Unexpected Coexisting Myocardial Infarction Detected by Delayed Enhancement MRI
Black blood T2 images (T2 weighted short inversion-time, inversion-recovery (STIR) breath hold pulse sequences) suggested myocardial oedema (arrowheads) strictly in the inferior wall (Figure 2, Panel (e)). Gadolinium-enhanced images (Inversion Recovery turboFLASH 3D short axis and long axis sequences) demonstrated transmural late enhancement of the inferior wall (arrowheads) associated with late microvascular obstruction (Panel (f) and (g)). Furthermore, these sequences showed a subendocardial delayed enhancement area (arrows) which was located in the anterior wall at mid-ventricular level in favour of a limited necrosis (Panel (f) and (g)). Myocardial perfusion scintigraphy with thallium-201 suggested hypoperfusion in the inferior and lateral walls during stress but did not detect at rest any hypouptake in the anterior wall (Panel (h)).
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