ECG-gated multi-detector row spiral CT in the assessment of myocardial infarction: correlation with non-invasive angiographic findings

Abstract

Our objective was to retrospectively evaluate the ability of multidetector-row computed tomography (MDCT) to detect previous myocardial infarctions (MIs) and to correlate necrosis with the status of coronary arteries supplying the infarcted territory. After having clinically evaluated 187 patients referred for ECG-gated MDCT of the coronary arteries, 30 previous MIs were identified in 29 patients (9 recent and 21 chronic). MDCT data were evaluated qualitatively and quantitatively by measuring attenuation values and wall thickness within the infarcted region and normal adjacent myocardium. Each MI was also assigned to the distribution territory of a coronary vessel, and morphological data were combined with MDCT angiographic findings. MDCT was able to detect 25/30 MIs showing an overall sensitivity and specificity of 83 and 91%, respectively. Quantitative analysis revealed a statistically significant difference in attenuation values between normal and infarcted regions (38.9+/-14 HU vs. 104.0+/-16 HU). Regional wall thinning was observed in chronic MIs (4.1+/-2 mm vs. 10.5+/-3.8 mm), and not in patients with recent event (7.9+/-1.6 mm vs 9.1+/-4 mm). In 22/25 cases, MDCT angiographic findings showed the presence of suspicious critical lumen narrowing (n=3), previous coronary stenting (n=14) and surgical revascularization (n=5) in the infarct-related coronary. During a single examination, MDCT might provide comprehensive imaging of MI offering a combined morphological and angiographic assessment.

Dynamic multi-section CT imaging in acute myocardial infarction: preliminary animal experience

“…MR imaging is becoming an accepted alternative to nuclear medicine techniques [10]. While the use of electron beam computed tomography for the assessment of myocardial perfusion was shown about 20 years ago [13], cardiac MDCT only recently has proved its potential to depict myocardial infarction from hypo-enhanced myocardium [5,14,15]. So far, there are no data available on the use of cardiac MDCT for the dynamic assessment of firstpass myocardial perfusion.…”

“…Therefore, the particular innovation of the presented study is the introduction of dynamical multi-phase imaging in cardiac MDCT with myocardial contrast enhancement over time interpreted as myocardial perfusion. This approach adds valuable information on myocardial perfusion imaging when compared to the assessment of myocardial perfusion from single arterial phase imaging [14,15].…”

Facilitating coronary artery evaluation in MDCT using a 3D automatic vessel segmentation tool

“…Diameters between red and blue are represented by a rainbow-based transition from red to blue (middle image). Cone-shaped pointers are used for marking the detected calcifications (left image) [25][26][27][28][29][30][31][32][33]. For evaluation of the generated image dataset, various reformations such as MIP, MPR and VRT in addition to the axial images have been developed and their benefit evaluated [34][35][36].…”

ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography

“…A retrospective study of 202 patients (63Ϯ13 years) attempted to detect previous MI in patients referred for 64-channel coronary CTA. 130 Signif-icant differences were noted between attenuation values of infarcted versus normal myocardium (56Ϯ23 HU versus 124Ϯ19 HU, PϽ0.01). Thinning of myocardial walls was noted only in chronic MIs (PϽ0.01).…”