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Kersten J, Eberhardt N, Prasad V, Keßler M, Markovic S, Mörike J, Nita N, Stephan T, Tadic M, Tesfay T, Rottbauer W, Buckert D. Non-invasive Imaging in Patients With Chronic Total Occlusions of the Coronary Arteries-What Does the Interventionalist Need for Success? Front Cardiovasc Med 2021; 8:713625. [PMID: 34527713 PMCID: PMC8435679 DOI: 10.3389/fcvm.2021.713625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/06/2021] [Indexed: 10/26/2022] Open
Abstract
Chronic total occlusion (CTO) of coronary arteries is a common finding in patients with known or suspected coronary artery disease (CAD). Although tremendous advances have been made in the interventional treatment of CTOs over the past decade, correct patient selection remains an important parameter for achieving optimal results. Non-invasive imaging can make a valuable contribution. Ischemia and viability, two major factors in this regard, can be displayed using echocardiography, single-photon emission tomography, positron emission tomography, computed tomography, and cardiac magnetic resonance imaging. Each has its own strengths and weaknesses. Although most have been studied in patients with CAD in general, there is an increasing number of studies with positive preselectional factors for patients with CTOs. The aim of this review is to provide a structured overview of the current state of pre-interventional imaging for CTOs.
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Affiliation(s)
- Johannes Kersten
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Nina Eberhardt
- Department for Nuclear Medicine, University of Ulm, Ulm, Germany
| | - Vikas Prasad
- Department for Nuclear Medicine, University of Ulm, Ulm, Germany
| | - Mirjam Keßler
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Johannes Mörike
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Nicoleta Nita
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Tilman Stephan
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Marijana Tadic
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Temsgen Tesfay
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | | | - Dominik Buckert
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
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La Grutta L, Toia P, Maffei E, Cademartiri F, Lagalla R, Midiri M. Infarct characterization using CT. Cardiovasc Diagn Ther 2017; 7:171-188. [PMID: 28540212 DOI: 10.21037/cdt.2017.03.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Myocardial infarction (MI) is a major cause of death and disability worldwide. The incidence is not expected to diminish, despite better prevention, diagnosis and treatment, because of the ageing population in industrialized countries and unhealthy lifestyles in developing countries. Nowadays it is highly requested an imaging tool able to evaluate MI and viability. Technology improvements determined an expansion of clinical indications from coronary plaque evaluation to functional applications (perfusion, ischemia and viability after MI) integrating additional phases and information in the mainstream examination. Cardiac computed tomography (CCT) and cardiac MR (CMR) employ different contrast media, but may characterize MI with overlapping imaging findings due to the similar kinetics and tissue distribution of gadolinium and iodinated contrast media. CCT may detect first-pass perfusion defects, dynamic perfusion after pharmacological stress, and delayed enhancement (DE) of non-viable territories.
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Affiliation(s)
| | - Patrizia Toia
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, Canada
| | - Filippo Cademartiri
- Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, Canada.,Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roberto Lagalla
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
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Sheriff A, Schindler R, Vogt B, Abdel-Aty H, Unger JK, Bock C, Gebauer F, Slagman A, Jerichow T, Mans D, Yapici G, Janelt G, Schröder M, Kunze R, Möckel M. Selective apheresis of C-reactive protein: a new therapeutic option in myocardial infarction? J Clin Apher 2014; 30:15-21. [PMID: 25044559 DOI: 10.1002/jca.21344] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/17/2014] [Accepted: 06/20/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is substantial evidence that C-reactive protein (CRP) mediates secondary damage of the myocardium after acute myocardial infarction (AMI). The aim of this animal trial in pigs was to specifically deplete CRP from porcine plasma after AMI and to study possible beneficial effects of the reduced CRP concentration on the infarcted area. METHODS Ten pigs received balloon catheter-induced myocardial infarction. CRP was depleted from five animals utilizing a new specific CRP-adsorber, five animals served as controls. The area of infarction was analyzed by cardiovascular magnetic resonance imaging on day 1 and day 14 after AMI. Porcine CRP levels were determined by ELISA. RESULTS CRP-apheresis resulted in a mean reduction of the CRP levels up to 48.3%. The area of infarction was significantly reduced by 30 ± 6% (P = 0.003) within 14 days in the treatment group, whereas it increased by 19 ± 11% (P = 0.260) in the controls. Fourteen days after infarction, the infarcted area revealed compact, transmural scars in the controls, whereas animals receiving CRP-apheresis showed spotted scar morphology. In the interventional group, a significantly higher left ventricular ejection fraction (LVEF) was observed after 14 days as compared to the controls (57.6 ± 2.4% vs. 46.4 ± 2.7%; P = 0.007). CONCLUSIONS In a pig model for AMI, we observed that selective CRP-apheresis significantly reduces CRP levels and the volume of the infarction zone after AMI. Additionally, it changes the morphology of the scars and preserves cardiac output (LVEF).
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Affiliation(s)
- Ahmed Sheriff
- Department of Nephrology and Internal Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Weininger M, Renker M, Rowe GW, Abro JA, Costello P, Schoepf UJ. Integrative computed tomographic imaging of coronary artery disease. Expert Rev Cardiovasc Ther 2014; 9:27-43. [DOI: 10.1586/erc.10.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Spectral CT imaging of myocardial infarction: preliminary animal experience. Eur Radiol 2012; 23:133-8. [PMID: 22814826 DOI: 10.1007/s00330-012-2560-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 06/04/2012] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To evaluate the capability of spectral CT imaging to detect the different stages and angiogenesis of myocardial infarction (MI). METHODS MI was surgically induced in 40 rabbits that were evenly divided into four stages of MI: 6 h (6H), 3 days (3D), 7 days (7D) and 14 days (14D). Spectral CT was performed at 10 s, 1 min and 3 min after intravenous contrast medium administration. CD31 immunohistochemistry was used for the microvessel density (MVD) measurement. Iodine concentrations in the myocardium were measured and normalised to the aorta as nIC. The relationships between infarcted myocardial nIC and MVD were analysed. RESULTS The nIC of infarct myocardium decreased at 10 s and increased in late-phase CT images. There were significant differences between the 6H and other groups (P ( 6H-3D ) = 0.01, P ( 6H-7D ) = 0.01, P ( 6H-14D ) = 0.00). There was a significant difference in the MVD of infarct myocardium between the two groups except in the 7D and 14D groups (P = 0.08). In the 10-s phase, the nIC of infarct myocardium was negatively correlated with MVD (r = -0.54, P = 0.00), whereas in the late phases, there was a positive correlation between them (r = 0.57, P = 0.00 in the 1-min phase, r = 0.48, P = 0.00 in the 3-min phase). CONCLUSION Spectral CT imaging of the myocardium can be used to evaluate the different stages and angiogenesis of MI.
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CT of coronary heart disease: Part 1, CT of myocardial infarction, ischemia, and viability. AJR Am J Roentgenol 2012; 198:531-47. [PMID: 22357992 DOI: 10.2214/ajr.11.7082] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This article reviews the CT-based approaches aimed at the assessment of myocardial infarction, ischemia, and viability described in the recent literature. CONCLUSION Rapid advances in CT technology not only have improved visualization of coronary arteries but also increasingly enable noncoronary myocardial applications, including analysis of wall motion and the state of the myocardial blood supply. These advancements hold promise for eventually accomplishing the goal of comprehensively evaluating coronary heart disease with a single noninvasive modality.
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Accuracy of Dynamic Computed Tomography Adenosine Stress Myocardial Perfusion Imaging in Estimating Myocardial Blood Flow at Various Degrees of Coronary Artery Stenosis Using a Porcine Animal Model. Invest Radiol 2012; 47:71-7. [DOI: 10.1097/rli.0b013e31823fd42b] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Over recent decades, noninvasive imaging has become well established in the diagnostic work-up of patients suffering from myocardial infarction. It provides insights into the individual patient's prognosis and guides therapeutic decisions. MRI has long been considered the standard of reference in the noninvasive imaging of myocardial infarction. Only recently have different multidetector-row spiral computed tomography (MDCT) techniques successfully been evaluated for the visualization of myocardial infarction. This article describes different concepts of cardiac MDCT imaging in acute and chronic myocardial infarction. MDCT assessment of myocardial edema, myocardial perfusion and delayed myocardial contrast enhancement are introduced, with the latter evolving as key concept of viability imaging by means of MDCT. The current status of MDCT in the diagnostic work-up of myocardial infarction is reviewed.
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Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, D-52074 Aachen, Germany.
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Abstract
Recent advances in multidetector-row computed tomography (MDCT) technology have created new opportunities in cardiac imaging and provided new insights into a variety of disease states. Use of 64-slice coronary computed tomography angiography has been validated for the evaluation of clinically relevant coronary artery stenosis with high negative predictive values for ruling out significant obstructive disease. This technology has also advanced the care of patients with acute chest pain by simultaneous assessment of acute coronary syndrome, pulmonary embolism, and acute aortic syndrome ("triple rule out"). Although MDCT has been instrumental in the advancement of cardiac imaging, there are still limitations in patients with high or irregular heart rates. Newer MDCT scanner generations hold promise to improve some of these limitations for noninvasive cardiac imaging. The evaluation of coronary artery stenosis remains the primary clinical indication for cardiac computed tomography angiography. However, the use of MDCT for simultaneous assessment of coronary artery stenosis, atherosclerotic plaque formation, ventricular function, myocardial perfusion, and viability with a single modality is under intense investigation. Recent technical developments hold promise for accomplishing this goal and establishing MDCT as a comprehensive stand-alone test for integrative imaging of coronary heart disease.
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Goetti R, Feuchtner G, Stolzmann P, Donati OF, Wieser M, Plass A, Frauenfelder T, Leschka S, Alkadhi H. Delayed enhancement imaging of myocardial viability: low-dose high-pitch CT versus MRI. Eur Radiol 2011; 21:2091-9. [PMID: 21573970 DOI: 10.1007/s00330-011-2149-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 03/29/2011] [Accepted: 04/11/2011] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the accuracy of high-pitch delayed enhancement (DE) CT for the assessment of myocardial viability with MRI as the reference standard. METHODS Twenty-four patients (mean age 66.9 ± 9.2 years) with coronary artery disease underwent DE imaging with 128-slice dual-source CT (prospective electrocardiography (ECG)-triggering) and MRI at 1.5 T. Two observers assessed DE transmurality per segment, and measured signal intensity (MRI) or attenuation (CT) in infarcted and healthy myocardium and noise in the left ventricular blood pool for calculating contrast-to-noise ratios (CNR). RESULTS 75/408 (18.4%) segments in 18/24 patients (75.0%) showed DE in MRI, of which 28 segments in 10/24 (41.7%) patients were non-viable (scar tissue transmurality >50%). Sensitivity, specificity and accuracy of CT for diagnosis of non-viability were 60.7%, 96.8% and 94.4% per segment, and 90.0%, 92.9% and 91.7% per patient. CNR was significantly higher in MR (7.4 ± 3.0 vs. 4.6 ± 1.5; p = 0.018), and image noise significantly lower (11.6 ± 5.7 vs.15.0 ± 4.5; p = 0.019). Radiation dose of DECT was 0.89 ± 0.07 mSv. CONCLUSIONS CTDE imaging in the high-pitch mode enables myocardial viability assessment at a low radiation dose and good accuracy compared with MR, although associated with a lower CNR and higher noise.
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Affiliation(s)
- Robert Goetti
- Department of Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
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Qu X, Fang W, Ye J, Koh AS, Xu Y, Guan S, Li R, Shen Y. Acute and chronic myocardial infarction in a pig model: utility of multi-slice cardiac computed tomography in assessing myocardial viability and infarct parameters. Eur J Radiol 2011; 81:e431-7. [PMID: 21550194 DOI: 10.1016/j.ejrad.2011.03.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 03/13/2011] [Accepted: 03/16/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to determine the feasibility of multi-slice computed tomography (MSCT) biphasic imaging in assessing myocardial viability and infarct parameters in both acutely and chronically infarcted pig models. MATERIALS AND METHODS Seven pigs underwent ligation of the distal left anterior descending artery. Imaging was performed on the day of infarction and 3 months post-infarct, with contrast infusion followed by MSCT scan acquisition at different time-points. Left ventricular ejection fractions (LVEFs) were obtained by left ventriculography (LVG) after 3 months. Infarcted locations found using MSCT were compared with those obtained using SPECT. Infarcted areas were also analysed histopathologically and compared with the findings from MSCT. RESULTS Chronic phase images had perfusion defects with lower CT values relative to normal myocardium (43±10HU vs. 156±13HU, p=0.001) on the early images but no residual defects on delayed images. However, we found hyperenhancing regions on delayed images (244±20HU vs. 121±25HU, p=0.001), and good correlation between MSCT- and LVG-derived LVEFs (60.56±7.56%). The areas identified by MSCT corresponded to the location of (201)Tl SPECT-/pathologic staining-derived regions in all models. Infarct size was in good agreement with MSCT and pathological analyses of chronic phase models. CONCLUSIONS Necrotic myocardium in different stages after infarction could be qualitatively and quantitatively assessed using MSCT biphasic imaging, as could the status of microcirculation formation. MSCT-measured LVEFs matched well with other modalities, and hence MSCT is a useful tool in assessing post-infarct cardiac function.
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Affiliation(s)
- Xinkai Qu
- Department of Cardiology and Radiology, Shanghai Chest Hospital, Shanghai Jiaotong University, No. 241, West Huaihai Road, Shanghai, 200030, China
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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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Bauer RW, Kerl JM, Fischer N, Burkhard T, Larson MC, Ackermann H, Vogl TJ. Dual-Energy CT for the Assessment of Chronic Myocardial Infarction in Patients With Chronic Coronary Artery Disease: Comparison With 3-T MRI. AJR Am J Roentgenol 2010; 195:639-646. [DOI: 10.2214/ajr.09.3849] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Ralf W. Bauer
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - J. Matthias Kerl
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Nadine Fischer
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Thorsten Burkhard
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Maya C. Larson
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Hanns Ackermann
- Department of Medicine, Institute of Biostatistics and Mathematical Modeling, Clinic of the Goethe University, Frankfurt am Main, Germany
| | - Thomas J. Vogl
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
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The culprit lesion and its consequences: combined visualization of the coronary arteries and delayed myocardial enhancement in dual-source CT: a pilot study. Eur Radiol 2010; 20:2834-43. [DOI: 10.1007/s00330-010-1864-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Accepted: 05/04/2010] [Indexed: 01/10/2023]
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The correlation of 3D DT-MRI fiber disruption with structural and mechanical degeneration in porcine myocardium. Ann Biomed Eng 2010; 38:3084-95. [PMID: 20499182 DOI: 10.1007/s10439-010-0073-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 05/11/2010] [Indexed: 10/19/2022]
Abstract
Evaluation of structural parameters following a myocardial infarction (MI) is important to assess left ventricular function and remodeling. In this study, we assessed the capability of 3D diffusion tensor magnetic resonance imaging (DT-MRI) to assess tissue degeneration shortly after an MI using a porcine model of infarction. Two days after an induced infarction, hearts were explanted and immediately scanned by a 3T MRI scanner with a diffusion tensor imaging protocol. 3D fiber tracks and clustering models were generated from the diffusion-weighted imaging data. We found in a normal explanted heart that DT-MRI fibers showed a multilayered helical structure, with fiber architecture and fiber density reflecting the integrity of muscle fibers. For infarcted heart explants, we observed either a lack of fibers or disruption of fibers in the infarcted regions. Contours of the disrupted DT-MRI fibers were found to be consistent with the infarcted regions. Both histological and mechanical analysis of the infarcted hearts suggested DT-MRI fiber disruption correlated with altered microstructure and tissue mechanics. The ability of 3D DT-MRI to accurately distinguish viable myocardium from dead myocardium only 2 days post infarct without the use of radioisotopes or ionotropic agents makes it a promising approach to evaluate cardiac damage early post-MI.
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Mahnken AH, Bruners P, Bornikoel CM, Krämer N, Guenther RW. Assessment of myocardial edema by computed tomography in myocardial infarction. JACC Cardiovasc Imaging 2010; 2:1167-74. [PMID: 19833305 DOI: 10.1016/j.jcmg.2009.05.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 05/07/2009] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to analyze whether cardiac computed tomography (CT) permits the assessment of myocardial edema in acute myocardial infarction (MI). BACKGROUND Several studies proved the value of detecting myocardial edema from T2-weighted cardiac magnetic resonance (CMR) for differentiating acute from chronic MI. Computed tomography is suited for depicting MI, but there are no data on CT imaging of myocardial edema. We hypothesized that areas of reduced attenuation in acute MI may correspond to edema. METHODS In 7 pigs (55.2 +/- 7.3 kg), acute MI was induced using a closed chest model. Animals underwent unenhanced arterial and late-phase dual source computed tomography (DSCT) followed by T2-weighted and delayed contrast-enhanced CMR. Animals were sacrificed, and the excised hearts were stained with 2,3,5-triphenyltetrazolin chloride (TTC). Size of MI, contrast-to-noise ratio, and percent signal difference were compared among the different imaging techniques with concordance-correlation coefficients (rho(c)), Bland-Altman plots, and analysis of variance for repeated measures. RESULTS Infarction was transmural on all slices. On unenhanced, arterial, and late-phase DSCT, mean sizes of MI were 27.2 +/- 8.5%, 20.1 +/- 6.9%, and 23.1 +/- 8.2%, respectively. Corresponding values on T2-weighted and delayed enhanced CMR were 28.5 +/- 7.8% and 22.2 +/- 7.7%. Size of MI on TTC staining was 22.6 +/- 7.8%. Best agreement was observed when comparing late-phase CT (rho(c) = 0.9356) and delayed enhanced CMR (rho(c) = 0.9248) with TTC staining. There was substantial agreement between unenhanced DSCT and T2-weighted CMR (rho(c) = 0.8629). Unenhanced DSCT presented with the lowest percent signal difference (46.0 +/- 18.3) and the lowest contrast-to-noise ratio (4.7 +/- 2.0) between infarcted and healthy myocardium. CONCLUSIONS Unenhanced DSCT permits the detection of myocardial edema in large acute MI. Further studies including smaller MI in different coronary artery territories and techniques for improving the contrast-to-noise ratio are needed.
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Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic Radiology, RWTH Aachen University, Aachen, Germany.
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Bastarrika G, Lee YS, Huda W, Ruzsics B, Costello P, Schoepf UJ. CT of coronary artery disease. Radiology 2009; 253:317-38. [PMID: 19864526 DOI: 10.1148/radiol.2532081738] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Technical innovation is rapidly improving the clinical utility of cardiac computed tomography (CT) and will increasingly address current technical limitations, especially the association of this test with relatively high levels of radiation. Guidelines for appropriate indications are in place and are evolving, with an increasing evidence base to ensure the appropriate use of this modality. New technologies and new applications, such as myocardial perfusion imaging and dual-energy CT, are being explored and are widening the scope of coronary CT angiography from mere coronary artery assessment to the integrative analysis of cardiac morphology, function, perfusion, and viability. The scientific evaluation of coronary CT angiography has left the stage of feasibility testing and increasingly, evidence-based data are accumulating on outcomes, prognosis, and cost-effectiveness. In this review, these developments will be discussed in the context of current pivotal transitions in cardiovascular disease management and their potential influence on the current role and future fate of coronary CT angiography will be examined.
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Affiliation(s)
- Gorka Bastarrika
- Department of Radiology and Division of Cardiology, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29401, USA
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Bastarrika G, Schoepf UJ. [Clinical applications of computed tomography coronary angiography]. RADIOLOGIA 2009; 51:457-68. [PMID: 19748109 DOI: 10.1016/j.rx.2009.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 06/24/2009] [Accepted: 06/29/2009] [Indexed: 11/16/2022]
Abstract
The clinical applications of computed tomography coronary angiography (CTCA) are constantly evolving. Initially employed to quantify coronary artery calcification, multidetector CT also makes it possible to evaluate the anatomy and anatomical variations of coronary circulation, rule out coronary disease, and follow up surgical and percutaneous revascularization procedures. Moreover, CTCA may potentially be useful to quantify ventricular function, characterize non-calcified atherosclerotic plaques, and analyze myocardial perfusion and viability, providing anatomical, morphological, and functional information in patients with suspected ischemic heart disease.
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Affiliation(s)
- G Bastarrika
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, España.
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Vernhet Kovacsik H, Jacquier A, Gaubert JY, Paul J, Dupouy P, Cluzel P, Hamon M. [Technological advances in cardiac CT]. JOURNAL DE RADIOLOGIE 2009; 90:1161-1171. [PMID: 19752826 DOI: 10.1016/s0221-0363(09)73262-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The SFR-SFC presents guidelines dedicated to cardiac and coronary imaging using CT in the area of indications, technological requirement including both hardware and software, patient conditioning, CT protocols and related results concerning radiation dose, image quality and diagnostic value. These guidelines are based either on up-dated medical literature proofs and/or on expert consensus.
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Affiliation(s)
- H Vernhet Kovacsik
- Service de Radiologie, Hôpital Arnaud de Villeneuve, 371 Avenue Doyen Gaston Giraud, 34295 Montpellier cedex 05, France.
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Évolutions technologiques en tomodensitométrie cardiaque. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2009. [DOI: 10.1016/s1878-6480(09)70354-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Evaluation of myocardial viability by multidetector CT. J Cardiovasc Comput Tomogr 2009; 3:S2-12. [DOI: 10.1016/j.jcct.2008.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 09/17/2008] [Accepted: 10/01/2008] [Indexed: 01/28/2023]
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Multidetector computed tomography (MDCT) evaluation of myocardial viability: intraindividual comparison of monomeric vs. dimeric contrast media in a rabbit model. Eur Radiol 2008; 19:290-7. [DOI: 10.1007/s00330-008-1150-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 07/17/2008] [Accepted: 07/24/2008] [Indexed: 10/21/2022]
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MDCT of the myocardium: a new contribution to ischemic heart disease. Acad Radiol 2008; 15:477-87. [PMID: 18342773 DOI: 10.1016/j.acra.2007.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Revised: 11/07/2007] [Accepted: 11/08/2007] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES Despite the progress made in diagnosis and treatment, cardiovascular diseases remain the main cause of death worldwide. MATERIALS AND METHODS Multidetector row computed tomography (MDCT) provides several diagnostic insights, namely assessment of coronary artery anatomy and measurement of left ventricular volume and function. The ability of CT to show myocardial infarcted areas as an enhanced territory was described in the late 1970s in an animal model. RESULTS This method found a second wind with the arrival of MDCT technology that led to its clinical application. Several authors describe the ability of MDCT to assess myocardial injury both in animals and humans. The MDCT assessment of myocardial late enhancement is based on the same principle as delayed enhancement MRI. CONCLUSIONS The aim of this review is to cover the technical aspects of cardiac MDCT in assessing the myocardium and its potential in diagnosing ischemic heart disease.
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