Published Online
on September 29, 2009

A more recent version of this article appeared on November 1, 2009

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Original Article

Molecular MRI of Cardiomyocyte Apoptosis with Simultaneous Delayed Enhancement MRI Distinguishes Apoptotic and Necrotic Myocytes In Vivo: Potential for Midmyocardial Salvage in Acute Ischemia.

David E. Sosnovik^1,3; Elisabeth Garanger¹; Elena Aikawa¹; Matthias Nahrendorf¹; Jose-Luiz Figueiredo¹; Guangping Dai¹; Fred Reynolds¹; Anthony Rosenzweig²; Ralph Weissleder¹ and Lee Josephson¹

¹ Massachusetts General Hospital, Harvard Medical School, Boston, MA;
² Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

^* Corresponding author; email: sosnovik{at}nmr.mgh.harvard.edu

Background—A novel dual contrast molecular MRI technique to image both cardiomyocyte (CM) apoptosis and necrosis in-vivo within 4-6 hours of ischemia is presented. The technique utilizes the annexin-based nanoparticle AnxCLIO-Cy5.5 (apoptosis) and simultaneous delayed enhancement (DE) imaging with a novel gadolinium chelate, Gd-DTPA-NBD (necrosis).

Methods and Results—Mice with transient coronary ligation were injected intravenously at the onset of reperfusion with AnxCLIO-Cy5.5 (n=7) or the control probe Inact_CLIO-Cy5.5 (n=6). T2* weighted MR images (9.4 Tesla) were acquired within 4-6 hours of reperfusion. The contrast-to-noise ratio (CNR) between injured and uninjured myocardium was measured. The mice were then injected with Gd-DTPA-NBD and DE imaging was performed within 10-30 minutes. Uptake of AnxCLIO-Cy5.5 was most prominent in the midmyocardium and was significantly greater than that of Inact_CLIO-Cy5.5 (CNR 8.82 +/- 1.5 versus 3.78 +/- 1.1, p < 0.05). Only 21 +/- 3% of the myocardium with accumulation of AnxCLIO-Cy5.5 showed DE of Gd-DTPA-NBD. Wall thickening was significantly reduced in segments with DE and/or transmural accumulation of AnxCLIO-Cy5.5 (p < 0.001). Fluorescence microscopy of AnxCLIO-Cy5.5 and immunohistochemistry of Gd-DTPA-NBD confirmed the presence of large numbers of apoptotic but potentially viable CMs (AnxCLIO-Cy5.5 positive, Gd-DTPA-NBD negative) in the midmyocardium.

Conclusions—A novel technique to image CM apoptosis and necrosis in-vivo within 4-6 hours of injury is presented, and reveals large areas of apoptotic but viable myocardium in the midmyocardium. Strategies to salvage the numerous apoptotic but potentially viable CMs in the midmyocardium in acute ischemia should be investigated.

Key Words: apoptosis • ischemia • magnetic resonance imaging • myocardium • molecular imaging