Reperfused myocardial infarction: contrast-enhanced 64-Section CT in comparison to MR imaging.

PURPOSE To prospectively compare 64-section multidetector computed tomography (CT) and cardiac magnetic resonance (MR) imaging for the early assessment of myocardial enhancement and infarct size after acute reperfused myocardial infarction (MI). MATERIALS AND METHODS The study was HIPAA compliant and was approved by the institutional review board. All participants gave written informed consent. Twenty-one patients (18 men; mean age, 60 years +/- 13 [standard deviation]) were examined with 64-section multidetector CT and cardiac MR imaging 5 days or fewer after a first reperfused MI. Multidetector CT was performed during the first pass of contrast material to assess myocardial perfusion and detect microvascular obstruction (no reflow). In 15 patients, a second scan was performed 7 minutes later to assess total infarct size by using delayed hyperenhancement. Early hypoenhancement and delayed hyperenhancement were compared between multidetector CT and cardiac MR imaging with Pearson correlation coefficient and Bland-Altman analysis. RESULTS Early hypoenhancement was recognized on all multidetector CT and cardiac MR images. Delayed hyperenhancement was observed with cardiac MR imaging at all examinations and with multidetector CT at 11 of 15 examinations. While signal intensity differences between hypoperfused and normal myocardium were comparable for first-pass multidetector CT and cardiac MR imaging, cardiac MR imaging had a far better contrast-to-noise ratio (CNR) for delayed acquisitions than did CT (P < .001). Hypoenhanced areas (as a percentage of left ventricular mass) at first-pass multidetector CT (11% +/- 6) correlated well with those at first-pass cardiac MR imaging (7% +/- 4, R(2) = 0.72). Delayed-enhancement multidetector CT (13% +/- 9) correlated well with delayed-enhancement cardiac MR imaging (15% +/- 7, R(2) = 0.55). Quantification of delayed hypoenhancement (n = 12) had very good correlation between multidetector CT (4% +/- 4) and cardiac MR imaging (3% +/- 2) (R(2) = 0.85). CONCLUSION Early and late hypoenhancement showed good CNR and correlated well between multidetector CT and cardiac MR imaging.

[1]  M. Kawakami,et al.  Multi-detector computed tomography for imaging of subendocardial infarction: prediction of wall motion recovery after reperfused anterior myocardial infarction. , 2004, Circulation journal : official journal of the Japanese Circulation Society.

[2]  Bénédicte Belge,et al.  Characterization of Acute and Chronic Myocardial Infarcts by Multidetector Computed Tomography: Comparison With Contrast-Enhanced Magnetic Resonance , 2006, Circulation.

[3]  F. Van de Werf,et al.  Impaired myocardial tissue perfusion early after successful thrombolysis. Impact on myocardial flow, metabolism, and function at late follow-up. , 1995, Circulation.

[4]  O. Simonetti,et al.  Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. , 1999, Circulation.

[5]  R. Judd,et al.  Assessment of Myocardial Viability by Cardiovascular Magnetic Resonance Imaging , 2022 .

[6]  C. Kramer,et al.  Early contrast-enhanced MRI predicts late functional recovery after reperfused myocardial infarction. , 1999, Circulation.

[7]  R. Cury,et al.  Differentiation of recent and chronic myocardial infarction by cardiac computed tomography. , 2006, The American journal of cardiology.

[8]  D Hahn,et al.  Analysis of first-pass and delayed contrast-enhancement patterns of dysfunctional myocardium on MR imaging: use in the prediction of myocardial viability. , 2000, AJR. American journal of roentgenology.

[9]  C. Higgins,et al.  Evaluation of Myocardial Ischemic Damage of Various Ages by Computerized Transmission Tomography: Time-dependent Effects of Contrast Material , 1979, Circulation.

[10]  E. Atalar,et al.  Regional heterogeneity of human myocardial infarcts demonstrated by contrast-enhanced MRI. Potential mechanisms. , 1995, Circulation.

[11]  S. Hessel,et al.  In vivo evaluation of experimental myocardial infarcts by ungated computed tomography. , 1981, AJR. American journal of roentgenology.

[12]  R. Redington,et al.  Detection and Quantitation of Myocardial Infarction In Vivo Using Transmission Computed Tomography , 1981, Circulation.

[13]  A. Kitabatake,et al.  Lack of Myocardial Perfusion Immediately After Successful Thrombolysis: A Predictor of Poor Recovery of Left Ventricular Function in Anterior Myocardial Infarction , 1992, Circulation.

[14]  R. Kim,et al.  Transmural Extent of Acute Myocardial Infarction Predicts Long-Term Improvement in Contractile Function , 2001, Circulation.

[15]  K Stierstorfer,et al.  Performance evaluation of a 64-slice CT system with z-flying focal spot. , 2004, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[16]  Dudley J Pennell,et al.  Myocardial contrast echocardiography accurately reflects transmurality of myocardial necrosis and predicts contractile reserve after acute myocardial infarction. , 2005, American heart journal.

[17]  R. Kim,et al.  Myocardial Gd-DTPA kinetics determine MRI contrast enhancement and reflect the extent and severity of myocardial injury after acute reperfused infarction. , 1996, Circulation.

[18]  Elmar Spuentrup,et al.  Assessment of myocardial viability in reperfused acute myocardial infarction using 16-slice computed tomography in comparison to magnetic resonance imaging. , 2005, Journal of the American College of Cardiology.

[19]  Katherine C. Wu,et al.  Quantification and time course of microvascular obstruction by contrast-enhanced echocardiography and magnetic resonance imaging following acute myocardial infarction and reperfusion. , 1998, Journal of the American College of Cardiology.

[20]  C. Claussen,et al.  Late myocardial enhancement assessed by 64-MSCT in reperfused porcine myocardial infarction: diagnostic accuracy of low-dose CT protocols in comparison with magnetic resonance imaging , 2007, European Radiology.

[21]  Simon Wildermuth,et al.  Accuracy of MSCT coronary angiography with 64-slice technology: first experience. , 2005 .

[22]  Henry R. Halperin,et al.  Contrast-Enhanced Multidetector Computed Tomography Viability Imaging After Myocardial Infarction: Characterization of Myocyte Death, Microvascular Obstruction, and Chronic Scar , 2006, Circulation.

[23]  Philipp Bruners,et al.  Acute myocardial infarction: assessment of left ventricular function with 16-detector row spiral CT versus MR imaging--study in pigs. , 2005, Radiology.

[24]  Olga Bondarenko,et al.  Delayed contrast-enhanced magnetic resonance imaging for the prediction of regional functional improvement after acute myocardial infarction. , 2003, Journal of the American College of Cardiology.

[25]  W. Heindel,et al.  Multi-detector row CT of left ventricular function with dedicated analysis software versus MR imaging: initial experience. , 2004, Radiology.

[26]  E R McVeigh,et al.  Magnitude and time course of microvascular obstruction and tissue injury after acute myocardial infarction. , 1998, Circulation.

[27]  R W Parkey,et al.  Computed Tomography for Localization and Sizing of Experimental Acute Myocardial Infarcts , 1978, Circulation.

[28]  C. Higgins,et al.  Contrast‐enhanced MRI for quantification of myocardial viability , 1999, Journal of magnetic resonance imaging : JMRI.

[29]  G. Raff,et al.  Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. , 2005, Journal of the American College of Cardiology.

[30]  R. Judd,et al.  Physiological basis of myocardial contrast enhancement in fast magnetic resonance images of 2-day-old reperfused canine infarcts. , 1995, Circulation.

[31]  Katherine C. Wu,et al.  Microvascular obstruction and left ventricular remodeling early after acute myocardial infarction. , 2000, Circulation.

[32]  Yasuo Ohashi,et al.  Assessment of reperfused acute myocardial infarction with two-phase contrast-enhanced helical CT: prediction of left ventricular function and wall thickness. , 2005, Radiology.

[33]  R. Kim,et al.  Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study , 2003, The Lancet.

[34]  H. S. Mueller,et al.  The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. , 1985, The New England journal of medicine.

[35]  J. Boura,et al.  Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction : a quantitative review of 23 randomised trials , 2022 .

[36]  Samuel Chang,et al.  Usefulness of Multidetector-row CT in the Evaluation of Reperfused Myocardial Infarction in a Rabbit Model , 2004, Korean journal of radiology.