The Usefulness of X-Ray Computed Tomography for the Diagnosis of Myocardial Infarction

Masuda, Yoshiaki; Yoshida, Hideo; Morooka, Nobuhiro; Watanabe, Shotaro; Inagaki, Yoshiaki

doi:10.1097/00004728-198505000-00089

Cited by 9 publications

(13 citation statements)

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“…Contrast-enhanced electron beam computed tomography (EBT) is reported to be useful for both the detection of ischemic myocardium and the quantitative evaluation of myocardial characteristics in a variety of heart diseases. [1][2][3][4] The degree of myocardial ischemia and fibrosis is important information for the evaluation of subendocardial ischemia. In the present study we used contrast-enhanced EBT, with and without dipyridamole (Dp) loading, to quantitatively examine the myocardial perfusion and tissue characteristics of the left ventricular (LV) myocardium.…”

mentioning

confidence: 99%

Evaluation by Contrast-Enhanced Electron Beam Computed Tomography of Myocardial Perfusion and Tissue Characteristics in Congenital Aortic Stenosis

Sugiyama

Naito

Tsukano³

et al. 2003

Circ J

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mentioning

confidence: 99%

Evaluation by Contrast-Enhanced Electron Beam Computed Tomography of Myocardial Perfusion and Tissue Characteristics in Congenital Aortic Stenosis

Sugiyama

Naito

Tsukano³

et al. 2003

Circ J

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“…The apparently normal wall thickness of the infarcted segments found in all patients (n=9) with a recent event can be interpreted as another indirect CT sign of myocardial edema and might be a useful criterion to differentiate recent (<1 month) from non-recent (>1 month ) MI, since myocardial wall thickness constantly decreases over time in patients with MI [25,26]. Myocardial edema gradually resolves, being constantly replaced by progressive wall thinning of the LV due to healing of the infarcted region and to left ventricular remodeling [24,27].…”

Section: Discussionmentioning

confidence: 99%

“…First of all, no delayed acquisitions were available for images analysis and therefore the phenomenon of myocardial delayed enhancement previously described by Musuda et al [22,26] could not be assessed. However, the clinical utility of CT delayed-enhancement images has not been fully determined, and it still remains controversial whether an additional radiation exposure provides clinical advantages.…”

Section: Study Limitationsmentioning

confidence: 99%

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

et al. 2005

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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.

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“…Masuda et al demonstrated an initial filling defect and late enhancement of the infarcted myocardium on the CT image after intravenous bolus injection of the contrast material. 22 They speculated regarding the mechanism of late enhancement that microvascular damage at the infarcted area might allow leakage of the contrast to the extravascular space, and the damaged cell membrane might allow the entry of contrast medium into the cells. However, Naito et al demonstrated that some patients with hypertrophic cardiomyopathy also showed a patchy late enhancement distribution and speculated that entrapment of the contrast medium in the interstitial space and delayed washout must play a role in late enhancement.…”

Section: Discussionmentioning

confidence: 99%

Plain Computed Tomography for Assessment of Early Coronary Microcirculatory Damage After Revascularization Therapy in Acute Myocardial Infarction

Kato

Dote

Sasaki

et al. 2006

Circ J

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yocardial salvage after reperfusion may be limited by deleterious changes in the microcirculation of the previously ischemic tissue, 1 which can result in a progressive decrease of capillary blood flow to potentially viable myocytes (no-reflow phenomenon) in acute myocardial infarction (MI). 2 Previous studies using an intracoronary Doppler guidewire demonstrated that the coronary flow velocity pattern measured immediately after successful revascularization is predictive of the recovery of regional and global left ventricular function in patients with acute MI. 3,4 Furthermore, myocardial contrast echocardiography can independently detect microcirculatory damage and myocardial viability early after acute MI. [5][6][7] Recently, computed tomography (CT) has been used to evaluate the myocardial perfusion in stable angina or acute coronary syndrome. 8,9 A previous experimental study in a canine model demonstrated that both progression of the contrast defect area in myocardial contrast echocardiography with a gradual thickening of the wall and an enhancement of myocardial area detected by CT just after reperfusion are charCirculation Journal Vol. 70, November 2006 acteristic of hemorrhagic infarction. 10,11 The aim of the present study was to clarify the relationship between the microcirculatory impairment and prolonged enhancement of reperfused myocardium after successful revascularization in acute MI. Methods Patient Population and Study DesignThirteen consecutive patients (11 men, 2 women), aged from 45 to 79 years (mean age: 67±12 years), who suffered their first acute anterior MI were enrolled in the study. The diagnosis of acute MI was made on the basis of chest pain lasting for over 30 min, ST elevation of at least 2 mm in 2 adjacent leads on the electrocardiogram, and an increase of serum creatine kinase (CK) to more than twice the normal upper limit. Each patient had complete occlusion or severe stenotic lesion of the proximal or middle segment of the left anterior descending artery (LAD) on emergency coronary angiography, and underwent successful percutaneous coronary intervention (PCI) within 6 h after the onset of symptoms. The coronary blood flow velocity pattern and coronary flow velocity reserve in the LAD were measured immediately after PCI using a Doppler guidewire in 13 patients. All patients underwent chest CT immediately after successful revascularization. The left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume (LVEDV) Background Coronary microcirculatory damage is an important factor for the prognosis for acute myocardial infarction (MI) after revascularization. The myocardial enhancement area with contrast media infused during coronary revascularization therapy, detected by computed tomography (CT) just after revascularization, has been reported to correspond to the area of hemorrhagic infarction. The relationship between myocardial contrast enhancement and coronary microcirculatory damage was investigated in the present study. Methods and ResultsThirteen pati...

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The Usefulness of X-Ray Computed Tomography for the Diagnosis of Myocardial Infarction

Cited by 9 publications

References 0 publications

Evaluation by Contrast-Enhanced Electron Beam Computed Tomography of Myocardial Perfusion and Tissue Characteristics in Congenital Aortic Stenosis

Evaluation by Contrast-Enhanced Electron Beam Computed Tomography of Myocardial Perfusion and Tissue Characteristics in Congenital Aortic Stenosis

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

Plain Computed Tomography for Assessment of Early Coronary Microcirculatory Damage After Revascularization Therapy in Acute Myocardial Infarction

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