Motivational and cognitive predictors of apathy after subthalamic nucleus stimulation in Parkinson's disease.

Postoperative apathy is a frequent symptom in Parkinson's disease patients who have undergone bilateral deep brain stimulation of the subthalamic nucleus. Two main hypotheses for postoperative apathy have been suggested: (i) dopaminergic withdrawal syndrome relative to postoperative dopaminergic drug tapering; and (ii) direct effect of chronic stimulation of the subthalamic nucleus. The primary objective of our study was to describe preoperative and 1-year postoperative apathy in Parkinson's disease patients who underwent chronic bilateral deep brain stimulation of the subthalamic nucleus. We also aimed to identify factors associated with 1-year postoperative apathy considering: (i) preoperative clinical phenotype; (ii) dopaminergic drug management; and (iii) volume of tissue activated within the subthalamic nucleus and the surrounding structures. We investigated a prospective clinical cohort of 367 patients before and 1 year after chronic bilateral deep brain stimulation of the subthalamic nucleus. We assessed apathy using the Lille Apathy Rating Scale and carried out a systematic evaluation of motor, cognitive and behavioural signs. We modelled the volume of tissue activated in 161 patients using the Lead-DBS toolbox and analysed overlaps within motor, cognitive and limbic parts of the subthalamic nucleus. Of the 367 patients, 94 (25.6%) exhibited 1-year postoperative apathy: 67 (18.2%) with 'de novo apathy' and 27 (7.4%) with 'sustained apathy'. We observed disappearance of preoperative apathy in 22 (6.0%) patients, who were classified as having 'reversed apathy'. Lastly, 251 (68.4%) patients had neither preoperative nor postoperative apathy and were classified as having 'no apathy'. We identified preoperative apathy score [odds ratio (OR) 1.16; 95% confidence interval (CI) 1.10, 1.22; P < 0.001], preoperative episodic memory free recall score (OR 0.93; 95% CI 0.88, 0.97; P = 0.003) and 1-year postoperative motor responsiveness (OR 0.98; 95% CI 0.96, 0.99; P = 0.009) as the main factors associated with postoperative apathy. We showed that neither dopaminergic dose reduction nor subthalamic stimulation were associated with postoperative apathy. Patients with 'sustained apathy' had poorer preoperative fronto-striatal cognitive status and a higher preoperative action initiation apathy subscore. In these patients, apathy score and cognitive status worsened postoperatively despite significantly lower reduction in dopamine agonists (P = 0.023), suggesting cognitive dopa-resistant apathy. Patients with 'reversed apathy' benefited from the psychostimulant effect of chronic stimulation of the limbic part of the left subthalamic nucleus (P = 0.043), suggesting motivational apathy. Our results highlight the need for careful preoperative assessment of motivational and cognitive components of apathy as well as executive functions in order to better prevent or manage postoperative apathy.

Adaptations of the balloon analog risk task for neuroimaging settings: a systematic review.

Introduction: The Balloon Analog Risk Task (BART), a computerized behavioral paradigm, is one of the most common tools used to assess the risk-taking propensity of an individual. Since its initial behavioral version, the BART has been adapted to neuroimaging technique to explore brain networks of risk-taking behavior. However, while there are a variety of paradigms adapted to neuroimaging to date, no consensus has been reached on the best paradigm with the appropriate parameters to study the brain during risk-taking assessed by the BART. In this review of the literature, we aimed to identify the most appropriate BART parameters to adapt the initial paradigm to neuroimaging and increase the reliability of this tool. Methods: A systematic review focused on the BART versions adapted to neuroimaging was performed in accordance with PRISMA guidelines. Results: A total of 105 articles with 6,879 subjects identified from the PubMed database met the inclusion criteria. The BART was adapted in four neuroimaging techniques, mostly in functional magnetic resonance imaging or electroencephalography settings. Discussion: First, to adapt the BART to neuroimaging, a delay was included between each trial, the total number of inflations was reduced between 12 and 30 pumps, and the number of trials was increased between 80 and 100 balloons, enabling us to respect the recording constraints of neuroimaging. Second, explicit feedback about the balloon burst limited the decisions under ambiguity associated with the first trials. Third, employing an outcome index that provides more informative measures than the standard average pump score, along with a model incorporating an exponential monotonic increase in explosion probability and a maximum explosion probability between 50 and 75%, can yield a reliable estimation of risk profile. Additionally, enhancing participant motivation can be achieved by increasing the reward in line with the risk level and implementing payment based on their performance in the BART. Although there is no universal adaptation of the BART to neuroimaging, and depending on the objectives of a study, an adjustment of parameters optimizes its evaluation and clinical utility in assessing risk-taking.

Audience Interbrain Synchrony During Live Music Is Shaped by Both the Number of People Sharing Pleasure and the Strength of This Pleasure.

The study of interbrain coupling in a group of people attending a concert together is a favorable framework to estimate group emotions and more precisely emotional connection between people sharing situations in the same environment. It offers the advantage of studying interactions at the group level. By recording the cerebral activity of people from an audience during a concert using electroencephalography, we previously demonstrated that the higher the emotions and the physically closer the people were, the more the interbrain synchrony (IBS) was enhanced. To further investigate the parameters that shaped inter-brain synchronization in this context, we now focus on the emotional dynamics of the group as a whole by identifying specific moments in the concert that evoked strong or weak emotions, as well as strong or weak emotional cohesion between individuals. We demonstrated that audience interbrain synchrony is mainly associated with experiencing high musical pleasure and that the group emotional cohesion can enhance IBS, but alone is not the major parameter that shapes it in this context.

Interbrain emotional connection during music performances is driven by physical proximity and individual traits.

How musical emotions and the pleasure derived from music, regardless of the musical valence, can be shared between individuals is a fascinating question, and investigating it can shed light on the function of musical reward. We carried out our investigations in a natural setting during an international competition for orchestra conductors. Participants (n = 15) used a dedicated smartphone app to report their subjective emotional experiences in real time while we recorded their cerebral activity using electroencephalography and their electrodermal activity. The overall behavioral real-time behavioral ratings suggest a possible social influence on the reported and felt pleasure. The physically closer the participants, the more similar their reported pleasure. By calculating the interindividual cerebral coherence (n = 21 pairs), we showed that when people simultaneously reported either high or low pleasure, their cerebral activities were closer than for simultaneous neutral pleasure reports. Participants' skin conductance levels were also more coupled when reporting higher emotional degrees simultaneously. More importantly, the participants who were physically closer had higher cerebral coherence, but only when they simultaneously reported a high level of pleasure. We propose that emotional contagion and/or emotional resonance mechanisms could explain why a form of "emotional connecting force" arises between people during shared appraisal situations.

Added value of functional neuroimaging to assess decision-making capacity of older adults with neurocognitive disorders: protocol for a prospective, monocentric, single-arm study (IMAGISION).

INTRODUCTION: Assessment of decision-making capacity (DMC) is essential in daily life as well as for defining a person-centred care plan. Nevertheless, in ageing, especially if signs of dementia appear, it becomes difficult to assess decision-making ability and raises ethical questions. Currently, the assessment of DMC is based on the clinician's evaluation, completed by neuropsychological tests. Functional MRI (fMRI) could bring added value to the diagnosis of DMC in difficult situations. METHODS AND ANALYSIS: IMAGISION is a prospective, monocentric, single-arm study evaluating fMRI compared with clinical assessment of DMC. The study will begin during Fall 2021 and should be completed by Spring 2023. Participants will be recruited from a memory clinic where they will come for an assessment of their cognitive abilities due to decision-making needs to support ageing in place. They will be older people over 70 years of age, living at home, presenting with a diagnosis of mild dementia, and no exclusion criteria of MRI. They will be clinically assessed by a geriatrician on their DMC, based on the neuropsychological tests usually performed. Participants will then perform a behavioural task in fMRI (Balloon Analogue Risk Task) to analyse the activation areas. Additional semistructured interviews will be conducted to explore real life implications. The main analysis will study concordance/discordance between the clinical classification and the activation of fMRI regions of interest. Reclassification as 'capable', based on fMRI, of patients for whom clinical diagnosis is 'questionable' will be considered as a diagnostic gain. ETHICS AND DISSEMINATION: IMAGISION has been authorised by a research ethics board (Comité de Protection des Personnes, Bordeaux, II) in France, in accordance with French legislation on interventional biomedical research, under the reference IDRCB number 2019-A00863-54, since 30 September 2020. Participants will sign an informed consent form. The results of the study will be presented in international peer-reviewed scientific journals, international scientific conferences and public lectures. TRIAL REGISTRATION NUMBER: NCT03931148.

Neural Activation in Risky Decision-Making Tasks in Healthy Older Adults: A Meta-Analysis of fMRI Data.

Decision making is a complex cognitive phenomenon commonly used in everyday life. Studies have shown differences in behavioral strategies in risky decision-making tasks over the course of aging. The development of functional neuroimaging has gradually allowed the exploration of the neurofunctional bases of these behaviors. The purpose of our study was to carry out a meta-analysis on the neural networks underlying risky decision making in healthy older adults. Following the PRISMA guidelines, we systematically searched for fMRI studies of decision making in older adults using risky decision-making tasks. To perform the quantitative meta-analysis, we used the revised version of the activation likelihood estimation (ALE) algorithm. A total of 620 references were selected for initial screening. Among these, five studies with a total of 98 cognitively normal older participants (mean age: 69.5 years) were included. The meta-analysis yielded two clusters. Main activations were found in the right insula, bilateral dorsolateral prefrontal cortex (dlPFC) and left orbitofrontal cortex (OFC). Despite the limited number of studies included, our meta-analysis highlights the crucial involvement of circuits associated with both emotion regulation and the decision to act. However, in contrast to the literature on young adults, our results indicate a different pattern of hemispheric lateralization in older participants. These activations can be used as a minimum pattern of activation in the risky decision-making tasks of healthy older subjects.

Cortical Patterns of Pleasurable Musical Chills Revealed by High-Density EEG.

Music has the capacity to elicit strong positive feelings in humans by activating the brain's reward system. Because group emotional dynamics is a central concern of social neurosciences, the study of emotion in natural/ecological conditions is gaining interest. This study aimed to show that high-density EEG (HD-EEG) is able to reveal patterns of cerebral activities previously identified by fMRI or PET scans when the subject experiences pleasurable musical chills. We used HD-EEG to record participants (11 female, 7 male) while listening to their favorite pleasurable chill-inducing musical excerpts; they reported their subjective emotional state from low pleasure up to chills. HD-EEG results showed an increase of theta activity in the prefrontal cortex when arousal and emotional ratings increased, which are associated with orbitofrontal cortex activation localized using source localization algorithms. In addition, we identified two specific patterns of chills: a decreased theta activity in the right central region, which could reflect supplementary motor area activation during chills and may be related to rhythmic anticipation processing, and a decreased theta activity in the right temporal region, which may be related to musical appreciation and could reflect the right superior temporal gyrus activity. The alpha frontal/prefrontal asymmetry did not reflect the felt emotional pleasure, but the increased frontal beta to alpha ratio (measure of arousal) corresponded to increased emotional ratings. These results suggest that EEG may be a reliable method and a promising tool for the investigation of group musical pleasure through musical reward processing.

The Relevance of a Conductor Competition for the Study of Emotional Synchronization Within and Between Groups in a Natural Musical Setting.

Group emotional dynamics are a central concern in the study of human interaction and communication. To study group emotions, the social context of a musical event in natural conditions may overcome several limits of laboratory experiments and could provide a suitable framework. This study aimed to evaluate if cultural events such as a conductor competition could welcome scientific research for the study of group emotional sharing. We led an observational study, which suggests that in this particular context, public, musicians and jury would agree to participate and to wear neurophysiological and physiological devices to monitor their emotional state during the competition. Self-administrated scales showed that, in the context of a musical competition, members of the public felt strong musical emotions such as music chills. Our results suggest that such a specific competition design is a suitable experimental model to lead an experiment under ecological conditions to effectively investigate collective emotional synchronization. In the future, with the implementation of an acquisition system recording synchronous neurophysiological data for a large group of participants, we may be able to highlight mechanisms involved in emotional synchronization in a natural musical setting.

The Besançon affective picture set-adult (BAPS-Adult): Development and validation.

We developed and validated a new picture database of attachment-related photographs, the BAPS-Adult. Participants (N = 315) rated 256 pictures, according to dimension (valence, arousal, and dominance) using Self-Assessment Manikins (SAM), emotional category (positive, negative, mixed, and neutral) using labels, and discrete emotion (comfort, joy, complicity, distress, horror, and hate) using linear scales. Pictures were then classified into four types, depending on content (distress, comfort, complicity-joy, and neutral). Dimensional ratings of valence, arousal, and dominance, as well as discrete emotion ratings, differed significantly from each other between picture types. The BAPS-Adult is a new, highly discriminated database, allowing researchers to select from a variety of pre-rated, attachment-related pictures.

The role of the amygdala in the perception of positive emotions: an "intensity detector".

The specific role of the amygdala remains controversial even though the development of functional imaging techniques has established its implication in the emotional process. The aim of this study was to highlight the sensitivity of the amygdala to emotional intensity (arousal). We conducted an analysis of the modulation of amygdala activation according to variation in emotional intensity via an fMRI event-related protocol. Monitoring of electrodermal activity, a marker of psychophysiological emotional perception and a reflection of the activation of the autonomic nervous system, was carried out concurrently. Eighteen subjects (10 men; aged from 22 to 29 years) looked at emotionally positive photographs. We demonstrated that the left and right amygdalae were sensitive to changes in emotional intensity, activating more in response to stimuli with higher intensity. Furthermore, electrodermal responses were more frequent for the most intense stimuli, demonstrating the concomitant activation of the autonomic nervous system. These results highlight the sensitivity of the amygdala to the intensity of positively valenced visual stimuli, and in conjunction with results in the literature on negative emotions, reinforce the role of the amygdala in the perception of intensity.

A simplified CT-guided approach for greater occipital nerve infiltration in the management of occipital neuralgia.

OBJECTIVES: To evaluate the efficacy of a simplified CT-guided greater occipital nerve (GON) infiltration approach in the management of occipital neuralgia (ON). METHODS: Local IRB approval was obtained and written informed consent was waived. Thirty three patients suffering from severe refractory ON who underwent a total of 37 CT-guided GON infiltrations were included between 2012 and 2014. GON infiltration was performed at the first bend of the GON, between the inferior obliqus capitis and semispinalis capitis muscles with local anaesthetics and cortivazol. Pain was evaluated via VAS scores. Clinical success was defined by pain relief greater than or equal to 50 % lasting for at least 3 months. RESULTS: The pre-procedure mean pain score was 8/10. Patients suffered from left GON neuralgia in 13 cases, right GON neuralgia in 16 cases and bilateral GON neuralgia in 4 cases. The clinical success rate was 86 %. In case of clinical success, the mean pain relief duration following the procedure was 9.16 months. CONCLUSIONS: Simplified CT-guided infiltration appears to be effective in managing refractory ON. With this technique, infiltration of the GON appears to be faster, technically easier and, therefore, safer compared with other previously described techniques. KEY POINTS: • Occipital neuralgia is a very painful and debilitating condition • GON infiltrations have been successful in the treatment of occipital neuralgia • This simplified technique presents a high efficacy rate with long-lasting pain relief • This infiltration technique does not require contrast media injection for pre-planning • GON infiltration at the first bend appears easier and safer.

An fMRI study on the influence of sommeliers' expertise on the integration of flavor.

Flavors guide consumers' choice of foodstuffs, preferring those that they like and meet their needs, and dismissing those for which they have a conditioned aversion. Flavor affects the learning and consumption of foods and drinks; what is already well-known is favored and what is new is apprehended. The flavor of foodstuffs is also crucial in explaining some eating behaviors such as overconsumption. The "blind" taste test of wine is a good model for assessing the ability of people to convert mouth feelings into flavor. To determine the relative importance of memory and sensory capabilities, we present the results of an fMRI neuro-imaging study involving 10 experts and 10 matched control subjects using wine as a stimulus in a blind taste test, focusing primarily on the assessment of flavor integration. The results revealed activations in the brain areas involved in sensory integration, both in experts and control subjects (insula, frontal operculum, orbitofrontal cortex, amygdala). However, experts were mainly characterized by a more immediate and targeted sensory reaction to wine stimulation with an economic mechanism reducing effort than control subjects. Wine experts showed brainstem and left-hemispheric activations in the hippocampal and parahippocampal formations and the temporal pole, whereas control subjects showed activations in different associative cortices, predominantly in the right hemisphere. These results also confirm that wine experts work simultaneously on sensory quality assessment and on label recognition of wine.

Alcohol percutaneous neurolysis of the sphenopalatine ganglion in the management of refractory cranio-facial pain.

INTRODUCTION: The sphenopalatine ganglion (SPN) has been proven to be involved in various types of facial pain syndromes. Management of these cranio-facial pain syndromes can be challenging, and existing specific treatments are sometimes inefficient and may fail. The purpose of this study is to describe and evaluate alcohol SPN in the management of cranio-facial pain. METHODS: Forty-two patients suffering from refractory facial pain who underwent 58 consecutive SPN were included in this study between 2000 and 2013. Patients were divided into three groups: group "cluster headache" (CH), group "persistent idiopathic facial pain" (PFIP), and group "Other". Pain was assessed using Visual Analogue Scale scores (measured immediately before and after procedure and at regular intervals following the procedure). Alcohol SPN was considered to be effective when pain relief was equal to or greater than 50 % and lasting for at least 1 month. All procedures were realized ambulatory under CT guidance and consisted of an injection of 1 ml of absolute alcohol. RESULTS: Overall efficacy rate of alcohol SPN was 67.2 %, with mean pain relief duration of 10.3 months. Procedure was graded either not painful or tolerable by patients in 64.2 %. Analysis showed a higher efficacy rate in the groups CH (76.5 %) and PFIP (85.7 %) compared to the group Other (40 %). No difference was found between groups regarding the recurrence rate. CONCLUSION: Alcohol SPN under CT guidance appears as a safe and effective treatment of refractory facial pain, especially in cases of cluster headache and persistent idiopathic facial pain.

Effects of an ambient odor on brain activations during episodic retrieval of objects.

This study investigated the brain areas involved in episodic memory retrieval of pictures depending on the characteristics of the contextual environment during encoding (i.e. presence or absence of an odor). In the first stage, subjects were presented with a series of 32 pictures. Half of the pictures were presented while the subjects smelled an odor (vanillin). No particular odor was associated with the presentation of the other half of the pictures. Two weeks later, a retrieval task was performed in which the same pictures were presented during an fMRI session but without any odor association involved. The results show that both conditions activate a common episodic memory network including the hippocampal formation. Compared with the "encoding without odor" condition, the "encoding with odor" condition shows greater activations in temporal, parietal and frontal cortices, notably within the area of the orbitofrontal cortex which constitutes a main site of the secondary olfactory cortex. No activated areas were observed in the inverse contrast. These results highlight the complexity of the networks involved in episodic memory according to the context during encoding.

Clinical safety of cardiac magnetic resonance imaging at 3 T early after stent placement for acute myocardial infarction.

The purpose of this study was to prospectively evaluate the safety of cardiac magnetic resonance (CMR) imaging at 3 T performed early (less than 14 days) after bare metal or drug-eluting coronary stent implantation in patients with acute myocardial infarction (AMI). Seventy-two consecutive patients with AMI treated by percutaneous revascularisation with a stent underwent CMR examination with a median delay of 6 days. Patients were followed-up for major adverse cardiac events, during hospitalisation and at 6 months. After CMR imaging, no acute stent thrombosis, death or repeated AMI were recorded at 6-month follow-up. Two symptomatic in-stent restenoses and two silent in-stent restenoses were recorded, at a mean delay of 106 days. In our population, we found a target revascularisation rate of 5.6%. This is consistent with the 6-month event rates after coronary artery stent (CAS) placement for AMI, evaluated by several studies. This preliminary clinical study supports the safety of 3-T CMR imaging performed early after coronary stent placement.

Patterns of cerebral activation during olfactory and trigeminal stimulations.

It is well known that most odorants stimulate both the olfactory system and the trigeminal system. However, the overlap between the brain processes involved in each of these sensorial perceptions is still poorly documented. This study aims to compare fMRI brain activations while smelling two odorants of a similar perceived intensity and pleasantness: phenyl ethyl alcohol (a pure olfactory stimulus) and iso-amyl-acetate (a bimodal olfactory-trigeminal stimulus) in a homogeneous sample of 15 healthy, right-handed female subjects. The analysis deals with the contrasts of brain activation patterns between these two odorant conditions. The results showed a significant recruitment of the right insular cortex, and bilaterally in the cingulate in response to the trigeminal component. These findings are discussed in relation to the characteristics of these odorants compared with those tested in previous studies.

Using a contrast-enhanced imaging sequence at 3-minute delay in 3-T magnetic resonance imaging for acute infarct evaluation.

OBJECTIVES: To investigate the performance of a delayed-enhancement (DE) sequence adapted for a 3-minute delay after bolus injection of a contrast media in cardiac magnetic resonance imaging (MRI) in acute reperfused myocardial infarction. MATERIALS AND METHODS: Sixty-three patients with recent myocardial infarction underwent contrast-enhanced MRI. Sequences of first-pass (FP) perfusion imaging and DE imaging at 3 and 15 minutes were performed at the acute phase. Of these patients, 49 had a follow-up cardiac magnetic resonance examination. Infarct sizes were quantified by 2 experienced users with a 17-segment model at the acute phase (at FP and at 3- and 15-minute delay) and at the chronic phase (at 15 minutes because only fibrous areas hyperenhance late). Areas of hypoenhancement and hyperenhancement were also calculated. Results from the 3-minute imaging sequence at the acute phase were compared with the FP (taking into account dark signal areas), with the 15-minute DE imaging sequence results at the acute phase [taking into account dark signal and hyperenhanced (white plus dark signal) areas] and with the 15-minute DE imaging sequence from the chronic phase (taking into account hyperenhanced areas). Least squares regression and Bland-Altman plots were performed for the comparisons. RESULTS: For the evaluation of hyperenhancement, the comparison between imaging sequence results at 3 minutes versus 15-minute DE at the acute phase (respectively, at the chronic phase) shows a good correlation (r(2) = 0.941; respectively r(2) = 0.862, at the chronic phase) and the Bland-Altman plot indicates a good concordance (m =-0.43; SD = 2.69; respectively m = 2.76; SD = 3.92); For the evaluation of hypoenhancement, the comparison between imaging sequence results at 3 minutes versus FP (respectively, 15 minutes at the acute phase) also shows a good correlation (r(2) = 0.751; respectively r(2) = 0.71) and the Bland-Altman plot indicates a good concordance (m = -1.06; SD = 3.34; respectively m = 2.90; SD = 3.11). Finally, the interobserver study provides a very good kappa coefficient (kappa = 0.82), and good kappa coefficients from the intraobserver study (kappa1 = 0.78 and kappa2 = 0.86). CONCLUSIONS: The use of a delayed contrast-enhanced sequence adapted for a 3-minute delay after the bolus injection has the potential to obtain quickly reliable information comparable with the perfusion delay at FP and reliable information from the infarct size at 15 minutes and at the chronic phase.

Automatic fuzzy classification of the washout curves from magnetic resonance first-pass perfusion imaging after myocardial infarction.

OBJECTIVES: We sought to investigate the diagnostic ability of cardiac magnetic resonance imaging (MRI) perfusion in acute reperfused myocardial infarction. The study used fuzzy logic to automatically classify signal intensity-time curves from myocardial segments into 3 categories: normal, hypointense, and Hyperintense. MATERIALS AND METHODS: Thirty-eight patients with myocardial infarction underwent short-axis cine-MRI and contrast-enhanced MRI to provide data on wall thickening and the transmural extent of infarction. Of these, 17 had a second cardiac MRI to ascertain the functional recovery in each segment. RESULTS: The fuzzy logic based classification performs well (kappa= 0.87, P < 0.01) in comparison with a visual approach. Segments providing "hypo" curves do not recover (Delta = 0.11 SD = 0.96) whereas segments demonstrating the other curve types recover (Delta = 1 SD = 1.98 for "hyper" curves and Delta = 1.54 SD = 1.77 for "normal" curves). CONCLUSIONS: The proposed automatic signal intensity-time curve classification has a prognostic value when studying the functional recovery of pathologic segments and clearly identifies the no-reflow phenomenon known to induce poor recovery.

Visual estimation of the global myocardial extent of hyperenhancement on delayed contrast-enhanced MRI.

MRI with paramagnetic contrast agent allows the assessment of the extent of myocardial tissue injury after infarction. Visual segmental scoring has been widely used to define the transmural extent of myocardial infarction, but no attempt has been made to use visual scores in order to assess the percentage of the whole myocardium infarcted. By summing all the segmental scores using a 17-segment model, a global index of the size of the infarcted myocardium is easily obtained. The entire left ventricle of 60 patients with a recent myocardial infarction was scanned using an ECG-gated gradient echo sequence after injection of gadolinium contrast agent. The global score was defined as the sum of the scores on each segment, and expressed as a percentage of the maximum possible score. This index was compared with a planimetric evaluation of hyperenhancement, expressed as a percentage of the left ventricle myocardial volume. There is a good correlation between the two methods (r=0.91; y=1.06x+0.20), and the Bland-Altman plot shows a high concordance between the two approaches (mean of the differences =1.45%). A visual approach based on a 17-segment model can be used to evaluate the global myocardial extent of the hyperenhancement with similar results to planimetry.

The extent of myocardial damage assessed by contrast-enhanced MRI is a major determinant of N-BNP concentration after myocardial infarction.

AIMS: To evaluate the relationship between N-terminal Pro-Brain Natriuretic Peptide (N-BNP) level and contrast-enhanced MRI in patients after acute myocardial infarction (MI). METHODS: Eighty-two patients were studied. Venous blood samples were obtained 3 days after MI and MRI was performed from 2 to 7 days after MI, with determination of left ventricular function and acquisition of perfusion data after injection of gadolinium-DTPA. First-pass images (FPI) and Delayed contrast-enhanced (CE) images were analyzed using a 17-segment model, and the extent of transmurality was determined by a visual score. RESULTS: Univariate analysis showed that age (P<0.001), sex (P<0.02), Left Ventricular Ejection Fraction (LVEF) <45% (P<0.002), creatinine (P<0.05) and delayed CE-MR images (P<0.006) were predictors of a supramedian N-BNP level. FPI was not a predictor in this univariate analysis (P<0.078). In a multivariate model, only age, LVEF <45% and delayed CE-MRI were associated with an increased N-BNP level. CONCLUSION: After MI, high N-BNP levels are dependent on the LVEF but also on the myocardial infarct size derived from the delayed CE-MR images.