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(Circulation. 1999;99:2058-2059.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Demonstration of Acute Myocardial Infarction by Subsecond Spiral Computed Tomography

Early Defect and Delayed Enhancement

Teruhito Mochizuki, MD; Kenya Murase, PhD; Hiroshi Higashino, MD; Yasushi Koyama, MD; Shogo Azemoto, RT; Junpei Ikezoe, MD

From the Department of Radiology, Ehime University School of Medicine (T.M., K.M., J.I.); the Departments of Radiology (H.H.) and Cardiology (Y.K.) Ehime-Imabari Hospital; and GE-Yokogawa Medical Systems (S.A.), Japan.

Correspondence to Teruhito Mochizuki, MD, Department of Radiology, Ehime University School of Medicine, Shitsukawa, Shigenobu-cho, Onsen-gun, Ehime-ken 791-0204, Japan. E-mail tmochi@m.ehime-u.ac.jp

Case 1. An 85-year-old woman was hospitalized after 3 hours of chest pain and dyspnea. She was diagnosed as having anteroseptal acute myocardial infarction (AMI) from her symptoms and the ECG (elevated ST-T in leads I, aV_L, and V₁ through V₃). She had to wait for emergency coronary angiography (CAG), because another patient with AMI was occupying the catheter laboratory. During her standby status, contrast-enhancement spiral CT was performed (Figure 1a). Total occlusion of the left anterior descending coronary artery (segment 7) was observed by the CAG. Six days after successful direct PTCA, plain and Gd-enhancement T1-weighted MRI was performed (Figure 1b). Three days after the PTCA, dual SPECT with ^99mTc-pyrophosphate (hot scan) and ²⁰¹Tl was performed (Figure 1c). Seven days after the PTCA, serial dynamic spiral CT data were obtained at 50 seconds, 3 minutes, and 8 minutes at injection of the contrast material (1.2 mL/s, 100 mL total) (Figure 2).

View larger version (34K): [in this window] [in a new window]   Figure 1. Case 1. An 85-year-old woman with anteroseptal acute myocardial infarction. Contrast-enhancement spiral CT (CE-CT) started at 50 seconds of injection of contrast material (1.2 mL/s, 100 mL total) clearly demonstrates lower-density area (LDA) in anteroseptal wall, where neither wall motion nor systolic thickening was observed (a). With Gd-DTPA–enhanced T1-weighted imaging, abnormal enhancement of anteroseptal wall is evident that corresponds to LDA of CT (b). 99mTc-pyrophosphate (hot scan; PYP) depicts a hot lesion in anteroseptal wall, where deficient 201Tl accumulation was demonstrated with dual SPECT. Superimposed images of PYP (red) and . . . [Full Text of this Article]

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