T2-Weighted Cardiovascular Magnetic Resonance in Acute Cardiac Disease

Cardiovascular magnetic resonance (CMR) using T2-weighted sequences can visualize myocardial edema. When compared to previous protocols, newer pulse sequences with substantially improved image quality have increased its clinical utility. The assessment of myocardial edema provides useful incremental diagnostic and prognostic information in a variety of clinical settings associated with acute myocardial injury. In patients with acute chest pain, T2-weighted CMR is able to identify acute or recent myocardial ischemic injury and has been employed to distinguish acute coronary syndrome (ACS) from non-ACS as well as acute from chronic myocardial infarction. T2-weighted CMR can also be used to determine the area at risk in reperfused and non-reperfused infarction. When combined with contrast-enhanced imaging, the salvaged area and thus the success of early coronary revascularization can be quantified. Strong evidence for the prognostic value of myocardial salvage has enabled its use as a primary endpoint in clinical trials. The present article reviews the current evidence and clinical applications for T2-weighted CMR in acute cardiac disease and gives an outlook on future developments. “The principle of all things is water” Thales of Miletus (624 BC – 546 BC) 


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  1. This is a very nice review article summarizing the state of the art and state of practice for T2-weighted imaging. This is a current subject of much debate, and the article addresses the major issues (including both the benefits and the current limitations) surrounding T2 images.

  2. See post from February 6th:

    MRI in Acute Myocardial Infarction.
    Martina Perazzolo Marra, João A.C. Lima, Sabino Iliceto.
    Eur Heart J. 2011; 32(3):284-293.

  3. Great review!
    I mostly use STIR sequences in my clinical practice, as mentioned in this paper. However, I have found the “bright rim blood artifact adjacent to the endocardium (“slow flow artifact”)” to not represent a real problem in assessing the images. (In cases of non-compaction CM, it is nice to see the slow-flow of blood in the hypertabeculated regions).

  4. See also:

    Erica Dall’Armellina, Nina Karia, Alistair C. Lindsay, Theodoros D. Karamitsos, Vanessa Ferreira, Matthew D. Robson, Peter Kellman, Jane M. Francis, Colin Forfar, Bernard Prendergast, Adrian P. Banning, Keith M. Channon, Rajesh K. Kharbanda, Stefan Neubauer, and Robin P. Choudhury.
    Circ Cardiovasc Imaging published 29 March 2011, 10.1161/CIRCIMAGING.111.963421

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