Yonsei Med J.  2010 Sep;51(5):683-691. 10.3349/ymj.2010.51.5.683.

Evaluation of Reperfused Myocardial Infarction by Low-Dose Multidetector Computed Tomography Using Prospective Electrocardiography (ECG)-Triggering: Comparison with Magnetic Resonance Imaging

• Gweon HM
• Kim SJ
• Kim TH
• Lee SM
• Hong YJ
• Rim SJ
• Hong BK
• Min PK
• Yoon YW
• Kwon HM

• KMID: 1071419
• DOI: http://doi.org/10.3349/ymj.2010.51.5.683

Abstract

PURPOSE
To evaluate the potential of prospective electrocardiography (ECG)-gated 64-slice multidetector computed tomography (MDCT) for evaluation of myocardial enhancement, infarct size, and stent patency after percutaneous coronary intervention (PCI) with stenting in patients with myocardial infarction.
MATERIALS AND METHODS
Seventeen patients who were admitted with acute myocardial infarction were examined with prospective ECG-gated 64-slice cardiac MDCT and magnetic resonance (MR) imaging after reperfusion using PCI with stenting. Cardiac MDCT was performed with two different phases: arterial and delayed phases. We evaluated the stent patency on the arterial phase, and nonviable myocardium on the delayed phase of computed tomography (CT) image, and they were compared with the results from the delayed MR images.
RESULTS
Total mean radiation dose was 7.7 +/- 0.5 mSv on the two phases of CT images. All patients except one showed good patency of the stent at the culprit lesion on the arterial phase CT images. All patients had hyperenhanced area on the delayed phase CT images, which correlated well with those on the delayed phase MR images, with a mean difference of 1.6% (20 +/- 10% vs. 22 +/- 10%, r = 0.935, p = 0.10). Delayed MR images had a better contrast-to-noise ratio (CNR) than delayed CT images (27.1 +/- 17.8% vs. 4.3 +/- 2.1%, p < 0.001).
CONCLUSION
Prospective ECG-gated 64-slice MDCT provides the potential to evaluate myocardial viability on delayed phase as well as for stent patency on arterial phase with an acceptable radiation dose after PCI with stenting in patients with myocardial infarction.

Keyword

Prospective ECG-gated MDCT; magnetic resonance imaging; myocardial infarction; delayed enhancement imaging

MeSH Terms

Adult
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Electrocardiography/*methods
Female
Humans
Magnetic Resonance Imaging/*methods
Male
Middle Aged
Myocardial Infarction/*pathology/therapy
Myocardial Reperfusion
Prospective Studies
Tomography, X-Ray Computed/*methods

Figure

• 

  Fig. 1 Images obtained for a 50-year-old man with anterolateral myocardial infarction. (A) Total occlusion in the ramus intermedius (RI) (arrow) and 60% stenosis in the mid-LAD artery. (B and C) Patent stents at the culprit lesion of RI and the LAD artery on 3D-VRT (A) and curved MPR (C) CT images after PCI with stenting. (D-F) No definite area of hypoperfusion and some beam-hardening artifact in anterior and posterior wall of left ventricle on the arterial CT image (D), anterolateral hyperenhancement on delayed phase CT (E) (white arrows) and MR (F) images. LAD, left anterior descending artery; 3D-VRT, 3 dimensional volume rendering technique; MPR, multiplannar reformatted imaged; CT, computed tomography; PCI, percutaneous coronary intervention. LAD, left anterior descending artery; 3D-VRT, 3-dimensional volume rendering technique; MPR, multiplannar reformatted imaged; CT, computed tomography; PCI, percutaneous coronary intervention; MR, magnetic resonance.

• 

  Fig. 2 Images obtained for a 59-year-old man with anteroseptal myocardial infarction. (A) Total occlusion at ostium of the LAD artery (arrowhead). (B and C) A patent stent at the culprit lesion of LAD artery on 3D-VRT (B) and curved MPR (C) CT images after PCI with stenting. (D-I) Anteroseptal hypoperfusion on early arterial CT images (D-G) (arrows), anteroseptal hyperenhancement on delayed phase CT (E-H) (arrows) and MR (F-I) images. LAD, left anterior descending artery; 3D-VRT, 3-dimensional volume rendering technique; MPR, multiplannar reformatted imaged; CT, computed tomography; PCI, percutaneous coronary intervention; MR, magnetic resonance.

• 

  Fig. 3 Linear regression analysis and Bland-Altman plots for infarct size between early arterial and delayed phase MDCT images. (A) Areas of hypoperfusion and hyperenhancement for early arterial phase and delayed phase MDCT images (Y = 6.296 + 0.928X, r = 0.911, p < 0.001). (B) Bland-Altman plots showing the relationship between early arterial MDCT images and delayed enhanced MDCT images. Mean differences (y-axes) between each pair [(mean MDCTd) - (mean MDCTa)] are plotted against the average values (x-axes) of the same pair [{(mean MDCTd) + (mean MDCTa)}/2]. These results showed that area of hyperenhancement on the delayed phase MDCT images was 5.2% larger than that of hypoenhancement on the arterial phase MDCT images (p < 0.05). MDCTd (a) = multidetector computed tomography, arterial phase (delayed phase). MDCT, multidetector computed tomography.

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  Fig. 4 Linear regression analysis and Bland-Altman plots for infarct size between delayed phase MDCT images and delayed phase MR images. (A) Areas of hyperenhancement for delayed phase MDCT and MR images (Y = 3.209 + 0.919X, r = 0.935, p < 0.001). (B) Bland-Altman plots showing the relationships between delayed enhanced MDCT and MR images. Mean differences (y-axes) between each pair [(mean MRId) - (mean MDCTd)] are plotted against the average values (x-axes) of the same pair [{(mean MRId) + (mean MDCTd)}/2]. These results showed that the delayed phase MDCT infarct size was 1.6% larger than MRI (p = 0.10). MDCT, multidetector computed tomography.

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