Published online before print February 6, 2006, doi: 10.1161/CIRCULATIONAHA.104.529511
(Circulation. 2006;113:823-833.)
© 2006 American Heart Association, Inc.
Imaging |
Characterization of Acute and Chronic Myocardial Infarcts by Multidetector Computed Tomography
Comparison With Contrast-Enhanced Magnetic Resonance
From the Division of Cardiology (B.L.G., B.B., G.J.L., P.L., A.P., G.G., J.-L.J.V.), Laboratory of Experimental Surgery (A.P.), and Division of Radiology (E.C.), Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium.
Correspondence to Bernhard L. Gerber, MD, PhD, Department of Cardiology, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, B-1200 Woluwe St. Lambert, Belgium. E-mail Bernhard.gerber{at}clin.ucl.ac.be
Received December 24, 2004; revision received December 8, 2005; accepted December 9, 2005.
Background— We evaluated whether contrast-enhanced multidetector computed tomography (CE-MDCT) might characterize myocardial infarct (MI) with patterns similar to those obtained by contrast-enhanced magnetic resonance (CE-MR) and studied the underlying mechanisms.
Methods and Results— In vivo infarct characterization by CE-MDCT was shown to be feasible between 4 and 20 minutes after contrast injection in 7 pigs with MI. Subsequently, in 16 patients with acute MI and 21 patients with chronic MI, contrast patterns by CE-MDCT were related to CE-MR. Eighteen patients had hypoenhanced regions on early CE-MDCT images at the time of coronary imaging, and 34 patients had hyperenhanced regions on images acquired 10 minutes later. On a segmental basis, there was moderately good concordance of early hypoenhanced regions (92%, 
=0.54, P<0.001) and late hyperenhanced regions (82%, =0.61, P<0.001) between CE-MDCT and CE-MR. Absolute sizes of early hypoenhanced (6±16 versus 7±16 g, P=0.25) and late hyperenhanced (36±34 versus 31±40 g, P=0.14) regions were similar on CE-MDCT and CE-MR and were highly correlated (r=0.93, P<0.001 and r=0.89, P<0.001 respectively). In 8 retrogradely perfused infarcted rabbit hearts, contrast kinetics of iomeprol were similar to gadodiamide, ie, slow wash in (8.7±6.7 versus 1.2±0.3 minutes, P<0.001) in infarct core and slow washout (20±12 versus 2.5±0.5 minutes, P<0.001) in both infarct core and rim compared with the remote region.
Conclusions— Because iodated contrast agents have similar kinetics in infarcted and noninfarcted myocardium as gadolinium DPTA, CE-MDCT can characterize acute and chronic MI with contrast patterns similar to CE-MR. CE-MDCT may thus provide important information on infarct size and viability at the time of noninvasive coronary imaging.
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