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Saleh M, Tan TC. Dual-phase computed tomography imaging in acute chest pain: emerging protocols and potential future implications. Eur Heart J Case Rep 2021; 5:ytab178. [PMID: 33987525 PMCID: PMC8107293 DOI: 10.1093/ehjcr/ytab178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/07/2021] [Accepted: 04/16/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Mahdi Saleh
- Department of Radiology, Liverpool Heart and Chest Hospital, Thomas Dr, Liverpool L14 3PE, UK
| | - Timothy C Tan
- School of Medicine, 30, Western Sydney University, Narellan Road & Gilchrist Drive, Campbelltown NSW 2560, Australia
- Department of Cardiology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road Westmead NSW 2145, Australia
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Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. Circ J 2021; 85:402-572. [PMID: 33597320 DOI: 10.1253/circj.cj-19-1131] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine Graduate School
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa Universtiy
| | | | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Nohara
- Division of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | | | | | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Kinen Hospital
| | - Eri Kato
- Department of Cardiovascular Medicine, Department of Clinical Laboratory, Kyoto University Hospital
| | | | - Masaaki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University
| | - Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School
| | | | | | | | - Akira Kurata
- Department of Radiology, Ehime University Graduate School
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital
| | - Akira Sato
- Department of Cardiology, University of Tsukuba
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Ryoichi Tanaka
- Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
| | | | | | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Hospital
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University
| | | | | | | | - Keiichiro Yoshinaga
- Department of Diagnostic and Therapeutic Nuclear Medicine, Molecular Imaging at the National Institute of Radiological Sciences
| | - Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Nenadic IZ, Urban MW, Pislaru C, Escobar D, Vasconcelos L, Greenleaf JF. In Vivo Open- and Closed-chest Measurements of Left-Ventricular Myocardial Viscoelasticity using Lamb wave Dispersion Ultrasound Vibrometry (LDUV): A Feasibility Study. Biomed Phys Eng Express 2018; 4. [PMID: 30455983 DOI: 10.1088/2057-1976/aabe41] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Diastolic dysfunction causes close to half of congestive heart failures and is associated with increased stiffness in left-ventricular myocardium. A clinical tool capable of measuring viscoelasticity of the myocardium could be beneficial in clinical settings. We used Lamb wave Dispersion Ultrasound Vibrometry (LDUV) for assessing the feasibility of making in vivo non-invasive measurements of myocardial elasticity and viscosity in pigs. In vivo open-chest measurements of myocardial elasticity and viscosity obtained using a Fourier space based analysis of Lamb wave dispersion are reported. The approach was used to perform ECG-gated transthoracic in vivo measurements of group velocity, elasticity and viscosity throughout a single heart cycle. Group velocity, elasticity and viscosity in the frequency range 50-500 Hz increased from diastole to systole, consistent with contraction and relaxation of the myocardium. Systolic group velocity, elasticity and viscosity were 5.0 m/s, 19.1 kPa, 6.8 Pa·s, respectively. In diastole, the measured group velocity, elasticity and viscosity were 1.5 m/s, 5.1 kPa and 3.2 Pa·s, respectively.
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Affiliation(s)
- Ivan Z Nenadic
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 1 Street SW, Rochester, MN, 55905, USA
| | - Matthew W Urban
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 1 Street SW, Rochester, MN, 55905, USA.,Department of Radiology, Mayo Clinic, 200 1 Street SW, Rochester, MN, 55905, USA
| | - Cristina Pislaru
- Division of Cardiovascular Diseases, Mayo Clinic, 200 1 Street SW, Rochester, MN, 55905, USA
| | - Daniel Escobar
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 1 Street SW, Rochester, MN, 55905, USA
| | - Luiz Vasconcelos
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 1 Street SW, Rochester, MN, 55905, USA
| | - James F Greenleaf
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 1 Street SW, Rochester, MN, 55905, USA
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Myocardial delayed-enhancement CT: initial experience in children and young adults. Pediatr Radiol 2017; 47:1452-1462. [PMID: 28534155 DOI: 10.1007/s00247-017-3889-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/01/2017] [Accepted: 05/04/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Clinical utility of myocardial delayed enhancement CT has not been reported in children and young adults. OBJECTIVE To describe initial experience of myocardial delayed enhancement CT regarding image quality, radiation dose and identification of myocardial lesions in children and young adults. MATERIALS AND METHODS Between August 2013 and November 2016, 29 consecutive children and young adults (median age 16 months) with suspected coronary artery or myocardial abnormality underwent arterial- and delayed-phase cardiac CT at our institution. We measured CT densities in normal myocardium, left ventricular cavity, and arterial and delayed hypo-enhancing and delayed hyperenhancing myocardial lesions. We then compared the extent of delayed hyperenhancing lesions with delayed-enhancement MRI or thallium single-photon emission CT. RESULTS Normal myocardium and left ventricular cavity showed significantly higher CT numbers on arterial-phase CT than on delayed-phase CT (t-test, P<0.0001). Contrast-to-noise ratios of the arterial and delayed hypo-enhancing and delayed hyperenhancing lesions on CT were 26.7, 17.6 and 18.7, respectively. Delayed-phase CT findings were equivalent to those of delayed-enhancement MRI in all cases (7/7) and to those of thallium single-photon emission CT in 70% (7/10). CONCLUSION Myocardial delayed-enhancement CT can be added to evaluate myocardial lesions in select children and young adults with suspected coronary artery or myocardial abnormality.
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Watanabe T, Furuse Y, Ohta Y, Kato M, Ogawa T, Yamamoto K. The Effectiveness of Non-ECG-Gated Contrast-Enhanced Computed Tomography for the Diagnosis of Non-ST Segment Elevation Acute Coronary Syndrome. Int Heart J 2016; 57:558-64. [PMID: 27593539 DOI: 10.1536/ihj.16-072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Non-ST segment elevation acute coronary syndrome (NSTE-ACS) can be difficult to diagnose accurately, especially in the hyper-acute phase. Non-ECG-gated contrast-enhanced computed tomography (non-ECG-gated CE-CT) has been used in many institutions for screening acute chest pain. Although early defects (EDs) observed in non-ECG-gated CE-CT have been reported as a sign of acute myocardial ischemia, the precise diagnostic value of this sign for acute coronary syndrome has not been fully elucidated. We investigated the usefulness of non-ECG-gated CE-CT for the diagnosis of NSTE-ACS. We retrospectively reviewed 556 patients who were hospitalized for acute-onset chest pain and who underwent emergent coronary angiography. Non-ECG-gated CE-CT was performed in 23 of these patients. Two readers independently analyzed CT images using a 5-point scale. Of the 23 patients, 13 were diagnosed with NSTE-ACS. The remaining 10 patients were diagnosed with other conditions. The sensitivity, specificity, positive predictive value, and negative predictive value, respectively, of EDs on non-ECG-gated CE-CT to detect NSTE-ACS were 84.6%, 90%, 91.7%, and 81.8%. The identification of EDs was consistent between the two readers. Non-ECG-gated CE-CT may be useful not only to triage patients with chest pain by ruling out other conditions, but also to accurately diagnose NSTE-ACS.
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Affiliation(s)
- Tomomi Watanabe
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University
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Udholm S, Laugesen S, Agger P, Hønge J, Smerup M, Udholm N, Bøtker HE, Bøttcher M. Delayed uptake and washout of contrast in non-viable infarcted myocardium shown with dynamic computed tomography. Cardiovasc Diagn Ther 2014; 4:350-6. [PMID: 25414821 DOI: 10.3978/j.issn.2223-3652.2014.09.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/12/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Assessment of ischemic but potentially viable myocardium plays an important role in the planning of coronary revascularization. Until now SPECT, PET, and MRI have been used to identify viable myocardium. Computed tomography (CT) is increasingly used to diagnose coronary atherosclerosis. OBJECTIVE To evaluate the feasibility of CT enhancement as a viability marker by investigating myocardial contrast distribution over time in pigs with experimentally induced antero-septal myocardial infarctions. METHODS Twelve pigs were subjected to 60 min of balloon occlusion of the left anterior descending artery, followed by removal of the balloon and reperfusion. Four pigs died due to refractory ventricular fibrillation. After 6 weeks, dynamic cardiac CT was performed assessing both wall motion and contrast attenuation. Measurements of attenuation values in Hounsfield units (HU) in the infarct zone and the normal lateral wall were performed at 20 s, and 1, 3, 5, 8 and 12 min after contrast injection. RESULTS We found highly significant differences in attenuation values between the two zones at all-time points except t =1 min (ANOVA P=0.85). The normal myocardium showed higher uptake- and washout-rates of contrast than the infarct zone (84±15 vs. 58±8 at 20 s, P=0.0001 and 27±12 vs. 81±13 at 12 min, P=0.0001). Specifically, the ratio between early (20 s) and late (12 min) uptake is a valid marker of viable myocardium. In all animals this ration was above one in the normal zone and below one in the infarct zone. CONCLUSIONS Delayed infarct related uptake and washout of contrast shows promise for future clinical application of CT in a combined assessment of coronary atherosclerosis and myocardial viability.
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Affiliation(s)
- Sebastian Udholm
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Sofie Laugesen
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Peter Agger
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Jesper Hønge
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Morten Smerup
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Nichlas Udholm
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Hans Erik Bøtker
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Morten Bøttcher
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
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Sano T. [6. Diagnosis of ischemic heart disease by multidetector computed tomography]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2013; 69:1444-1454. [PMID: 24366565 DOI: 10.6009/jjrt.2013_jsrt_69.12.1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Girard EE, Al-Ahmad A, Rosenberg J, Luong R, Moore T, Lauritsch G, Boese J, Fahrig R. Contrast-enhanced C-arm CT evaluation of radiofrequency ablation lesions in the left ventricle. JACC Cardiovasc Imaging 2012; 4:259-68. [PMID: 21414574 DOI: 10.1016/j.jcmg.2010.11.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 11/22/2010] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate use of cardiac C-arm computed tomography (CT) in the assessment of the dimensions and temporal characteristics of radiofrequency ablation (RFA) lesions. This imaging modality uses a standard C-arm fluoroscopy system rotating around the patient, providing CT-like images during the RFA procedure. BACKGROUND Both cardiac magnetic resonance (CMR) and CT can be used to assess myocardial necrotic tissue. Several studies have reported visualizing cardiac RFA lesions with CMR; however, obtaining CMR images during interventional procedures is not common practice. Direct visualization of RFA lesions using C-arm CT during the procedure may improve outcomes and circumvent complications associated with cardiac ablation procedures. METHODS RFA lesions were created on the endocardial surface of the left ventricle of 9 swine using a 7-F RFA catheter. An electrocardiographically gated C-arm CT imaging protocol was used to acquire projection images during iodine contrast injection and after the injection every 5 min for up to 30 min, with no additional contrast. Reconstructed images were analyzed offline. The mean and SD of the signal intensity of the lesion and normal myocardium were measured in all images in each time series. Lesion dimensions and area were measured and compared in pathologic specimens and C-arm CT images. RESULTS All ablation lesions (n = 29) were visualized and lesion dimensions, as measured on C-arm CT, correlated well with postmortem tissue measurements (linear dimensions: concordance correlation = 0.87; area: concordance correlation = 0.90. Lesions were visualized as a perfusion defect on first-pass C-arm CT images with a signal intensity of 95 HU lower than that of normal myocardium (95% confidence interval: -111 HU to -79 HU). Images acquired at 1 and 5 min exhibited an enhancing ring surrounding the perfusion defect in 24 lesions (83%). CONCLUSIONS RFA lesion size, including transmurality, can be assessed using electrocardiographically gated cardiac C-arm CT in the interventional suite. Visualization of RFA lesions using cardiac C-arm CT may facilitate the assessment of adequate lesion delivery and provide valuable feedback during cardiac ablation procedures.
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Affiliation(s)
- Erin E Girard
- Department of Bioengineering, Stanford University, Palo Alto, California 94304, USA.
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Lessick J, Abadi S, Agmon Y, Keidar Z, Carasso S, Aronson D, Ghersin E, Rispler S, Sebbag A, Israel O, Hammerman H, Roguin A. Multidetector computed tomography predictors of late ventricular remodeling and function after acute myocardial infarction. Eur J Radiol 2011; 81:2648-57. [PMID: 22209631 DOI: 10.1016/j.ejrad.2011.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 12/06/2011] [Accepted: 12/08/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite advent of rapid arterial revascularization as 1st line treatment for acute myocardial infarction (AMI), incomplete restoral of flow at the microvascular level remains a problem and is associated with adverse prognosis, including pathological ventricular remodeling. We aimed to study the association between multidetector row computed tomography (MDCT) perfusion defects and ventricular remodeling post-AMI. METHODS In a prospective study, 20 patients with ST-elevation AMI, treated by primary angioplasty, underwent arterial and late phase MDCT as well as radionuclide scans to study presence, size and severity of myocardial perfusion defects. Contrast echocardiography was performed at baseline and at 4 months follow-up to evaluate changes in myocardial function and remodeling. RESULTS Early defects (ED), late defects (LD) and late enhancement (LE) were detected in 15, 7 and 16 patients, respectively and radionuclide defects in 15 patients. The ED area (r=0.74), and LD area (r=0.72), and to a lesser extent LE area (r=0.62) correlated moderately well with SPECT summed rest score. By univariate analysis, follow-up end-systolic volume index and ejection fraction were both significantly related to ED and LD size and severity, but not to LE size or severity. By multivariate analysis, end-systolic volume index was best predicted by LD area (p<0.05) and ejection fraction by LD enhancement ratio. CONCLUSIONS LD size and severity on MDCT are most closely associated with pathological ventricular remodeling after AMI and may thus play a role in early identification and treatment of this condition.
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Affiliation(s)
- Jonathan Lessick
- Cardiology Department, Rambam Health Care Campus, Haaliya Street, Haifa, Israel; Technion-IIT, Haaliya Street, Haifa, Israel. j
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11
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Nikolaou K, Alkadhi H, Bamberg F, Leschka S, Wintersperger BJ. MRI and CT in the diagnosis of coronary artery disease: indications and applications. Insights Imaging 2010; 2:9-24. [PMID: 22347932 PMCID: PMC3259311 DOI: 10.1007/s13244-010-0049-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 09/27/2010] [Accepted: 10/19/2010] [Indexed: 01/16/2023] Open
Abstract
In recent years, technical advances and improvements in cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI) have provoked increasing interest in the potential clinical role of these techniques in the non-invasive work-up of patients with suspected coronary artery disease (CAD) and correct patient selection for these emerging imaging techniques. In the primary detection or exclusion of significant CAD, e.g. in the patient with unspecific thoracic complaints, and also in patients with known CAD or advanced stages of CAD, both CT and MRI yield specific advantages. In this review, the major aspects of non-invasive MR and CT imaging in the diagnosis of CAD will be discussed. The first part describes the clinical value of contrast-enhanced non-invasive CT coronary angiography (CTCA), including the diagnostic accuracy of CTCA for the exclusion or detection of significant CAD with coronary artery stenoses that may require angioplastic intervention, as well as potentially valuable information on the coronary artery vessel wall. In the second section, the potential of CT for the imaging of myocardial viability and perfusion will be highlighted. In the third and final part, the range of applications of cardiac MRI in CAD patients will be outlined.
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Kang DK, Schoepf UJ, Bastarrika G, Nance JW, Abro JA, Ruzsics B. Dual-energy computed tomography for integrative imaging of coronary artery disease: principles and clinical applications. Semin Ultrasound CT MR 2010; 31:276-91. [PMID: 20691928 DOI: 10.1053/j.sult.2010.05.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The introduction of coronary CT angiography (cCTA) has reinvigorated the debate whether management of patients with suspected coronary artery disease (CAD) should be primarily based on physiological, functional versus anatomical testing. Anatomical testing (i.e., cCTA or invasive catheterization) enables direct visualization and grading of coronary artery stenoses but has shortcomings for gauging the hemodynamic significance of lesions for myocardial perfusion. Rest/stress myocardial perfusion imaging (MPI) has been extensively validated for assessing the clinical significance of CAD by demonstrating fixed or reversible perfusion defects but has only limited anatomical information. There is growing evidence that contrast medium enhanced dual-energy cCTA (DECT) has potential for the comprehensive analysis of coronary artery morphology as well as changes in myocardial perfusion. DECT exploits the fact that tissues in the human body and iodine-based contrast media have unique absorption characteristics when penetrated with different X-ray energy levels, which enables mapping the iodine (and thus blood) distribution within the myocardium. The purpose of this communication is to describe the practical application of this technology for the comprehensive diagnosis of ischemic heart disease. We examine recent scientific findings in the context of current pivotal transitions in cardiovascular disease management and demonstrate the potential of cardiac DECT for the integrative assessment of patients with known or suspected CAD within a single CT-based protocol.
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Affiliation(s)
- Doo Kyoung Kang
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29401, USA
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Durst R, Bogot N, Gilon D, Drenger B. Potential role for coronary computerized angiography for assessing preoperative ischemic risk. J Cardiothorac Vasc Anesth 2010; 24:348-55. [PMID: 20149691 DOI: 10.1053/j.jvca.2009.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Indexed: 11/11/2022]
Affiliation(s)
- Ronen Durst
- Cardiology Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Abstract
Multidetector CT (MDCT) with 64-slice capability continues to gain momentum for cardiovascular imaging. Beyond images of coronary arteries, it also provides reliable information on left ventricular structure and function, cardiac venous anatomy, the pulmonary venous system, and right ventricular function-all aspects important in the management of heart failure patients. Potential unique applications in heart failure include cardiac dyssynchrony evaluation, assessing cardiomyopathies, and post-transplant annual follow-up. This review details the multiple applications and limitations of MDCT in the heart failure population, including comparison with other commonly used imaging modalities such as echocardiography and MRI.
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Hetterich H, Redel T, Lauritsch G, Rohkohl C, Rieber J. New X-ray imaging modalities and their integration with intravascular imaging and interventions. Int J Cardiovasc Imaging 2009; 26:797-808. [PMID: 19898992 DOI: 10.1007/s10554-009-9529-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 10/22/2009] [Indexed: 12/17/2022]
Affiliation(s)
- H Hetterich
- Department of Cardiology, Medizinische Poliklinik, University of Munich, Ziemssenstrasse 1, Munich, Germany
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Rieber J, Rohkohl C, Lauritsch G, Rittger H, Meissner O. Kardiale Anwendung der C-Arm-Computertomographie. Radiologe 2009; 49:862-7. [DOI: 10.1007/s00117-009-1869-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Anatomy and Terminology for the Interpretation and Reporting of Cardiac MDCT: Part 2, CT Angiography, Cardiac Function Assessment, and Noncoronary and Extracardiac Findings. AJR Am J Roentgenol 2009; 192:584-98. [DOI: 10.2214/ajr.08.1178] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hurlock GS, Higashino H, Mochizuki T. History of cardiac computed tomography: single to 320-detector row multislice computed tomography. Int J Cardiovasc Imaging 2009; 25 Suppl 1:31-42. [PMID: 19145476 DOI: 10.1007/s10554-008-9408-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 12/17/2008] [Indexed: 12/18/2022]
Abstract
Since the introduction of computed tomography (CT) over 30 years ago, the challenge of imaging the beating heart has been a driving force in the innovation of cardiac CT. Imaging the anatomy and physiology of the heart demands temporal, spatial and contrast resolution is arguably greater than for any other organ system in the body. Great progress has been achieved in using CT to evaluate coronary artery stenosis and plaque composition. In addition, techniques to evaluate cardiac function, including myocardial perfusion, regional ventricular wall motion, systolic thickening, ejection fraction, valve function, and congenital cardiac abnormalities are also gaining a foothold in clinical practice as adjuncts to or replacements for invasive coronary angiography, cardiac single photon emission CT (SPECT) imaging, ultrasound and magnetic resonance imaging (MRI). This review summarizes the major accomplishments and future directions in this field, with emphasis on developments over the past 10 years.
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Affiliation(s)
- Gregory S Hurlock
- Department of Radiology, Ehime University School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
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Ichinose T, Yamase M, Yokomatsu Y, Kawano Y, Konishi H, Tanimoto K, Oigawa T, Katoh Y, Nakazato Y, Suwa S, Sakurai H, Sumiyoshi M. Acute myocardial infarction with myocardial perfusion defect detected by contrast-enhanced computed tomography. Intern Med 2009; 48:1235-8. [PMID: 19602792 DOI: 10.2169/internalmedicine.48.1753] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The first case was a 68-year-old woman who had acute migratory pain from back to anterior chest and the second case was 66-year-old man with a cardiac tamponade. Two cases were demonstrated with a low density area of the left ventricular postero-lateral wall with conventional contrast-enhanced computed tomography (CE-CT) performed to differentiate the diagnosis of acute coronary syndrome and acute aortic dissection. Subsequent coronary angiograms showed the lesions of left circumflex. These cases of early contrast-defect corresponded to a decreased myocardial blood flow with AMI. CE-CT image facilitated the diagnosis of AMI preceding CAG examination.
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Affiliation(s)
- Tetsuo Ichinose
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu.
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Pannu HK, Johnson PT, Fishman EK. 64 Slice multi-detector row cardiac CT. Emerg Radiol 2008; 16:1-10. [PMID: 18941811 DOI: 10.1007/s10140-008-0760-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 08/04/2008] [Indexed: 10/21/2022]
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Furtado AD, Carlsson M, Wintermark M, Ordovas K, Saeed M. Identification of residual ischemia, infarction, and microvascular impairment in revascularized myocardial infarction using 64-slice MDCT. CONTRAST MEDIA & MOLECULAR IMAGING 2008; 3:198-206. [DOI: 10.1002/cmmi.253] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Koyama Y. [State of the art cardiac MDCT: where are we today and where are we going?]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2008; 64:725-733. [PMID: 18648164 DOI: 10.6009/jjrt.64.725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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24
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Reimann AJ, Kuettner A, Klumpp B, Heuschmid M, Schumacher F, Teufel M, Beck T, Burgstahler C, Schröder S, Claussen CD, Kopp AF. Late enhancement using multidetector row computer tomography: A feasibility study with low dose 80kV protocol. Eur J Radiol 2008; 66:127-33. [PMID: 17851011 DOI: 10.1016/j.ejrad.2007.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Revised: 10/19/2006] [Accepted: 04/12/2007] [Indexed: 11/21/2022]
Abstract
AIMS Detecting stenoses of coronary arteries with multidetector row computer tomography (MDCT) is a well feasible non-invasive method. However, there is still the problem of deciding whether a stenosis is hemodynamically relevant or not. Objective of the present study was to validate the feasibility of a low dose protocol for MDCT using 80 kV for detecting late enhancement. METHODS AND RESULTS Using a Alderson-Rando Phantom evaluation of the effective dose of this LE protocol was performed. Ten patients (six male, four female, mean age 61) with known coronary artery disease and scheduled for a conventional coronary angiogram in our facility were subsequently recruited. All patients underwent CT-angiography (CTA) 1 day prior to magnetic resonance imaging. Five minutes after the application of 100ml contrast agent for the CTA scan, a low dose late enhancement scan (80 kV, 400 mA s maximum, ECG pulsed scan, 64 mm x 0.6mm collimation, 0.33 s tube rotation) was performed. Phantom dose measurements showed an effective dose for this protocol of 1.19 mSv (male) and 1.61 mSv (female). Fifty-six percent (5/9) of the patients showed a late enhancement on the MRI scan. Three transmural late enhancements and all four negative findings were correctly identified by CT. This represents a sensitivity of 78% (3/5), specificity of 100% (3/3), NPV of 100% (4/4) and a PPV of 97%. CONCLUSION We were able to show that the low dose protocol is feasible and, furthermore, preliminary results look promising.
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Affiliation(s)
- Anja J Reimann
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
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Francone M, Carbone I, Napoli A, Algeri E, Grazhdani H, Lezoche R, Mirabelli F, Gaudio C, Calabrese FA, Catalano C, Passariello R. Imaging of myocardial infarction using a 64-slice MDCT scanner: correlation between infarcted region and status of territory-dependent coronary artery. Radiol Med 2007; 112:1100-16. [PMID: 18080098 DOI: 10.1007/s11547-007-0209-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 04/26/2007] [Indexed: 12/01/2022]
Abstract
PURPOSE This study was performed to evaluate the ability of 64-slice multidetector computed tomography (MDCT) to detect previous myocardial infarctions (MIs) in patients referred for the assessment of the coronary arteries. In patients with regional changes of left ventricular wall myocardial density, the territory-dependent coronary vessel status was examined. MATERIALS AND METHODS We retrospectively assessed 202 consecutive patients referred for 64-slice MDCT of the coronary arteries. In all cases, detailed, clinical, serological and electrocardiograph (ECG) data were collected to identify patients with a previous diagnosis of MI. An initial qualitative evaluation of MDCT images was performed in all patients to identify areas of suspected myocardial necrosis, which were defined as regions of lower density within normally enhanced left ventricular myocardium. Thereafter, in all patients with suspected MIs, attenuation values and left ventricular wall thickness were also measured at the level of the normal myocardium and within the hypodense regions. Each MI was also assigned to the distribution territory of a coronary vessel, and morphological data were combined with MDCT angiographic findings. RESULTS After clinical assessment, MI was found in 27 patients (six acute).; 64-slice MDCT was able to detect the presence of MI in 24/27 cases, showing sensitivity and specificity of 89% and 95%, respectively, and an overall diagnostic accuracy of 95%. Quantitative analysis showed a significant difference (p<0.01) between attenuation values of normal vs. infarcted myocardium (124.5+/-19 HU vs. 56.1+/-23 HU, respectively); wall thinning was exclusively observed in chronic MIs (p<0.01). In 23/24 detected cases, analysis of territory-dependent arteries showed findings compatible with presence of MI. CONCLUSIONS The presence of MI is well depicted with retrospective 64-slice MDCT. The main advantage of 64-slice MDCT is that it allows to evaluate and relate the status of a vessel and its dependent myocardial region in a single exam.
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Affiliation(s)
- M Francone
- Dipartimento di Scienze Radiologiche, Università degli Studi di Roma La Sapienza, Viale Regina Elena 324, Rome, Italy.
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Lessick J, Ghersin E, Dragu R, Litmanovich D, Mutlak D, Rispler S, Agmon Y, Engel A, Beyar R. Diagnostic accuracy of myocardial hypoenhancement on multidetector computed tomography in identifying myocardial infarction in patients admitted with acute chest pain syndrome. J Comput Assist Tomogr 2007; 31:780-8. [PMID: 17895792 DOI: 10.1097/rct.0b013e318033d6fc] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate prevalence and diagnostic accuracy of myocardial hypoenhancement (MH) using multidetector computed tomography (MDCT) in patients admitted for acute chest pain syndromes. METHODS Sixty-nine patients underwent first-pass MDCT, coronary angiography, and echocardiography. Using a standardized analysis protocol, left ventricular short-axis reformations were evaluated for presence, size, and density of MH in 16 myocardial segments. These were correlated with the presence and location of myocardial infarction (MI), regional myocardial dysfunction, and coronary artery disease. RESULTS Myocardial hypoenhancement was found in acute MI (27/35), healed MI (6/14), unstable angina (3/9), and atypical chest pain (0/11). Sensitivity, specificity, and positive and negative predictive values of MH for diagnosing any MI were 67%, 85%, 92% and 52%, respectively. CONCLUSIONS The presence of MH on MDCT in acute chest pain patients has high positive predictive value and specificity but only moderate sensitivity for presence of acute or healed MI using the strict criteria proposed in this study.
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Affiliation(s)
- Jonathan Lessick
- Cardiology Department, Rambam Medical Center and Technion-IIT, Haifa, Israel.
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Hsu SJ, Bouchard RR, Dumont DM, Wolf PD, Trahey GE. In vivo assessment of myocardial stiffness with acoustic radiation force impulse imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:1706-19. [PMID: 17698282 PMCID: PMC2117626 DOI: 10.1016/j.ultrasmedbio.2007.05.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 04/16/2007] [Accepted: 05/10/2007] [Indexed: 05/04/2023]
Abstract
Acoustic radiation force impulse (ARFI) imaging has been demonstrated to be capable of visualizing variations in local stiffness within soft tissue. Recent advances in ARFI beam sequencing and parallel imaging have shortened acquisition times and lessened transducer heating to a point where ARFI acquisitions can be executed at high frame rates on commercially available diagnostic scanners. In vivo ARFI images were acquired with a linear array placed on an exposed canine heart. The electrocardiogram (ECG) was also recorded. When coregistered with the ECG, ARFI displacement images of the heart reflect the expected myocardial stiffness changes during the cardiac cycle. A radio-frequency ablation was performed on the epicardial surface of the left ventricular free wall, creating a small lesion that did not vary in stiffness during a heartbeat, though continued to move with the rest of the heart. ARFI images showed a hemispherical, stiffer region at the ablation site whose displacement magnitude and temporal variation through the cardiac cycle were less than the surrounding untreated myocardium. Sequences with radiation force pulse amplitudes set to zero were acquired to measure potential cardiac motion artifacts within the ARFI images. The results show promise for real-time cardiac ARFI imaging.
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Affiliation(s)
- Stephen J Hsu
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
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Arnett JH, Mohajer K, Okon SA. Evidence of acute myocardial infarction on CT. Br J Radiol 2007; 80:e219-21. [PMID: 17928493 DOI: 10.1259/bjr/24678934] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Improvements in CT technology, specifically with respect to the development of multi-row detector CT, have increased the ability to detect acute myocardial ischaemia. This case report details the finding of decreased myocardial enhancement on CT in a patient who complained of acute chest symptomalogy and was diagnosed with acute myocardial infarction, which was subsequently confirmed by cardiac catheterization. Given the variability of the clinical presentation of acute myocardial infarction, greater attention should be paid by radiologists to myocardial enhancement in patients with significant coronary risk factors, as evidence of acute myocardial infarct or ischaemia may be detected.
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Affiliation(s)
- J H Arnett
- Department of Radiology, Beth Israel Medical Center, First Avenue at 16th St., New York, NY 10003, USA.
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Abstract
Coronary artery disease and other acquired and congenital cardiac diseases are major medical and socio-economic problems. Historically, imaging has had a critical role in the diagnosis and evaluation of acquired and congenital cardiac disease. Advances in computed tomography (CT), with multidetector CT and electron beam CT technology, and magnetic resonance (MR) imaging, now make it possible to noninvasively image the coronary arteries, cardiac chambers, valves, myocardium, and pericardium and assess cardiac function, and CT and MR imaging are becoming increasingly important in the evaluation of cardiac disease. Radiologists, because of their extensive experience in CT and MR imaging, have an important role in imaging cardiac patients using these modalities. This clinical statement of the ACR discusses various technical and patient safety issues related to cardiac CT and MR imaging, and it suggests appropriate qualifications for radiologists until such time as ACR practice guidelines for the performance of cardiac CT and cardiac MR imaging are written and approved through the usual ACR process. It stresses that the interpreting physician is responsible for examining not only the cardiac structures of interest but also all the visualized noncardiac structures and must report any clinically relevant abnormalities of these adjacent structures.
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Jacobs JE, Boxt LM, Desjardins B, Fishman EK, Larson PA, Schoepf J. ACR practice guideline for the performance and interpretation of cardiac computed tomography (CT). J Am Coll Radiol 2007; 3:677-85. [PMID: 17412148 DOI: 10.1016/j.jacr.2006.06.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Indexed: 10/24/2022]
Abstract
Cardiac computed tomography (CT) is an evolving modality that includes a variety of examinations to assess the anatomy and pathology of the cardiac chambers, valves, myocardium, coronary arteries and veins, pericardium, aortic root, and central great vessels. The development of multidetector CT scanners with increasing numbers of detector rows, narrow section thicknesses, increasing scanner speeds, the ability for electrocardiographic gating, and radiation dose modulation allows the performance of CT coronary arteriography. Computed tomography coronary arteriography enables the assessment of multiple types of cardiac pathology, including intraluminal coronary arterial plaque formation, coronary artery stenosis, congenital anomalies, coronary artery aneurysms, sequelae of cardiac ischemia, and the assessment of prior vascular interventions, while providing information about cardiac and valvular function. Noncardiac structures included in cardiac CT examinations must also be evaluated. This guideline attempts to maximize the probability of detecting cardiac abnormalities with cardiac CT. American College of Radiology requirements for physicians and personnel performing examinations are also addressed and will become applicable by July 1, 2008.
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Affiliation(s)
- Jill E Jacobs
- New York University Medical Center, New York, NY, USA
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Lessick J, Dragu R, Mutlak D, Rispler S, Beyar R, Litmanovich D, Engel A, Agmon Y, Kapeliovich M, Hammerman H, Ghersin E. Is functional improvement after myocardial infarction predicted with myocardial enhancement patterns at multidetector CT? Radiology 2007; 244:736-44. [PMID: 17690323 DOI: 10.1148/radiol.2443061397] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate the sensitivity of myocardial early perfusion defects (EDs) and late enhancement (LE) at multidetector computed tomography (CT) following acute myocardial infarction (AMI) to predict segment myocardial dysfunction and myocardial functional recovery (MFR), by using echocardiography as the reference standard. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained. Twenty-six patients (25 men, one woman; mean age, 53 years+/-9 [standard deviation]), underwent baseline multidetector CT, coronary angiography, and echocardiography within a week of AMI and a follow-up echocardiography at 3 months. ED, LE, and late hypoattenuation were compared with regional left ventricular function and MFR. A logistic regression model and generalized estimating equation analysis were applied to estimate the predictive effect of ED and LE. Differences between groups were evaluated by using nonpaired Student t tests. RESULTS All EDs and LE corresponded with AMI location determined by using angiography and echocardiography. For occluded arteries (n=5), no relationship was found between the presence of ED or LE and MFR. For patent arteries (n=21), presence of LE had a respective sensitivity and specificity of 73% and 85% for predicting follow-up segment dysfunction, compared with 57% and 90% for ED. In abnormal baseline segments, nonrecovery was clearly related to the presence and size of segment defect area for both ED (odds ratio: 1.95 [95% confidence interval: 0.9, 4.1] per square centimeter) and LE (odds ratio: 1.85 [95% confidence interval: 1.2, 2.9] per square centimeter). Segments that recovered had significantly lower prevalence of ED and LE, and if present, were significantly smaller than in segments remaining abnormal (P<.05). CONCLUSION The presence and size of ED and LE at multidetector CT is closely related to follow-up segment myocardial dysfunction and MFR.
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Affiliation(s)
- Jonathan Lessick
- Department of Cardiology, Rambam Health Care Campus, Haaliya St, Haifa 31096, Israel.
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Ko SM, Kim YW, Han SW, Seo JB. Early and delayed myocardial enhancement in myocardial infarction using two-phase contrast-enhanced multidetector-row CT. Korean J Radiol 2007; 8:94-102. [PMID: 17420626 PMCID: PMC2626780 DOI: 10.3348/kjr.2007.8.2.94] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective The purpose of this study was to describe the myocardial enhancement patterns in patients with myocardial infarction using two-phase contrast-enhanced multidetector-row computed tomography (MDCT). Materials and Methods Twenty-three patients with clinically proven myocardial infarction (17 acute myocardial infarction [AMI] and 6 chronic myocardial infarction [CMI]) were examined with two-phase contrast-enhanced ECG-gated MDCT. The presence, location, and patterns of myocardial enhancement on two-phase MDCT images were compared with infarcted myocardial territories determined by using electrocardiogram, echocardiography, thallium-201 single photon emission computed tomography, catheter and MDCT coronary angiography. Results After clinical assessment, the presence of myocardial infarctions were found in 27 territories (19 AMI and 8 CMI) of 23 patients. Early perfusion defects were observed in 30 territories of all 23 patients. Three territories not corresponding to a myocardial infarction were detected in three patients with AMI and were associated with artifacts. Fourteen of perfusion defects were in the left anterior descending artery territory, four in the left circumflex artery territory, and nine in the right coronary artery territory. Delayed enhancement was observed in 25 territories (17 AMI and 8 CMI) of 21 patients. Delayed enhancement patterns were variable. Transmural early perfusion defects (n =12) were closely associated with transmural late enhancement (n = 5) and subendocardial residual defect with subepicardial late enhancement (n = 5). Conclusion Myocardial infarction showed early perfusion defects and variable delayed enhancement patterns on two-phase contrast-enhanced MDCT. Delayed enhancement technique of MDCT could provide additional information of the location and extent of infarcted myocardium, and could be useful to plan appropriate therapeutic strategies in patients with AMI.
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Affiliation(s)
- Sung-Min Ko
- Department of Radiology, University of Keimyung College of Medicine, Dongsan Medical Center, Daegu, Korea.
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Brodoefel H, Reimann A, Klumpp B, Fenchel M, Ohmer M, Miller S, Schroeder S, Claussen C, Scheule A, Kopp AF. Assessment of myocardial viability in a reperfused porcine model: evaluation of different MSCT contrast protocols in acute and subacute infarct stages in comparison with MRI. J Comput Assist Tomogr 2007; 31:290-8. [PMID: 17414768 DOI: 10.1097/01.rct.0000237806.57757.e6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess myocardial viability in acute and subacute infarcts using different multislice spiral computed tomography contrast protocols with magnetic resonance imaging (MRI) correlation. METHODS Seven pigs were studied with 64-multislice spiral computed tomography and MRI (1.5 T) at a median of 1 and 21 days after temporary occlusion of the second diagonal branch. Computed tomography was performed at 3, 5, 10, and 15 minutes after injection of contrast medium. Contrast agent was applied either as a bolus (protocol 1; n = 7 for the first; n = 5 for the second scan) or as a bolus plus 30 mL of subsequent 0.1 mL/s low-flow (protocol 2; n = 7 for the first; n = 6 for the second scan). Finally, histological sections were obtained. Volumes of infarcted myocardium were assessed as the percentage of the left ventricle. Computed tomography attenuation values were obtained, and image quality was assessed. RESULTS When compared with protocol 1, protocol 2 provided greater Hounsfield unit attenuation difference between viable and nonviable myocardium at 5, 10, and 15 minutes (P = 0.19; 0.003; 0.0006) and an additional significant contrast between nonviable myocardium and ventricular blood at 3 and 5 minutes (P < 0.001). Image quality was rated significantly higher with the use of protocol 2 at 5, 10, and 15 minutes (P < or = 0.027) and for all time points use of protocol 2 resulted in improved correlation of acute and subacute infarct size with MRI. CONCLUSIONS Good correlation of infarct zones with MRI was achieved for both acute and subacute infarcts. With the use of a bolus/low-flow protocol, image quality was substantially improved by means of a higher tissue contrast.
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Affiliation(s)
- Harald Brodoefel
- Department of Diagnostic Radiology, Eberhard-Karls-University, Tübingen, Germany.
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Abstract
Methods of noninvasive evaluation of coronary artery disease-including multidetector row computed tomography, electron beam computed tomography, magnetic resonance imaging, and nuclear studies (single photon emission computed tomography, positron emission tomography)-are reviewed.
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Affiliation(s)
- Gopi Kiran Reddy Sirineni
- Division of Cardiothoracic Imaging, Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322, USA
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Lim SJ, Choo KS. Multi-Detector Computed Tomography for Assessing the Left Ventricular Function, Perfusion and Viability. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.5.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Soo Jin Lim
- Department of Cardiology, Kim Hae Bokum Hospital, Kimhae, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University Hospital, Busan, Korea
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Jung JI. The Effects of Trimetazidine on the Enhancement Patterns of Multi-Detector Computed Tomography in a Porcine Myocardial Infarction Model: What is the Meaning of the MDCT Enhancement Pattern in this Myocardial Infarction Model? Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.2.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jung Im Jung
- Department of Radiology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lee SR, Jeong MH, Yim NY, Yoon NS, Kim KH, Hong YJ, Park HW, Kim JH, Moon JY, Ahn YK, Kim YH, Cho JG, Park JC, Kang JC. The Effects of Trimetazidine on the Enhancement Pattern of Multi-detector Computed Tomography in a Porcine Myocardial Infarction Model. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.2.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sang Rok Lee
- The Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Nam Yeol Yim
- Department of Diagnostic Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Nam Sik Yoon
- The Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Kye Hun Kim
- The Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- The Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Hyung Wook Park
- Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Ju Han Kim
- The Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Youn Moon
- The Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Young Keun Ahn
- Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Yun-Hyeon Kim
- Department of Diagnostic Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jong Chun Park
- Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jung Chaee Kang
- Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
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Brodoefel H, Klumpp B, Reimann A, Fenchel M, Heuschmid M, Miller S, Schroeder S, Claussen C, Scheule AM, Kopp AF. Sixty-four-MSCT in the characterization of porcine acute and subacute myocardial infarction: determination of transmurality in comparison to magnetic resonance imaging and histopathology. Eur J Radiol 2006; 62:235-46. [PMID: 17187952 DOI: 10.1016/j.ejrad.2006.11.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Revised: 11/22/2006] [Accepted: 11/24/2006] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to assess the accuracy of MSCT in characterizing myocardial infarction (MI) and, thereby, determine the extent of early perfusion defect (ED), microvascular obstruction (MO) and transmural depth of late enhancement (LE) in comparison to MRI and histology. MATERIALS AND METHODS Seven pigs were studied with MSCT (Somatom Sensation 64) and MRI (Magnetom Sonata) a median 1 and 21 days following temporary occlusion of a diagonal branch and creation of small reperfused infarction. For depiction of ED, CT images were acquired in the early arterial phase and following 35 s; LE and MO were evaluated on images obtained at 3, 5, 10 and 15 min. Thereby, a bolus/low-flow contrast injection protocol was used. Triphenyltetrazolium-chloride (TTC) stain and histology were obtained. Volumes of enhancement patterns were assessed as percentage of the ventricle and compared by Bland-Altman analysis. Segmental co-localization and graded transmurality was evaluated with weighted-kappa-test. RESULTS Close spatial agreement was observed for MRI-MO and MSCT-MO (bias=0.55; CI=-1.49 to 2.60 at 5 min MSCT), TTC and MSCT-LE (bias=-1.28; CI=-3.76 to 1.19) or MRI-LE and MSCT-LE (bias=-0.79; CI=-4.19 to 2.60). There was good segmental co-localization for MO (weighted kappa=0.93) and high agreement for transmural extent of TTC, MRI-LE and MSCT-LE (weighted kappa=0.84 TTC versus MSCT; 0.86 MRI versus MSCT). Arterial and 35s ED significantly underestimated infarct size and showed poor segmental or transmural agreement (weighted kappa=0.33; 0.44). CONCLUSIONS MSCT late-scans not only reliably depict size of MO and LE in acute or subacute infarct phases but, moreover, allow for accurate determination of LE transmurality.
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Affiliation(s)
- H Brodoefel
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
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Haraikawa T, Higashino H, Sugawara Y, Miki H, Kurata A, Higaki J, Mochizuki T. Assessment of left ventricular wall motion using 16-channel multislice computed tomography: comparison with left ventriculography. ACTA ACUST UNITED AC 2006; 24:159-64. [PMID: 16875302 DOI: 10.1007/s11604-005-1468-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Using the raw data from coronary computed tomography (CT) angiography, multislice CT (MSCT) can be used to evaluate cardiac function. However, the accuracy of left ventricular (LV) wall motion assessment by MSCT has not been thoroughly investigated. We investigated whether 16-channel MSCT could accurately assess LV wall motion by comparing its results with those of conventional biplane left ventriculography (LVG). MATERIALS AND METHODS The study included 20 patients with various kinds of heart disease. All patients underwent both contrast-enhanced MSCT and biplane LVG. Using a retrospective electrocardiography-gating technique, 10 phases over one cardiac cycle were extracted. The left ventricle was divided into seven segments according to the American Heart Association classification. Wall motion was scored as follows: 1, normal; 2, mild to moderate hypokinesis; 3, severe hypokinesis; 4, akinesis; 5, dyskinesis; and 6, aneurysm. The scores obtained by MSCT were compared with those obtained by LVG. The wall motion scores were analyzed using the chi-squared independence test (6 x 6 contingency table). RESULTS Wall motion could be assessed in all segments of the 20 patients using interactive multiplanar animation. Among a total of 140 segments in 20 patients, scores in 118 were concordant between MSCT and LVG (118/140, 84.3%). CONCLUSION The 16-MSCT can accurately assess LV wall motion.
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Affiliation(s)
- Toyoaki Haraikawa
- Department of Radiology, Ehime University School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
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Sanz J, Weeks D, Nikolaou K, Sirol M, Rius T, Rajagopalan S, Dellegrottaglie S, Strobeck J, Fuster V, Poon M. Detection of healed myocardial infarction with multidetector-row computed tomography and comparison with cardiac magnetic resonance delayed hyperenhancement. Am J Cardiol 2006; 98:149-55. [PMID: 16828583 DOI: 10.1016/j.amjcard.2006.01.093] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 01/19/2006] [Accepted: 01/19/2006] [Indexed: 12/11/2022]
Abstract
Decreased myocardial attenuation on contrast-enhanced multidetector computed tomography (MDCT) images can be observed in subjects with myocardial infarctions (MIs). It was hypothesized that myocardial hypoattenuation in MDCT can accurately detect the presence of a healed MI as determined by cardiac magnetic resonance delayed hyperenhancement (CMR-DH). Coronary MDCT and CMR-DH were performed in 42 subjects. Pre- and postcontrast MDCT images were analyzed for the presence of myocardial hypoattenuation, and volumes of MIs were quantified on MDCT and CMR-DH images in a blinded manner. The sensitivity, specificity, and negative and positive predictive values of postcontrast MDCT for the detection of MI were 91%, 81%, 83%, and 90%, respectively. MI sizes by postcontrast MDCT and by CMR-DH were strongly correlated (r=0.87, p<0.0001), although MDCT systematically underestimated MI volume (2.7+/-2.5 vs 25.9+/-19.9 ml, p<0.0001). MI size by MDCT was correlated negatively with the left ventricular ejection fraction (r=-0.62, p=0.03) and positively with left ventricular volumes (r=0.68 to 0.72, p<0.01). In 71% of subjects with MIs by CMR-DH, corresponding areas of hypoattenuation were noted also in precontrast MDCT. In conclusion, healed MIs can be detected as areas of myocardial hypoattenuation on MDCT images with high diagnostic accuracy, although their sizes are largely underestimated compared with CMR-DH. The presence of precontrast hypoattenuation suggests that mechanisms independent of reduced contrast delivery contribute to this finding.
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Affiliation(s)
- Javier Sanz
- Mount Sinai School of Medicine, New York, New York, USA, and Department of Cardiology, Hôpital Lariboisière, Paris, France.
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Brodoefel H, Klumpp B, Reimann A, Ohmer M, Fenchel M, Schroeder S, Miller S, Claussen C, Kopp AF, Scheule AM. Late myocardial enhancement assessed by 64-MSCT in reperfused porcine myocardial infarction: diagnostic accuracy of low-dose CT protocols in comparison with magnetic resonance imaging. Eur Radiol 2006; 17:475-83. [PMID: 16802125 DOI: 10.1007/s00330-006-0334-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 04/23/2006] [Accepted: 05/08/2006] [Indexed: 02/06/2023]
Abstract
The purpose was to assess the practicability of low-dose CT imaging of late enhancement in acute infarction. Following temporary occlusion of the second diagonal branch, seven pigs were studied by multislice computed tomography (MSCT) and magnetic resonance imaging (MRI). Thus, 64-slice CT was performed at 3, 5, 10 and 15 min following the injection of contrast medium according to a bolus/low-flow protocol. Standard parameters of 120 kV and 800 mAs were compared with 80 kV and 400 mAs in various combinations. Infarct volumes were assessed as percentage of the ventricle for both MSCT and MR images. CT density values for viable and infarcted myocardium were obtained and image quality assessed. Mean infarct volume as measured by MRI was 12.33+/-7.06%. MSCT achieved best correlation of volumes at 5 and 10 min. Whilst lowering of tube current resulted in poor correlation, tube voltage did not affect accuracy of infarct measurement (r (2)=0.92 or 0.93 at 5 min, 800 mAs and 80 or 120 kV). In terms of image quality, greater image noise with 80 kV was compensated by significantly better contrast enhancement between viable and non-viable myocardium at lower voltage. Myocardial viability can accurately be assessed by MSCT at 80 kV, which ensures higher contrast for late enhancement and yields good correlation with MRI.
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Affiliation(s)
- H Brodoefel
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
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Ko SM, Seo JB, Hong MK, Do KH, Lee SH, Lee JS, Song JW, Park SJ, Park SW, Lim TH. Myocardial enhancement pattern in patients with acute myocardial infarction on two-phase contrast-enhanced ECG-gated multidetector-row computed tomography. Clin Radiol 2006; 61:417-22. [PMID: 16679115 DOI: 10.1016/j.crad.2005.11.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Revised: 11/13/2005] [Accepted: 11/17/2005] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the myocardial enhancement pattern of the left ventricle on two-phase contrast-enhanced electrocardiogram (ECG)-gated multidetector computed tomography (MDCT) images in patients with acute myocardial infarction (AMI). METHODS Two-phase contrast-enhanced ECG-gated MDCT examinations were performed in 16 patients with AMI. The presence, location and pattern of myocardial enhancement were evaluated. MDCT findings were compared with the catheter angiographic results. RESULTS Subendocardial (n = 9) or transmural (n = 6) area of early perfusion defects of the myocardium was detected in 15 of 16 patients (94%) on early-phase CT images. Variable delayed myocardial enhancement patterns on late-phase CT images were observed in 12 patients (75%): (1) subendocardial residual perfusion defect and subepicardial late enhancement (n = 6); (2) transmural late enhancement (n = 1); (3) isolated subendocardial late enhancement (n=1); and (4) isolated subendocardial residual perfusion defect (n = 2). On catheter angiography, 14 of 15 corresponding coronary arteries showed significant stenosis. CONCLUSION Variable abnormal myocardial enhancement pattern was seen on two-phase, contrast-enhanced ECG-gated MDCT in patients with AMI. Assessment of myocardial attenuation on CT angiography gives additional information of the location and extent of infarction.
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Affiliation(s)
- S M Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Vembar M, Walker MJ, Johnson PC. Cardiac imaging using multislice computed tomography scanners: technical considerations. Coron Artery Dis 2006; 17:115-23. [PMID: 16474229 DOI: 10.1097/00019501-200603000-00004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Conventional coronary angiography is currently the gold standard in the detection and diagnosis of coronary artery disease. This modality, however, is invasive in nature. Hence, there is a need for noninvasive imaging techniques to provide comprehensive assessment of coronary artery disease, especially in stable patients at low to moderate risk of disease. In recent years, a number of noninvasive modalities have found wide applications in cardiac imaging. Most recent investigations have used magnetic resonance imaging, multislice computed tomography and electron-beam computed tomography scanners. This review discusses the clinical challenges existing in the field of cardiac imaging and focuses on the technical advancements of multislice computed tomography scanners that have made them a very attractive noninvasive option for the detection and diagnosis of coronary artery disease.
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Affiliation(s)
- Mani Vembar
- Clinical Science, Computed Tomography Division, Philips Medical Systems, Cleveland, Ohio 44143, USA.
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Gerber BL, Belge B, Legros GJ, Lim P, Poncelet A, Pasquet A, Gisellu G, Coche E, Vanoverschelde JLJ. Characterization of acute and chronic myocardial infarcts by multidetector computed tomography: comparison with contrast-enhanced magnetic resonance. Circulation 2006; 113:823-33. [PMID: 16461822 DOI: 10.1161/circulationaha.104.529511] [Citation(s) in RCA: 281] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
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%, kappa=0.54, P<0.001) and late hyperenhanced regions (82%, kappa=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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Affiliation(s)
- Bernhard L Gerber
- Department of Cardiology, Cliniques Universitaires St. Luc UCL, Université Catholique de Louvain, Brussels, Belgium.
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Abstract
Cardiac multidetector CT (MDCT) has moved from purely anatomic imaging, to assessment of cardiac function. Significant advances since the advent of multidetector CT now make it feasible to assess not only the coronary arteries, but also ejection fraction, ventricular volumes, myocardial mass and the presence of wall-motion abnormalities. Advances include improvements in EKG-gating, including improvements in temporal resolution, as well as the addition of delayed contrast-enhanced methods. Anatomic imaging has improved as well, with thinner collimation and better reconstruction methods. Three-dimensional software programs now permit excellent surface rendered displays and multiplanar reconstructions suitable as surgical and procedural "road maps."
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Affiliation(s)
- Pamela K Woodard
- Cardiovascular Imaging Laboratory, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Bruzzi JF, Rémy-Jardin M, Delhaye D, Teisseire A, Khalil C, Rémy J. When, Why, and How to Examine the Heart During Thoracic CT: Part 2, Clinical Applications. AJR Am J Roentgenol 2006; 186:333-41. [PMID: 16423935 DOI: 10.2214/ajr.05.0718] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE CT examination of the thorax is often requested for the investigation of disorders that may have an important underlying cardiac cause or association that is not clinically obvious. Conditions such as idiopathic and acquired cardiomyopathy, ischemic heart disease, and valvular dysfunction may underlie symptoms such as dyspnea, chest pain, and hemoptysis that prompt the request for CT of the thorax. Other conditions such as pulmonary thromboembolic disease, chronic obstructive airways disease, pectus excavatum, sleep apnea, and many intrathoracic malignancies may have an important effect on cardiac structure and function. Patients undergoing thoracic surgery may have unsuspected coronary artery disease that can be detected in the course of preoperative evaluation by CT; similarly, postoperative complications often have a cardiogenic basis. CONCLUSION Examination of the heart in the course of CT of the chest often can provide important and clinically relevant information that is not otherwise easily available.
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Affiliation(s)
- John F Bruzzi
- Department of Radiology, Hospital Calmette, Boulevard Pr. J. Leclerq, Lille 59037, France
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Kanao S, Tadamura E, Yamamuro M, Kubo S, Kimura T, Kita T, Togashi K. Demonstration of Cardiac Involvement of Sarcoidosis by Contrast-Enhanced Multislice Computed Tomography and Delayed-Enhanced Magnetic Resonance Imaging. J Comput Assist Tomogr 2005; 29:745-8. [PMID: 16272844 DOI: 10.1097/01.rct.0000177519.25045.01] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Delayed-enhanced magnetic resonance (MR) imaging has recently been shown to be effective in detecting cardiac sarcoidosis. Two cases in which contrast-enhanced multislice computed tomography imaging clearly identified the localization and extension of cardiac sarcoidosis as delayed-enhanced MR imaging are presented.
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Affiliation(s)
- Shotaro Kanao
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Kurata A, Mochizuki T, Koyama Y, Haraikawa T, Suzuki J, Shigematsu Y, Higaki J. Myocardial perfusion imaging using adenosine triphosphate stress multi-slice spiral computed tomography: alternative to stress myocardial perfusion scintigraphy. Circ J 2005; 69:550-7. [PMID: 15849441 DOI: 10.1253/circj.69.550] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The present study was designed to: (i) detect myocardial ischemia in contrast enhanced multi-slice spiral computed tomography (CE-MSCT) using adenosine triphosphate (ATP) pharmacological stress test; and (ii) evaluate the potential of ATP stress CE-MSCT in a clinical setting. METHODS AND RESULTS Twelve patients underwent ATP stress CE-MSCT and stress thallium-201 myocardial perfusion scintigraphy (MPS) and 9 of the patients received conventional coronary angiography (CAG). Dual CE-MSCT scans were performed for stress and rest images, with and without intravenous infusion of ATP (0.16 mg.kg-1.min-1) at intervals of 20 min. Myocardial perfusion and coronary artery were visually evaluated using MSCT and compared the results obtained from MPS and CAG. Of 36 territories, stress images of CE-MSCT described 26 hypo-perfusion areas and MPS described 22 redistributions. The agreement between MSCT and MPS was 83% (30/36, p<0.05). In 141 coronary artery segments of 9 patients undergoing CAG, rest images of CE-MSCT, which had significantly higher assessability than stress images (89% vs 48%, p<0.05), described 76% (13/17) of culprit coronary stenoses. CONCLUSIONS Although CT-angiography should be currently assessed using rest images, ATP stress CE-MSCT can describe both ATP-induced myocardial ischemia and coronary artery stenoses in patients with coronary artery disease.
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Affiliation(s)
- Akira Kurata
- Second Department of Internal Medicine, Ehime University School of Medicine, Japan
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Francone M, Carbone I, Danti M, Lanciotti K, Cavacece M, Mirabelli F, Gaudio C, Catalano C, Passariello R. ECG-gated multi-detector row spiral CT in the assessment of myocardial infarction: correlation with non-invasive angiographic findings. Eur Radiol 2005; 16:15-24. [PMID: 16402255 DOI: 10.1007/s00330-005-2800-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2005] [Revised: 04/08/2005] [Accepted: 05/02/2005] [Indexed: 11/29/2022]
Abstract
Our objective was to retrospectively evaluate the ability of multidetector-row computed tomography (MDCT) to detect previous myocardial infarctions (MIs) and to correlate necrosis with the status of coronary arteries supplying the infarcted territory. After having clinically evaluated 187 patients referred for ECG-gated MDCT of the coronary arteries, 30 previous MIs were identified in 29 patients (9 recent and 21 chronic). MDCT data were evaluated qualitatively and quantitatively by measuring attenuation values and wall thickness within the infarcted region and normal adjacent myocardium. Each MI was also assigned to the distribution territory of a coronary vessel, and morphological data were combined with MDCT angiographic findings. MDCT was able to detect 25/30 MIs showing an overall sensitivity and specificity of 83 and 91%, respectively. Quantitative analysis revealed a statistically significant difference in attenuation values between normal and infarcted regions (38.9+/-14 HU vs. 104.0+/-16 HU). Regional wall thinning was observed in chronic MIs (4.1+/-2 mm vs. 10.5+/-3.8 mm), and not in patients with recent event (7.9+/-1.6 mm vs 9.1+/-4 mm). In 22/25 cases, MDCT angiographic findings showed the presence of suspicious critical lumen narrowing (n=3), previous coronary stenting (n=14) and surgical revascularization (n=5) in the infarct-related coronary. During a single examination, MDCT might provide comprehensive imaging of MI offering a combined morphological and angiographic assessment.
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Affiliation(s)
- Marco Francone
- Department of Radiological Sciences, University of Rome La Sapienza, V.le Regina Elena 324, 00161, Rome, Italy.
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