Demonstration of Acute Myocardial Infarction by Subsecond Spiral Computed Tomography
Early Defect and Delayed Enhancement
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, aVL, 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⇓).
Case 2. A 49-year-old man presented with chest pain. He was diagnosed as having inferior AMI from his symptoms and the ECG (elevated ST-T in leads II, III, aVF, and V6). CAG demonstrated 99% stenosis of the right coronary artery (segment 4PD). Two days after successful direct PTCA, contrast-enhancement spiral CT was performed (Figure 3a⇓). Three days after the PTCA, dual SPECT with 99mTc-pyrophosphate (hot scan) and 201Tl was performed (Figure 3b⇓).
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
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