): 1-14
Published online Jan 28, 2010. doi: 10.4329/wjr.v2.i1.1
Reperfusion injury components and manifestations determined by cardiovascular MR and MDCT imaging
Maythem Saeed, Steve Hetts, Mark Wilson
Maythem Saeed, Steve Hetts, Mark Wilson, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107-5705, United States
Author contributions: Saeed M contributed to conception and design of study, as well as acquisition of data, and analysis and interpretation of data, manuscript writing, including drafting the article, and revising it critically for important intellectual content; Hetts S and Wilson M reviewed it critically for important intellectual content.
Correspondence to: Maythem Saeed, Professor, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107-5705, United States. maythem.saeed@radiology.ucsf.edu
Telephone: +1-415-5146221 Fax: +1-415-3539423
Received: November 26, 2009
Revised: January 6, 2010
Accepted: January 13, 2010
Published online: January 28, 2010

Advances in magnetic resonance (MR) and computed tomography (CT) imaging have improved visualization of acute and scar infarct. Over the past decade, there have been and continues to be many significant technical advancements in cardiac MR and multi-detector computed tomography (MDCT) technologies. The strength of MR imaging relies on a variety of pulse sequences and the ability to noninvasively provide information on myocardial structure, function and perfusion in a single imaging session. The recent technical developments may also allow CT technologies to rise to the forefront for evaluating clinical ischemic heart disease. Components of reperfusion injury including myocardial edema, hemorrhage, calcium deposition and microvascular obstruction (MO) have been demonstrated using MR and CT technologies. MR imaging can be used serially and noninvasively in assessing acute and chronic consequences of reperfusion injury because there is no radiation exposure or administration of radioactive materials. MDCT is better suited for assessing coronary artery stenosis and as an alternative technique for assessing viability in patients where MR imaging is contraindicated. Changes in left ventricular (LV) volumes and function measured on cine MR are directly related to infarct size measured on delayed contrast enhanced images. Recent MR studies found that transmural infarct, MO and peri-infarct zone are excellent predictors of poor post-infarct recovery and mortality. Recent MR studies provided ample evidence that growth factor genes and stem cells delivered locally have beneficial effects on myocardial viability, perfusion and function. The significance of deposited calcium in acute infarct detected on MDCT requires further studies. Cardiac MR and MDCT imaging have the potential for assessing reperfusion injury components and manifestations.

Keywords: Calcium deposits in myocardium, Magnetic resonance imaging, Multi-detector computed tomography, Myocardial micro and macro-infarct, Reperfusion injury, Vascular injury