J Korean Med Assoc.  2007 Feb;50(2):143-150. 10.5124/jkma.2007.50.2.143.

Myocardial Contractility, Perfusion, and Viability Analysis Using Multidetector CT in Patients with Ischemic Heart Disease

• Ko SM

• KMID: 2137787
• DOI: http://doi.org/10.5124/jkma.2007.50.2.143

Abstract

The imaging technique that can provide detailed information on the left ventricular function, myocardial perfusion and viability at the same time will not only be helpful for the prognostic assessment of patients with ischemic heart disease but also be valuable in choosing appropriate therapeutic strategies. In recent years, multidetector CT (MDCT) has been proposed as a useful non-invasive imaging method of evaluating both coronary artery stenoses and cardiac morphology at the same time. MDCT has proved to be in excellent agreement with echocardiography and magnetic resonance imaging in the assessment of the left ventricular function. In addition, MDCT can provide information on myocardial viability, which can be assessed from the left ventricular wall thickness, myocardial perfusion, and a delayed contrast enhancement pattern. Despite several shortcomings to be the first-line modality for the assessment of ischemic heart disease, MDCT can provide valuable additional dynamic information in patients undergoing MDCT coronary angiography.

Keyword

Multidetector CT; Myocardial contractility; Myocardial perfusion; Myocardial viability

MeSH Terms

Coronary Angiography
Coronary Stenosis
Echocardiography
Humans
Magnetic Resonance Imaging
Myocardial Ischemia*
Perfusion*
Ventricular Function, Left

Figure

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  Figure 1 Screen-shot from Leonardo workstation(Siemens, Forchheim, Germany) displaying dedicated analysis software for MDCT left ventricular function.

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  Figure 2 Short axis reformats from retrospectively ECG-gated MDCT allow circulation of end-systolic (A) and end-diastolic (B) images for assessment of ventricular function.

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  Figure 3 Images obtained in a 63-year-old man with acute myocardial infarction. MR perfusion image (A) shows low signal area in the mid-inferior wall of left ventricle. Delayed enhanced MR image (B) shows subendocardial dark zone (arrow) surrounded by hyperenhancement (arrowhead) in the same area. Two-phase contrast enhanced MDCT shows early transmural perfusion defect (arrow) (C) and subendocardial residual perfusion defect (arrow) with subepicardial late enhancement (arrowhead) (D) in the mid inferior wall of left ventricle. This myocardial enhancement pattern correlates well with contrast-enhanced MR imaging

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  Figure 4 Images obtained in a 72-year-old man with reperfused acute myocardial infarction. Catheter coronary angiogram (A) shows multiple significant stenoses in the proximal and middle (arrows) right coronary artery and total occlusion at the distal segment (arrowhead) of the right coronary artery. Two-phase contrast enhanced MDCT shows early transmural perfusion defect (B) and subendocardial residual perfusion defect (arrow) with subepicardial late enhancement (arrowhead) (C) in the mid-inferior wall of left ventricle.

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