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Early and delayed myocardial enhancement in myocardial infarction using two-phase contrast-enhanced multidetector-row CT.

Ko SM, Kim YW, Han SW, Seo JB - Korean J Radiol (2007 Mar-Apr)

Bottom Line: The presence, location, and patterns of myocardial enhancement on two-phase MDCT images were compared with infarcted myocardial territories determined by using electrocardiogram, echocardiography, thallium-201 single photon emission computed tomography, catheter and MDCT coronary angiography.Early perfusion defects were observed in 30 territories of all 23 patients.Fourteen of perfusion defects were in the left anterior descending artery territory, four in the left circumflex artery territory, and nine in the right coronary artery territory.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University of Keimyung College of Medicine, Dongsan Medical Center, Daegu, Korea. ksm9723@yahoo.co.kr

ABSTRACT

Objective: The purpose of this study was to describe the myocardial enhancement patterns in patients with myocardial infarction using two-phase contrast-enhanced multidetector-row computed tomography (MDCT).

Materials and methods: Twenty-three patients with clinically proven myocardial infarction (17 acute myocardial infarction [AMI] and 6 chronic myocardial infarction [CMI]) were examined with two-phase contrast-enhanced ECG-gated MDCT. The presence, location, and patterns of myocardial enhancement on two-phase MDCT images were compared with infarcted myocardial territories determined by using electrocardiogram, echocardiography, thallium-201 single photon emission computed tomography, catheter and MDCT coronary angiography.

Results: After clinical assessment, the presence of myocardial infarctions were found in 27 territories (19 AMI and 8 CMI) of 23 patients. Early perfusion defects were observed in 30 territories of all 23 patients. Three territories not corresponding to a myocardial infarction were detected in three patients with AMI and were associated with artifacts. Fourteen of perfusion defects were in the left anterior descending artery territory, four in the left circumflex artery territory, and nine in the right coronary artery territory. Delayed enhancement was observed in 25 territories (17 AMI and 8 CMI) of 21 patients. Delayed enhancement patterns were variable. Transmural early perfusion defects (n =12) were closely associated with transmural late enhancement (n = 5) and subendocardial residual defect with subepicardial late enhancement (n = 5).

Conclusion: Myocardial infarction showed early perfusion defects and variable delayed enhancement patterns on two-phase contrast-enhanced MDCT. Delayed enhancement technique of MDCT could provide additional information of the location and extent of infarcted myocardium, and could be useful to plan appropriate therapeutic strategies in patients with AMI.

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Images obtained in a 73-year-old man with reperfused acute myocardial infarction.A. The short-axis multiplanar reformation image obtained with early-phase multidetector CT shows an early perfusion defect involving the whole thickness of the mid-anterolateral myocardium (arrow), which corresponds to significant stenosis of the left circumflex coronary artery.B. The short-axis multiplanar reformation image obtained with late-phase multidetector CT shows transmural late enhancement in the same area (arrow). Note the total absence of residual perfusion defect within the hyperenhanced area.C. Right oblique caudal projection of the left coronary angiogram shows total occlusion with bridge collateral flow at the proximal segment of the left circumflex coronary artery (arrow).
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Figure 2: Images obtained in a 73-year-old man with reperfused acute myocardial infarction.A. The short-axis multiplanar reformation image obtained with early-phase multidetector CT shows an early perfusion defect involving the whole thickness of the mid-anterolateral myocardium (arrow), which corresponds to significant stenosis of the left circumflex coronary artery.B. The short-axis multiplanar reformation image obtained with late-phase multidetector CT shows transmural late enhancement in the same area (arrow). Note the total absence of residual perfusion defect within the hyperenhanced area.C. Right oblique caudal projection of the left coronary angiogram shows total occlusion with bridge collateral flow at the proximal segment of the left circumflex coronary artery (arrow).

Mentions: By clinical assessment, a total of 27 infarct territories (19 AMI and 8 CMI) were identified in 23 patients. In the 19 patients who underwent catheter angiography, 21 infarcted myocardial territories were clinically identified and 17 infarct-related arteries were detected. Ten of these infarct-related arteries were in the left anterior descending coronary artery (LAD), two in the left circumflex coronary artery (LCX) and five in the right coronary artery (RCA). Two patients with AMI had double anterior and inferior MIs in which the infarct-related arteries were assigned to the LAD because each RCA was totally occluded along with the presence of collaterals from the LAD. Two infarcted territories (1 LAD and 1 LCX) that were not associated with significant coronary stenoses were noted in two patients with reperfused AMI. All 23 patients showed 30 hypoenhanced territories of the left ventricle myocardium on the early-phase MDCT scan. Twenty-seven of 30 territories corresponded to clinically assessed MI territories (Table 1). In three (1 LAD and 2 LCX) of 30 territories, the areas of decreased myocardial attenuation were not corresponded to infarcted myocardial territories and this discrepancy was caused by artifacts that were seen as transverse dark bands crossing the left ventricle on the short-axis images. Early perfusion defects were noted in the 19 territories of 17 patients with AMI (Figs. 2A, 3A, 4A) and 8 territories of six patients with CMI (Fig. 1A). The attenuation of the early perfusion defects (40.3 HU± 13.2) was significantly lower than that of the noninfarcted areas (120.3 HU±12.8, p < 0.001). Among the 27 territories of the early perfusion defects, 15 were located in the subendocardium (Figs. 1A, 4A) and 12 were located in the transmural myocardium (Figs. 2A, 3A) (Table 2). A total of 25 of the 27 (93%) territories with early perfusion defects were consistent with the territories of significant coronary stenoses, as observed on the catheter or MDCT coronary angiography.


Early and delayed myocardial enhancement in myocardial infarction using two-phase contrast-enhanced multidetector-row CT.

Ko SM, Kim YW, Han SW, Seo JB - Korean J Radiol (2007 Mar-Apr)

Images obtained in a 73-year-old man with reperfused acute myocardial infarction.A. The short-axis multiplanar reformation image obtained with early-phase multidetector CT shows an early perfusion defect involving the whole thickness of the mid-anterolateral myocardium (arrow), which corresponds to significant stenosis of the left circumflex coronary artery.B. The short-axis multiplanar reformation image obtained with late-phase multidetector CT shows transmural late enhancement in the same area (arrow). Note the total absence of residual perfusion defect within the hyperenhanced area.C. Right oblique caudal projection of the left coronary angiogram shows total occlusion with bridge collateral flow at the proximal segment of the left circumflex coronary artery (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2626780&req=5

Figure 2: Images obtained in a 73-year-old man with reperfused acute myocardial infarction.A. The short-axis multiplanar reformation image obtained with early-phase multidetector CT shows an early perfusion defect involving the whole thickness of the mid-anterolateral myocardium (arrow), which corresponds to significant stenosis of the left circumflex coronary artery.B. The short-axis multiplanar reformation image obtained with late-phase multidetector CT shows transmural late enhancement in the same area (arrow). Note the total absence of residual perfusion defect within the hyperenhanced area.C. Right oblique caudal projection of the left coronary angiogram shows total occlusion with bridge collateral flow at the proximal segment of the left circumflex coronary artery (arrow).
Mentions: By clinical assessment, a total of 27 infarct territories (19 AMI and 8 CMI) were identified in 23 patients. In the 19 patients who underwent catheter angiography, 21 infarcted myocardial territories were clinically identified and 17 infarct-related arteries were detected. Ten of these infarct-related arteries were in the left anterior descending coronary artery (LAD), two in the left circumflex coronary artery (LCX) and five in the right coronary artery (RCA). Two patients with AMI had double anterior and inferior MIs in which the infarct-related arteries were assigned to the LAD because each RCA was totally occluded along with the presence of collaterals from the LAD. Two infarcted territories (1 LAD and 1 LCX) that were not associated with significant coronary stenoses were noted in two patients with reperfused AMI. All 23 patients showed 30 hypoenhanced territories of the left ventricle myocardium on the early-phase MDCT scan. Twenty-seven of 30 territories corresponded to clinically assessed MI territories (Table 1). In three (1 LAD and 2 LCX) of 30 territories, the areas of decreased myocardial attenuation were not corresponded to infarcted myocardial territories and this discrepancy was caused by artifacts that were seen as transverse dark bands crossing the left ventricle on the short-axis images. Early perfusion defects were noted in the 19 territories of 17 patients with AMI (Figs. 2A, 3A, 4A) and 8 territories of six patients with CMI (Fig. 1A). The attenuation of the early perfusion defects (40.3 HU± 13.2) was significantly lower than that of the noninfarcted areas (120.3 HU±12.8, p < 0.001). Among the 27 territories of the early perfusion defects, 15 were located in the subendocardium (Figs. 1A, 4A) and 12 were located in the transmural myocardium (Figs. 2A, 3A) (Table 2). A total of 25 of the 27 (93%) territories with early perfusion defects were consistent with the territories of significant coronary stenoses, as observed on the catheter or MDCT coronary angiography.

Bottom Line: The presence, location, and patterns of myocardial enhancement on two-phase MDCT images were compared with infarcted myocardial territories determined by using electrocardiogram, echocardiography, thallium-201 single photon emission computed tomography, catheter and MDCT coronary angiography.Early perfusion defects were observed in 30 territories of all 23 patients.Fourteen of perfusion defects were in the left anterior descending artery territory, four in the left circumflex artery territory, and nine in the right coronary artery territory.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University of Keimyung College of Medicine, Dongsan Medical Center, Daegu, Korea. ksm9723@yahoo.co.kr

ABSTRACT

Objective: The purpose of this study was to describe the myocardial enhancement patterns in patients with myocardial infarction using two-phase contrast-enhanced multidetector-row computed tomography (MDCT).

Materials and methods: Twenty-three patients with clinically proven myocardial infarction (17 acute myocardial infarction [AMI] and 6 chronic myocardial infarction [CMI]) were examined with two-phase contrast-enhanced ECG-gated MDCT. The presence, location, and patterns of myocardial enhancement on two-phase MDCT images were compared with infarcted myocardial territories determined by using electrocardiogram, echocardiography, thallium-201 single photon emission computed tomography, catheter and MDCT coronary angiography.

Results: After clinical assessment, the presence of myocardial infarctions were found in 27 territories (19 AMI and 8 CMI) of 23 patients. Early perfusion defects were observed in 30 territories of all 23 patients. Three territories not corresponding to a myocardial infarction were detected in three patients with AMI and were associated with artifacts. Fourteen of perfusion defects were in the left anterior descending artery territory, four in the left circumflex artery territory, and nine in the right coronary artery territory. Delayed enhancement was observed in 25 territories (17 AMI and 8 CMI) of 21 patients. Delayed enhancement patterns were variable. Transmural early perfusion defects (n =12) were closely associated with transmural late enhancement (n = 5) and subendocardial residual defect with subepicardial late enhancement (n = 5).

Conclusion: Myocardial infarction showed early perfusion defects and variable delayed enhancement patterns on two-phase contrast-enhanced MDCT. Delayed enhancement technique of MDCT could provide additional information of the location and extent of infarcted myocardium, and could be useful to plan appropriate therapeutic strategies in patients with AMI.

Show MeSH
Related in: MedlinePlus