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Oyama-Manabe N, Oda S, Ohta Y, Takagi H, Kitagawa K, Jinzaki M. Myocardial late enhancement and extracellular volume with single-energy, dual-energy, and photon-counting computed tomography. J Cardiovasc Comput Tomogr 2024; 18:3-10. [PMID: 38218665 DOI: 10.1016/j.jcct.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 01/15/2024]
Abstract
Computed tomography late enhancement (CT-LE) is emerging as a non-invasive technique for cardiac diagnosis with wider accessibility compared to MRI, despite its typically lower contrast-to-noise ratio. Optimizing CT-LE image quality necessitates a thorough methodology addressing contrast administration, timing, and radiation dose, alongside a robust understanding of extracellular volume (ECV) quantification methods. This review summarizes CT-LE protocols, clinical utility, and advances in ECV measurement through both single-energy and dual-energy CT. It also highlights photon-counting detector CT technology as an innovative means to potentially improve image quality and reduce radiation exposure.
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Affiliation(s)
- Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasutoshi Ohta
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hidenobu Takagi
- Department of Advanced Radiological Imaging Collaborative Research, Tohoku University, Sendai, Japan; Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Hospital, Tsu, Japan.
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Enhancement patterns detected by multidetector computed tomography are associated with the long-term prognosis of patients with acute myocardial infarction. Heart Vessels 2021; 36:1784-1793. [PMID: 33997914 DOI: 10.1007/s00380-021-01868-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
The present study investigated the clinical value of myocardial contrast-delayed enhancement (DE) with multidetector computed tomography (MDCT) without iodine re-injection immediately after primary percutaneous coronary intervention (PCI) for predicting future cardiovascular events after acute myocardial infarction (AMI). We performed a prospective study in which 263 consecutive patients with first AMI successfully treated with primary PCI were enrolled. Sixty-four-slice MDCT without the re-injection of contrast medium was performed immediately after PCI. Myocardial DE was considered to be transmural when involving myocardial thickness ≥ 75% (Group A; n = 104), subendocardial (< 75%, Group B; n = 108), or normal (Group C; n = 51). A semiquantitative scale score was defined for 17 left ventricular segments to investigate the extent of the DE area assessed. We examined the relationship between the presence or absence of transmural DE and long-term cardiovascular event rates. The median follow-up period was 3.5 years. Kaplan-Meier survival curves showed that patient prognosis was poorer in the group with Group A than that in the group with Group B, which was equivalent to that with Group C. A multivariate analysis identified the presence of transmural DE as the strongest predictor for future cardiovascular events (hazard ratio: 3.7; P = 0.023). Transmural myocardial DE immediately following primary PCI without an iodine re-injection for AMI is a major risk factor for future cardiovascular events.
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Cobo AA, Margallo FMS, Díaz CB, Blázquez VB, Bueno IG, Crisóstomo V. Anesthesia Protocols used to Create Ischemia Reperfusion Myocardial Infarcts in Swine. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE 2020; 59:478-487. [PMID: 32709259 DOI: 10.30802/aalas-jaalas-19-000137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The porcine ischemia-reperfusion model is one of the most commonly used for cardiology research and for testing interventions for myocardial regeneration. In creating ischemic reperfusion injury, the anesthetic protocol is important for assuring hemodynamic stability of the animal during the induction of the experimental lesion and may affect its postoperative survival. This paper reviews the many drugs and anesthetic protocols used in recent studies involving porcine models of ischemiareperfusion injury. The paper also summarizes the most important characteristics of some commonly used anesthetic drugs. Literature was selected for inclusion in this review if the authors described the anesthetic protocol used and also reported the mortality rate attributed to the creation of the model. This information is an important consideration because the anesthetic protocol can influence hemodynamic stability during the experimental induction of an acute myocardial infarction, thereby impacting the survival rate and affecting the number of animals needed for each study.
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Affiliation(s)
- Ana Abad Cobo
- Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain;,
| | | | - Claudia Báez Díaz
- Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain; CIBERCV, Madrid, Spain
| | | | | | - Verónica Crisóstomo
- Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain; CIBERCV, Madrid, Spain
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Watabe H, Sato A, Sugano A, Takaiwa Y, Harunari T, Aihara H, Fumikura Y, Hoshi T, Yoshida K, Nishina H, Maruo K, Takeyasu N, Noguchi Y, Aonuma K, Ieda M. DE-MDCT Predicts Regional Functional Improvement After Reperfused AMI. JACC Cardiovasc Imaging 2019; 13:518-519. [PMID: 31607662 DOI: 10.1016/j.jcmg.2019.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/12/2019] [Accepted: 08/20/2019] [Indexed: 11/26/2022]
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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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Rodriguez-Granillo GA. Delayed enhancement cardiac computed tomography for the assessment of myocardial infarction: from bench to bedside. Cardiovasc Diagn Ther 2017; 7:159-170. [PMID: 28540211 DOI: 10.21037/cdt.2017.03.16] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A large number of studies support the increasingly relevant prognostic value of the presence and extent of delayed enhancement (DE), a surrogate marker of fibrosis, in diverse etiologies. Gadolinium and iodinated based contrast agents share similar kinetics, thus leading to comparable myocardial characterization with cardiac magnetic resonance (CMR) and cardiac computed tomography (CT) at both first-pass perfusion and DE imaging. We review the available evidence of DE imaging for the assessment of myocardial infarction (MI) using cardiac CT (CTDE), from animal to clinical studies, and from 16-slice CT to dual-energy CT systems (DECT). Although both CMR and gadolinium agents have been originally deemed innocuous, a number of concerns (though inconclusive and very rare) have been recently issued regarding safety issues, including DNA double-strand breaks related to CMR, and gadolinium-associated nephrogenic systemic fibrosis and deposition in the skin and certain brain structures. These concerns have to be considered in the context of non-negligible rates of claustrophobia, increasing rates of patients with implantable cardiac devices, and a number of logistic drawbacks compared with CTDE, such as higher costs, longer scanning times, and difficulties to scan patients with impaired breath-holding capabilities. Overall, these issues might encourage the role of CTDE as an alternative for DE-CMR in selected populations.
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Abstract
Non-Doppler, 2-dimensional strain imaging is a new echocardiographic technique for obtaining strain and strain rate measurements, which serves as a major advancement in understanding myocardial deformation. It analyzes motion in ultrasound imaging by tracking speckles in 2 dimensions. There are a lot of data emerging with multiple applications of strain imaging in the clinical practice of echocardiography. As incorporation of strain imaging in daily practice has been challenging, we intend to systematically highlight the top 10 applications of speckle-tracking echocardiography, which every cardiologist should be aware of: chemotherapy cardiotoxicity, left ventricular assessment, cardiac amyloidosis, hypertrophic obstructive cardiomyopathy, right ventricular dysfunction, valvular heart diseases (aortic stenosis and mitral regurgitation), cardiac sarcoidosis, athlete heart, left atrial assessment, and cardiac dyssynchrony.
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Khurelsukh K, Kim YH, Seon HJ, Song JH, Park SY, Moon SM, Kim SH, Sim DS, Ahn Y. Non-contrast cardiac CT immediately after percutaneous coronary intervention: does it predict the risk of left ventricular remodeling in patients with ST-elevation myocardial infarction? Int J Cardiovasc Imaging 2016; 32 Suppl 1:147-54. [PMID: 27139462 DOI: 10.1007/s10554-016-0900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
To assess the clinical utility of non-contrast cardiac CT (CCT) immediately after successful percutaneous coronary intervention (PCI) for predicting the risk of left ventricle (LV) remodeling in the management of patients with acute myocardial infarction (AMI), 35 patients with AMI underwent non-contrast CCT immediately after PCI. Volume and transmural extent of myocardial delayed enhancement (DE) were assessed on non-contrast CCT. Serial echocardiography and serologic biomarkers were evaluated at baseline and at 2 and 12 months after AMI. Based on an increase in left ventricular end-diastolic volume (LVEDV) ≥20 % at 2 months, patients were classified into two groups: LV remodeling (group 1, n = 14) and no LV remodeling (group 2, n = 21). Clinical characteristics, imaging parameters, and serologic biomarkers were compared between the two groups. Higher incidence of hypertension, longer time to reperfusion, and higher Killip classification at admission were observed for group 1 than for group 2, but these differences were not statistically significant (P > 0.05). Greater volume and transmural extent of DE on non-contrast CCT and poorer resolution of ST-segment elevation on ECG were observed in group 1 compared to group 2, but these results were not statistically significant (P > 0.05). Measurement of biochemical markers showed that probrain natriuretic peptide (proBNP), initial high sensitivity C reactive protein (hs-CRP), and maximum troponin T level were significantly higher in group 1 than in group 2 (P < 0.05) at 2 months. Based on the trend of greater volume and transmural extent of DE in group 1 compared to group 2, non-contrast CCT immediately after PCI, in combination with serologic biomarkers (proBNP, hs-CRP, and troponin T) might be useful for managing patients with AMI.
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Affiliation(s)
- Khulan Khurelsukh
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea.
| | - Hyun Ju Seon
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Jang Hyun Song
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Seo Yeon Park
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Sung Min Moon
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Soo Hyun Kim
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
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Melero-Ferrer JL, López-Vilella R, Morillas-Climent H, Sanz-Sánchez J, Sánchez-Lázaro IJ, Almenar-Bonet L, Martínez-Dolz L. Novel Imaging Techniques for Heart Failure. Card Fail Rev 2016; 2:27-34. [PMID: 28875038 DOI: 10.15420/cfr.2015:29:2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Imaging techniques play a main role in heart failure (HF) diagnosis, assessment of aetiology and treatment guidance. Echocardiography is the method of choice for its availability, cost and it provides most of the information required for the management and follow up of HF patients. Other non-invasive cardiac imaging modalities, such as cardiovascular magnetic resonance (CMR), nuclear imaging-positron emission tomography (PET) and single-photon emission computed tomography (SPECT) and computed tomography (CT) could provide additional aetiological, prognostic and therapeutic information, especially in selected populations. This article reviews current indications and possible future applications of imaging modalities to improve the management of HF patients.
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Affiliation(s)
- Josep L Melero-Ferrer
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Raquel López-Vilella
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Herminio Morillas-Climent
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Jorge Sanz-Sánchez
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Ignacio J Sánchez-Lázaro
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Luis Almenar-Bonet
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Luis Martínez-Dolz
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
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Watabe H, Sato A, Nishina H, Hoshi T, Sugano A, Kakefuda Y, Takaiwa Y, Aihara H, Fumikura Y, Noguchi Y, Aonuma K. Enhancement patterns detected by multidetector computed tomography are associated with microvascular obstruction and left ventricular remodelling in patients with acute myocardial infarction. Eur Heart J 2015; 37:684-92. [PMID: 26385959 DOI: 10.1093/eurheartj/ehv467] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 08/20/2015] [Indexed: 12/22/2022] Open
Abstract
AIMS This study evaluated the clinical value of myocardial contrast-delayed enhancement (DE) with multidetector computed tomography (MDCT) for detecting microvascular obstruction (MVO) and left ventricular (LV) remodelling revealed by DE magnetic resonance imaging after acute myocardial infarction (AMI). METHODS AND RESULTS In 92 patients with first AMI, MDCT without iodine reinjection was performed immediately following successful percutaneous coronary intervention (PCI). Delayed-enhancement magnetic resonance imaging performed in the acute and chronic phases was used to detect MVO and LV remodelling (any increase in LV end-systolic volume at 6 months after infarction compared with baseline). Patients were divided into two groups according to the presence (n = 33) or absence (n = 59) of heterogeneous enhancement (HE). Heterogeneous enhancement was defined as concomitant presence of hyper- and hypoenhancement within the infarcted myocardium on MDCT. Microvascular obstruction and LV remodelling were detected in 49 (53%) and 29 (32%) patients, respectively. In a multivariable analysis, HE and a relative CT density >2.20 were significant independent predictors for MVO [odds ratio (OR) 13.5; 95% confidence interval (CI), 2.15-84.9; P = 0.005 and OR 12.0; 95% CI, 2.94-49.2; P < 0.001, respectively). The presence of HE and relative CT density >2.20 showed a high positive predictive value of 93%, and the absence of these two findings yielded a high negative predictive value of 90% for the predictive value of MVO. Heterogeneous enhancement was significantly associated with LV remodelling (OR 6.75; 95% CI, 1.56-29.29; P = 0.011). CONCLUSION Heterogeneous enhancement detected by MDCT immediately after primary PCI may provide promising information for predicting MVO and LV remodelling in patients with AMI.
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Affiliation(s)
- Hiroaki Watabe
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Akira Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Tomoya Hoshi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Akinori Sugano
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Yuki Kakefuda
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Yui Takaiwa
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Hideaki Aihara
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Yuko Fumikura
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Yuichi Noguchi
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
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Jang Y, Cho I, Hartaigh BWÓ, Park SI, Hong Y, Shin S, Ha S, Jeon B, Jung H, Shim H, Min JK, Chang HJ, Jang Y, Chung N. Viability assessment after conventional coronary angiography using a novel cardiovascular interventional therapeutic CT system: Comparison with gross morphology in a subacute infarct swine model. J Cardiovasc Comput Tomogr 2015; 9:321-328. [PMID: 26088379 DOI: 10.1016/j.jcct.2015.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 03/30/2015] [Accepted: 04/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Given the lack of promptness and inevitable use of additional contrast agents, the myocardial viability imaging procedures have not been used widely for determining the need to performing revascularization. OBJECTIVE This study is aimed to evaluate the feasibility of myocardial viability assessment, consecutively with diagnostic invasive coronary angiography (ICA) without use of additional contrast agent, using a novel hybrid system comprising ICA and multislice CT (MSCT). METHODS In all, 14 Yucatan miniature swine models (female; age, 3 months; weight, 28-30 kg) were subjected to ICA followed by balloon occlusion (90 minutes) and reperfusion of the left anterior descending coronary artery. Two weeks after induction of myocardial infarction, delayed hyperenhancement (DHE) images were obtained, using a novel combined machine comprising ICA and 320-channel MSCT scanner (Aquilion ONE, Toshiba), after 2, 5, 7, 10, 15, and 20 minutes after conventional ICA. The heart was sliced in 10-mm consecutive sections in the short-axis plane and was embedded in a solution of 1% triphenyltetrazolium chloride (TTC). Infarct size was determined as TTC-negative areas as a percentage of total left ventricular area. On MSCT images, infarct size per slice was calculated by dividing the DHE area by the total slice area (%) and compared with histochemical analyses. RESULTS Serial MSCT scans revealed a peak CT attenuation of the infarct area (222.5 ± 36.5 Hounsfield units) with a maximum mean difference in CT attenuation between the infarct areas and normal myocardium of at 2 minutes after contrast injection (106.4; P for difference = 0.002). Furthermore, the percentage difference of infarct size by MSCT vs histopathologic specimen was significantly lower at 2 (8.5% ± 1.8%) and 5 minutes (9.5% ± 1.9%) than those after 7 minutes. Direct comparisons of slice-matched DHE area by MSCT demonstrated excellent correlation with TTC-derived infarct size (r = 0.952; P < .001). Bland-Altman plots of the differences between DHE by MSCT and TTC-derived infarct measurements plotted against their means showed good agreement between the 2 methods. CONCLUSION The feasibility of myocardial viability assessment by DHE using MSCT after conventional ICA was proven in experimental models, and the optimal viability images were obtained after 2 to 5 minutes after the final intracoronary injection of contrast agent for conventional ICA.
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Affiliation(s)
- Yeonggul Jang
- Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, Korea
| | - Iksung Cho
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Korea
| | - Bríain W Ó Hartaigh
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.,Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, Adler Geriatric Center, New Haven, CT, USA
| | - Se-Il Park
- Cardiovascular Product Evaluation Center, Yonsei University College of Medicine, Seoul, Korea
| | - Youngtaek Hong
- Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, Korea
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Korea
| | - Seongmin Ha
- Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, Korea
| | - Byunghwan Jeon
- Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, Korea
| | - Hoyup Jung
- Department of Computer Science and Engineering, Hankuk University of Foreign Studies, Kyonggi, 449-791, Korea
| | - Hackjoon Shim
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Korea
| | - Namsik Chung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
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12
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Ling Z, McManigle J, Zipunnikov V, Pashakhanloo F, Khurram IM, Zimmerman SL, Philips B, Marine JE, Spragg DD, Ashikaga H, Calkins H, Nazarian S. The association of left atrial low-voltage regions on electroanatomic mapping with low attenuation regions on cardiac computed tomography perfusion imaging in patients with atrial fibrillation. Heart Rhythm 2015; 12:857-64. [PMID: 25595922 DOI: 10.1016/j.hrthm.2015.01.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies have shown that contrast-enhanced multidetector computed tomography (CE-MDCT) could identify ventricular fibrosis after myocardial infarction. However, whether CE-MDCT can characterize atrial low-voltage regions remains unknown. OBJECTIVE The purpose of this study was to examine the association of CE-MDCT image attenuation with left atrial (LA) low bipolar voltage regions in patients undergoing repeat ablation for atrial fibrillation recurrence. METHODS We enrolled 20 patients undergoing repeat ablation for atrial fibrillation recurrence. All patients underwent preprocedural 3-dimensional CE-MDCT of the LA, followed by voltage mapping (>100 points) of the LA during the ablation procedure. Epicardial and endocardial contours were manually drawn around LA myocardium on multiplanar CE-MDCT axial images. Segmented 3-dimensional images of the LA myocardium were reconstructed. Electroanatomic map points were retrospectively registered to the corresponding CE-MDCT images. RESULTS A total of 2028 electroanatomic map points obtained in sinus rhythm from the LA endocardium were registered to the segmented LA wall CE-MDCT images. In a linear mixed model, each unit increase in the local image attenuation ratio was associated with 25.2% increase in log bipolar voltage (P = .046) after adjusting for age, sex, body mass index, and LA volume, as well as clustering of data by patient and LA regions. CONCLUSION We demonstrate that the image attenuation ratio derived from CE-MDCT is associated with LA bipolar voltage. The potential ability to image fibrosis via CE-MDCT may provide a useful alternative in patients with contraindications to magnetic resonance imaging.
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Affiliation(s)
- Zhiyu Ling
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - John McManigle
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Vadim Zipunnikov
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Irfan M Khurram
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | | | - Binu Philips
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Joseph E Marine
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - David D Spragg
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Hiroshi Ashikaga
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Hugh Calkins
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Saman Nazarian
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.
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Kochav J, Simprini L, Weinsaft JW. Imaging of the right heart--CT and CMR. Echocardiography 2014; 32 Suppl 1:S53-68. [PMID: 25244072 DOI: 10.1111/echo.12212] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Right ventricular (RV) structure and function is of substantial importance in a broad variety of clinical conditions. Cardiac magnetic resonance (CMR) and computed tomography (CT) each provide three-dimensional RV imaging, high-resolution evaluation of RV structure/anatomy, and accurate functional assessment without geometric assumptions. This is of particular significance for the RV, where complex geometry compromises reliance on indices derived from two-dimensional (2D) imaging planes. CMR flow-based imaging can be applied to right-sided heart valves, enabling evaluation of hemodynamic and valvular dysfunction that may contribute to or result from RV dysfunction. Tissue characterization imaging by both CMR and CT provides valuable complementary assessment of the RV. Changes in myocardial tissue composition provide a mechanistic substrate for RV dysfunction and cardiac arrhythmias. This review provides an overview of RV imaging by both CMR and CT, with focus on assessment of RV structure/function, flow, and tissue characterization. Emerging evidence and established guidelines are discussed in the context of imaging contributions to diagnosis, prognostic risk stratification and disease management of clinical conditions that impact the right ventricle.
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Affiliation(s)
- Jonathan Kochav
- Duke University School of Medicine, Durham, North Carolina; Weill Cornell Medical College, New York, New York
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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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Rossi A, Merkus D, Klotz E, Mollet N, de Feyter PJ, Krestin GP. Stress Myocardial Perfusion: Imaging with Multidetector CT. Radiology 2014; 270:25-46. [DOI: 10.1148/radiol.13112739] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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TNM-like classification: a new proposed method for heart failure staging. ScientificWorldJournal 2013; 2013:175925. [PMID: 24376377 PMCID: PMC3859030 DOI: 10.1155/2013/175925] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 09/29/2013] [Indexed: 11/18/2022] Open
Abstract
Heart Failure (HF) is an acute or chronic syndrome, that causes a lot of damaging effects to every system. The involvement of different systems is variably related to age and others comorbidities. The severity of organ damage is often proportional to the duration of heart failure. The typology of HF and the duration determine which organs will be affected and vice versa the severity of organ damage supplies precious information about prognosis and outcome of patients with heart failure. Moreover, a classification based not only on symptomatic and syndromic typical features of heart failure, but also on functional data of each system, could allow us to apply the most appropriate therapies, to obtain a more accurate prognosis, and to employ necessary and not redundant human and financial resources. With an eye on the TNM staging used in oncology, we drawn up a classification that will consider the different involvement of organs such as lungs, kidneys, and liver in addition to psychological pattern and quality of life in HF patients. For all these reasons, it is our intention to propose a valid and more specific classification available for the clinical staging of HF that takes into account pathophysiological and structural changes that can remark prognosis and management of HF.
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Dwivedi G, Al-Shehri H, deKemp RA, Ali I, Alghamdi AA, Klein R, Scullion A, Ruddy TD, Beanlands RS, Chow BJ. Scar imaging using multislice computed tomography versus metabolic imaging by F-18 FDG positron emission tomography: A pilot study. Int J Cardiol 2013; 168:739-45. [DOI: 10.1016/j.ijcard.2012.09.218] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 09/24/2012] [Accepted: 09/29/2012] [Indexed: 11/26/2022]
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Patel AR, Bhave NM, Mor-Avi V. Myocardial perfusion imaging with cardiac computed tomography: state of the art. J Cardiovasc Transl Res 2013; 6:695-707. [PMID: 23963959 DOI: 10.1007/s12265-013-9499-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/07/2013] [Indexed: 10/26/2022]
Abstract
Cardiac computed tomography (CCT) has become an important tool for the anatomic assessment of patients with suspected coronary disease. Its diagnostic accuracy for detecting the presence of underlying coronary artery disease and ability to risk stratify patients are well documented. However, the role of CCT for the physiologic assessment of myocardial perfusion during resting and stress conditions is only now emerging. With the addition of myocardial perfusion imaging to coronary imaging, CCT has the potential to assess both coronary anatomy and its functional significance with a single non-invasive test. In this review, we discuss the current state of CCT myocardial perfusion imaging for the detection of myocardial ischemia and myocardial infarction and examine its complementary role to CCT coronary imaging.
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Affiliation(s)
- Amit R Patel
- Department of Medicine, Section of Cardiology, Cardiac Imaging Center, University of Chicago, Medical Center, 5841 South Maryland Avenue, MC5084, Chicago, IL, 60637, USA,
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Zhu W, Liu W, Tong Y, Xiao J. Three-Dimensional Speckle Tracking Echocardiography for the Evaluation of the Infarct Size and Segmental Transmural Involvement in Patients with Acute Myocardial Infarction. Echocardiography 2013; 31:58-66. [PMID: 23953025 DOI: 10.1111/echo.12284] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Wenhui Zhu
- Department of Medical Ultrasonics; The Third Xiangya Hospital of Central South University; Changsha China
| | - Wengang Liu
- Department of Medical Ultrasonics; The Third Xiangya Hospital of Central South University; Changsha China
| | - Yan Tong
- Department of Medical Ultrasonics; The Third Xiangya Hospital of Central South University; Changsha China
| | - Jidong Xiao
- Department of Medical Ultrasonics; The Third Xiangya Hospital of Central South University; Changsha China
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Bengel FM, George RT, Schuleri KH, Lardo AC, Wollert KC. Image-guided therapies for myocardial repair: concepts and practical implementation. Eur Heart J Cardiovasc Imaging 2013; 14:741-51. [PMID: 23720377 DOI: 10.1093/ehjci/jet038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cell- and molecule-based therapeutic strategies to support wound healing and regeneration after myocardial infarction (MI) are under development. These emerging therapies aim at sustained preservation of ventricular function by enhancing tissue repair after myocardial ischaemia and reperfusion. Such therapies will benefit from guidance with regard to timing, regional targeting, suitable candidate selection, and effectiveness monitoring. Such guidance is effectively obtained by non-invasive tomographic imaging. Infarct size, tissue characteristics, muscle mass, and chamber geometry can be determined by magnetic resonance imaging and computed tomography. Radionuclide imaging can be used for the tracking of therapeutic agents and for the interrogation of molecular mechanisms such as inflammation, angiogenesis, and extracellular matrix activation. This review article portrays the hypothesis that an integrated approach with an early implementation of structural and molecular tomographic imaging in the development of novel therapies will provide a framework for achieving the goal of improved tissue repair after MI.
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Affiliation(s)
- Frank M Bengel
- Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
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Sharma A, Arbab-Zadeh A. Assessment of coronary heart disease by CT angiography: current and evolving applications. J Nucl Cardiol 2012; 19:796-806. [PMID: 22527798 DOI: 10.1007/s12350-012-9556-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Computed tomography angiography (CTA) of the heart is a rapidly evolving application for comprehensive assessment of coronary arterial anatomy, myocardial function, perfusion, and myocardial viability. Thus, cardiac CTA is capable of retrieving the most critical information for guiding the management of patients with suspected coronary heart disease (CHD). Ongoing technologic advancements have allowed acquiring such information within minutes, at radiation doses that are lower than those from conventional computed tomography imaging or common nuclear imaging techniques. Cardiac CTA has positioned itself as an imaging modality that may be well suited to fulfill central needs of cardiovascular medicine. This article reviews the evidence for the clinical utility of cardiac CTA in patients with suspected CHD.
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Affiliation(s)
- Abhishek Sharma
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
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Estornell-Erill J, Igual-Muñoz B, Monmeneu-Menadas JV, Soriano-Navarro C, Valle-Muñoz A, Vilar-Herrero JV, Perez-Bosca L, Paya-Serrano R, Martinez-Alzamora N, Ridocci-Soriano F. Diagnóstico etiológico de la disfunción ventricular izquierda con tomografía computarizada: comparación con coronariografía y cardiorresonancia. Rev Esp Cardiol 2012; 65:517-24. [DOI: 10.1016/j.recesp.2011.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 07/11/2011] [Indexed: 11/16/2022]
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Berliner JI, Kino A, Carr JC, Bonow RO, Choudhury L. Cardiac computed tomographic imaging to evaluate myocardial scarring/fibrosis in patients with hypertrophic cardiomyopathy: a comparison with cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 2012; 29:191-7. [DOI: 10.1007/s10554-012-0048-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 03/28/2012] [Indexed: 10/28/2022]
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Schuleri KH, Centola M, Choi SH, Evers KS, Dawoud F, George RT, Lima JAC, Lardo AC. CT for evaluation of myocardial cell therapy in heart failure: a comparison with CMR imaging. JACC Cardiovasc Imaging 2012; 4:1284-93. [PMID: 22172785 DOI: 10.1016/j.jcmg.2011.09.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 08/29/2011] [Accepted: 09/02/2011] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to use multidetector computed tomography (MDCT) to assess therapeutic effects of myocardial regenerative cell therapies. BACKGROUND Cell transplantation is being widely investigated as a potential therapy in heart failure. Noninvasive imaging techniques are frequently used to investigate therapeutic effects of cell therapies in the preclinical and clinical settings. Previous studies have shown that cardiac MDCT can accurately quantify myocardial scar tissue and determine left ventricular (LV) volumes and ejection fraction (LVEF). METHODS Twenty-two minipigs were randomized to intramyocardial injection of phosphate-buffered saline (placebo, n = 9) or 200 million mesenchymal stem cells (MSC, n = 13) 12 weeks after myocardial infarction (MI). Cardiac magnetic resonance and MDCT acquisitions were performed before randomization (12 weeks after MI induction) and at the study endpoint 24 weeks after MI induction. None of the animals received medication to control the intrinsic heart rate during first-pass acquisitions for assessment of LV volumes and LVEF. Delayed-enhancement MDCT imaging was performed 10 min after contrast delivery. Two blinded observers analyzed MDCT acquisitions. RESULTS MDCT demonstrated that MSC therapy resulted in a reduction of infarct size from 14.3 ± 1.2% to 10.3 ± 1.5% of LV mass (p = 0.005), whereas infarct size increased in nontreated animals (from 13.8 ± 1.3% to 16.5 ± 1.5%; p = 0.02) (placebo vs. MSC; p = 0.003). Both observers had excellent agreement for infarct size (r = 0.96; p < 0.001). LVEF increased from 32.6 ± 2.2% to 36.9 ± 2.7% in MSC-treated animals (p = 0.03) and decreased in placebo animals (from 33.3 ± 1.4% to 29.1 ± 1.5%; p = 0.01; at week 24: placebo vs. MSC; p = 0.02). Infarct size, end-diastolic LV volume, and LVEF assessed by MDCT compared favorably with those assessed by cardiac magnetic resonance acquisitions (r = 0.70, r = 0.82, and r = 0.902, respectively; p < 0.001). CONCLUSIONS This study demonstrated that cardiac MDCT can be used to evaluate infarct size, LV volumes, and LVEF after intramyocardial-delivered MSC therapy. These findings support the use of cardiac MDCT in preclinical and clinical studies for novel myocardial therapies.
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Affiliation(s)
- Karl H Schuleri
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21205, USA.
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Clinical indications for cardiac computed tomography. From the Working Group of the Cardiac Radiology Section of the Italian Society of Medical Radiology (SIRM). Radiol Med 2012; 117:901-38. [PMID: 22466874 DOI: 10.1007/s11547-012-0814-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 09/14/2011] [Indexed: 12/13/2022]
Abstract
Cardiac computed tomography (CCT) has grown as a useful means in different clinical contexts. Technological development has progressively extended the indications for CCT while reducing the required radiation dose. Even today there is little documentation from the main international scientific societies describing the proper use and clinical indications of CCT; in particular, there are no complete guidelines. This document reflects the position of the Working Group of the Cardiac Radiology Section of the Italian Society of Radiology concerning the indications for CCT.
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Gruszczynska K, Kirschbaum S, Baks T, Moelker A, Duncker DJ, Rossi A, Baron J, de Feyter PJ, Krestin GP, van Geuns RJM. Different algorithms for quantitative analysis of myocardial infarction with DE MRI: comparison with autopsy specimen measurements. Acad Radiol 2011; 18:1529-36. [PMID: 22055796 DOI: 10.1016/j.acra.2011.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 08/08/2011] [Accepted: 08/09/2011] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES To compare two semiautomated methods for measurement of infarcted myocardium area on delayed contrast enhanced magnetic resonance imaging, with histopathology findings as standard of reference. MATERIALS AND METHODS Percentage area of myocardial infarction was measured in 10 Yorkshire landrace pigs manually and using two semiautomated methods. The first (standard deviation method) used two operator-selected regions of interest (ROIs) and nine different cutoff values (one to nine times the standard deviation of signal intensity in normal myocardium) to identify infarction. The second (threshold method) used threshold values based on percentages of maximum signal intensity to identify infarction. Results were compared with histopathology findings. RESULTS Difference between percentage area of infarction obtained with standard deviation method and autopsy specimens was in the range: -13.5% to +13.2%. With threshold method (thresholds from 30% to 90% of signal intensity), difference was -15% to +23%. Manual contouring underestimated infarcted area by 2% comparing to autopsy results. The best agreement between histopathology and semi-automated software was achieved for 4 standard deviations with standard deviation method: difference -0.45%, and for a percentage threshold of 70% (difference +0.67%) with threshold method. However, with standard deviation method, there was statistically significant difference between ROIs based on their location in viable myocardium: mean difference 1.7 ± 4%, P < .0001. CONCLUSION Semiautomated measurement of myocardial infarcted area on delayed enhanced magnetic resonance images performs well compared to autopsy. The threshold method, based on percentages of maximum signal intensity is preferable over standard deviation method, which is more susceptible to variability from location of ROIs within viable myocardium.
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Affiliation(s)
- Katarzyna Gruszczynska
- Department of Radiology, Erasmus MC, Universitair Medisch Centrum, Thoraxcenter, Ba 585, 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
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Ghoshhajra BB, Maurovich-Horvat P, Techasith T, Medina HM, Verdini D, Sidhu MS, Blankstein R, Brady TJ, Cury RC. Infarct detection with a comprehensive cardiac CT protocol. J Cardiovasc Comput Tomogr 2011; 6:14-23. [PMID: 22210535 DOI: 10.1016/j.jcct.2011.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 09/01/2011] [Accepted: 10/21/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac CT has the potential to offer comprehensive infarct detection by assessing regional wall motion abnormalities (RWMAs), rest perfusion defects (RPDs), and delayed contrast enhancement (DCE). However, the diagnostic accuracy of these techniques for the detection of myocardial infarction (MI) is unknown. METHODS Forty-eight patients with intermediate-to-high probability for coronary artery disease after single-photon emitting CT myocardial perfusion imaging were prospectively enrolled for a research comprehensive 64-detector row dual-source cardiac CT protocol that included cine images for RWMA, first-pass images for RPD, and delayed images for DCE. Blinded readers independently assessed each technique. Subsequently, a final combined analysis (cine + rest + DCE) was performed. The universal definition for MI by the 2007 American Heart Association task force was used as the "gold standard." RESULTS Twenty-four of 48 patients (50%) had infarct by the universal definition. The combined CT analysis was most accurate (90%) with the highest per-patient sensitivity (88%) and specificity (92%) versus individual assessments (RWMA, 79% and 88%; RPD, 67% and 92%; DCE, 79% and 88%). Similar findings were observed on a per-vessel basis analysis. A combination of DCE and cine showed a good accuracy (85%) and high sensitivity (92%). CONCLUSIONS Infarct detection with CT is feasible with overall good diagnostic accuracy compared with the universal definition. A combined evaluation that included all techniques (cine, RPD, and DCE) had the highest diagnostic accuracy. These findings may have implications when designing future clinical and research CT protocols for optimal infarct detection.
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Affiliation(s)
- Brian B Ghoshhajra
- Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA
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Wang R, Zhang Z, Xu L, Ma Q, He Y, Lu D, Yu W, Fan Z. Low dose prospective ECG-gated delayed enhanced dual-source computed tomography in reperfused acute myocardial infarction comparison with cardiac magnetic resonance. Eur J Radiol 2011; 80:326-30. [DOI: 10.1016/j.ejrad.2010.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 01/08/2010] [Accepted: 01/08/2010] [Indexed: 10/19/2022]
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Kerl JM, Deseive S, Tandi C, Kaiser C, Kettner M, Korkusuz H, Lehmann R, Herzog C, Schoepf UJ, Vogl TJ, Bauer RW. Dual energy CT for the assessment of reperfused chronic infarction - a feasibility study in a porcine model. Acta Radiol 2011; 52:834-9. [PMID: 21873508 DOI: 10.1258/ar.2011.100315] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Detection of myocardial infarction has been the focus of considerable research over the past few decades. Recently developed dual source computed tomography (DSCT) scanners with dual energy mode have been used to detect myocardial infarction, but the studies on this topic are few. PURPOSE To evaluate the feasibility and performance of dual energy CT (DECT) during arterial phase in coronary CT angiography for the detection of chronic infarction compared with late enhancement MRI (LE-MRI) and histopathology in a porcine model of reperfused myocardial infarction. MATERIAL AND METHODS Myocardial infarctions were induced by 30 min occlusion of the proximal left anterior descending coronary artery in eight minipigs. DECT, post-contrast LE-MRI and histopathology were performed 60 days after infarct induction. The CT scan was performed in dual energy mode using a dedicated protocol. Myocardial iodine distribution was superimposed as color maps on grey scale multiplanar reformats of the heart. Two radiologists in consensus interpreted all imaging studies for presence of gadolinium uptake at LE-MRI reduced iodine content at DECT and hypoenhanced areas in the initial 100 kV coronary CT angiography images that were acquired during the DECT-acquisition. Results were compared with histopathology. RESULTS Based on evaluable segments, DECT showed a sensitivity and specificity of 0.72 and 0.88; LE-MRI showed a sensitivity and specificity of 0.78 and 0.92; and the 100 kV data-set of the DECT scan showed a sensitivity and specificity of 0.60 and 0.93, respectively, for the detection of histological proved ischemia. CONCLUSION DECT during arterial phase coronary CT angiography, which is ordinarily used for coronary artery evaluation, is feasible for the detection of a chronic reperfused myocardial infarction.
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Affiliation(s)
- J Matthias Kerl
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Simon Deseive
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Christa Tandi
- Department of Animal Research, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Christina Kaiser
- Department of Forensic Medicine, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Mattias Kettner
- Department of Forensic Medicine, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Huedayi Korkusuz
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Ralf Lehmann
- Department of Cardiology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Christopher Herzog
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - U Joseph Schoepf
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Ralf W Bauer
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Frankfurt, Germany
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Is multidetector computed tomography a suitable alternative to MR imaging for the assessment of myocardial necrosis after alcohol septal ablation? Int J Cardiol 2011; 164:306-11. [PMID: 21794940 DOI: 10.1016/j.ijcard.2011.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 06/26/2011] [Accepted: 07/03/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND To compare magnetic resonance (MR) imaging and multidetector computed tomography (MDCT) for the assessment of myocardial infarction (MI) after alcohol septal ablation (ASA). METHODS Ten patients (mean age, 60 years ± 16) were examined with both MDCT and 1.5-T MR imaging performed 10 minutes after injection, within 3 days after ASA. Half of them had a temporary pacemaker (PM) during MDCT examination. Global image quality (IQ) and localization of MI were noticed on both MDCT and MR images. Volumes of MI, contrast-to-noise ratios (CNR) and signal-to-noise ratios (SNR) were also calculated. ASA effectiveness was evaluated by echocardiography immediately and 3 months after procedure. RESULTS Global IQ was considered adequate for both procedures. In 8 patients, MI reached the basal part of the septum on both MDCT and MR images. The 2 remaining patients exhibited sparing of the basal septum on MDCT and MR images. Volumes of MI were within the same range with the 2 techniques (MDCT: 22.1 ± 8.8 mL; MR imaging: 23.8 ± 9.4 mL) and correlated well each other (R(2)=0.85, p<0.002). The 2 patients with sparing of the basal interventricular septum had persistent gradient on echocardiography 3 months after ASA, suggesting failure of the procedure. The volumes of MI didn't correlate with the reduction of pressure gradient on echocardiography 3 months after ASA (R(2)=0.02, p<0.05). CONCLUSIONS Evaluation of post ASA MI is feasible with MDCT by comparison with MR imaging. MDCT might serve as an alternative imaging method in case of PM implantation.
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Dual-Energy Computed Tomography for the Detection of Late Enhancement in Reperfused Chronic Infarction. Invest Radiol 2011; 46:450-6. [DOI: 10.1097/rli.0b013e3182145b4f] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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The in-situ pig heart with regional ischemia/reperfusion — Ready for translation. J Mol Cell Cardiol 2011; 50:951-63. [DOI: 10.1016/j.yjmcc.2011.02.016] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 02/22/2011] [Accepted: 02/23/2011] [Indexed: 11/18/2022]
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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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Gupta M, Kadakia J, Hacioglu Y, Ahmadi N, Patel A, Choi T, Yamada G, Budoff M. Non-contrast cardiac computed tomography can accurately detect chronic myocardial infarction: Validation study. J Nucl Cardiol 2011; 18:96-103. [PMID: 21128040 PMCID: PMC3032183 DOI: 10.1007/s12350-010-9314-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 10/25/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study evaluates whether non-contrast cardiac computed tomography (CCT) can detect chronic myocardial infarction (MI) in patients with irreversible perfusion defects on nuclear myocardial perfusion imaging (MPI). METHODS One hundred twenty-two symptomatic patients with irreversible perfusion defect (N = 62) or normal MPI (N = 60) underwent coronary artery calcium (CAC) scanning. MI on these non-contrast CCTs was visually detected based on the hypo-attenuation areas (dark) in the myocardium and corresponding Hounsfield units (HU) were measured. RESULTS Non-contrast CCT accurately detected MI in 57 patients with irreversible perfusion defect on MPI, yielding a sensitivity of 92%, specificity of 72%, negative predictive value (NPV) of 90%, and a positive predictive value (PPV) of 77%. On a per myocardial region analysis, non-contrast CT showed a sensitivity of 70%, specificity of 85%, NPV of 91%, and a PPV of 57%. The ROC curve showed that the optimal cutoff value of LV myocardium HU to predict MI on non-contrast CCT was 21.7 with a sensitivity of 97.4% and specificity of 99.7%. CONCLUSION Non-contrast CCT has an excellent agreement with MPI in detecting chronic MI. This study highlights a novel clinical utility of non-contrast CCT in addition to assessment of overall burden of atherosclerosis measured by CAC.
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Affiliation(s)
- Mohit Gupta
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA 90502, USA.
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Dual source dual-energy computed tomography of acute myocardial infarction: correlation with histopathologic findings in a canine model. Invest Radiol 2010; 45:290-7. [PMID: 20421797 DOI: 10.1097/rli.0b013e3181dfda60] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the feasibility and value of dual-energy computed tomography myocardial iodine maps in the diagnosis of acute myocardial infarction. MATERIALS AND METHODS In 6 dogs, arterial-phase myocardial dual-energy computed tomography imaging were performed 1 day prior to and 3 hours after the surgical ligation of the left anterior descending artery to generate 100 kVp, 140 kVp, average weighted images, and dual energy myocardial iodine maps. For each of the 17 segments of the left ventricle (LV, 102 total segments), the presence or absence myocardial infarction was determined by histopathology and correlated to blinded reader determination of infarcted and noninfarcted myocardium at computed tomography (CT). Statistical analysis for diagnostic accuracy of aforementioned techniques and inter-reader agreement was performed. RESULTS The LV myocardial contrast enhancement at the average weighted images and iodine maps were uniform in all 6 dogs before surgery. Following anterior descending artery ligation, histopathology showed 40 infarcted left ventricular segments and 62 noninfarcted segments. For the postligation CT scans, 100 kVp, 140 kVp, average weighted images, and myocardial iodine maps showed 33, 28, 33, 34 infarcted segments and 53, 56, 56, 52 noninfarcted segments for both readers; corresponding to per-segment sensitivities of 83%, 70%, 80%, 92% and specificities of 85%, 90%, 92%, 80% for detecting myocardial infarction. No statistical difference was found for diagnostic accuracy of 100 kV, 140 kV, weighted average images, and iodine maps to detect myocardial infarct segments (all P > 0.05 for both readers). Good inter-reader agreement was seen for myocardial infarct detection using iodine maps (kappa = 0.80). CONCLUSIONS Myocardial single- and dual-energy CT imaging shows high per-segment sensitivity and moderate specificity for detecting acute myocardial infarction in a canine model with histopathology as the standard of reference.
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Stanton T, Marwick TH. Assessment of Subendocardial Structure and Function. JACC Cardiovasc Imaging 2010; 3:867-75. [DOI: 10.1016/j.jcmg.2010.05.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 04/28/2010] [Accepted: 05/04/2010] [Indexed: 10/19/2022]
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Rodríguez-Granillo GA, Ingino CA, Lylyk P. Myocardial perfusion imaging and infarct characterization using multidetector cardiac computed tomography. World J Cardiol 2010; 2:198-204. [PMID: 21160751 PMCID: PMC2999055 DOI: 10.4330/wjc.v2.i7.198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 06/29/2010] [Accepted: 07/06/2010] [Indexed: 02/06/2023] Open
Abstract
Until recently, computed tomography coronary angiography was restricted to the anatomical assessment of coronary stenosis, whereas the functional significance of coronary lesions remained outside of its scope. Nevertheless, the kinetics of iodinated contrast is similar to gadolinium-diethylenetriamine pentaacetic acid used in contrast-enhanced magnetic resonance imaging, allowing assessment of myocardial perfusion and viability by cardiac computed tomography.
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Affiliation(s)
- Gastón A Rodríguez-Granillo
- Gastón A Rodríguez-Granillo, Carlos A Ingino, Pedro Lylyk, Department of Cardiovascular Imaging, Clínica La Sagrada Familia, José Hernández 1642 C1426EOB, Buenos Aires, Argentina
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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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Low dose CT of the heart: a quantum leap into a new era of cardiovascular imaging. LA RADIOLOGIA MEDICA 2010; 115:1179-207. [PMID: 20574700 DOI: 10.1007/s11547-010-0566-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 12/15/2009] [Indexed: 10/19/2022]
Abstract
In 10 years, computed tomography coronary angiography (CTCA) has shifted from an investigational tool to clinical reality. Even though CT technologies are very advanced and widely available, a large body of evidence supporting the clinical role of CTCA is missing. The reason is that the speed of technological development has outpaced the ability of the scientific community to demonstrate the clinical utility of the technique. In addition, with each new CT generation, there is a further broadening of actual and potential applications. In this review we examine the state of the art on CTCA. In particular, we focus on issues concerning technological development, radiation dose, implementation, training and organisation.
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Martini C, Maffei E, Palumbo A, Weustink A, Baks T, Moelker A, Dunker D, Cuttone A, Emiliano E, Mollet N, Krestin G, De Feyter P, Cademartiri F. Impact of tube current in the quantitative assessment of acute reperfused myocardial infarction with 64-slice delayed-enhancement CT: a porcine model. Radiol Med 2010; 115:1003-14. [PMID: 20221710 DOI: 10.1007/s11547-010-0541-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 06/26/2009] [Indexed: 11/26/2022]
Abstract
PURPOSE This study evaluated the impact of tube current (mAs) in delayed-enhancement computed tomography (CT) imaging for assessing acute reperfused myocardial infarction in a porcine model. MATERIALS AND METHODS In five domestic pigs (mean weight 24 kg), the circumflex coronary artery was balloon-occluded for 2 h and then reperfused. After 5 days, CT imaging was performed following administration of iodinated contrast material. A 64-slice CT system was used to perform first-pass coronary angiography with a tube current of 15 mAs/kg [Arterial Phase (ART)] followed by two delayed-enhancement (DE) scans 15 min after contrast material administration, with a tube current of 15 mAs/kg and 37.5 mAs/kg, respectively (DE(1) and DE(2)). The mean heart rate decreased to 51±9 beats/min after administration of zatebradine (10 mg/kg IV). The data set was reconstructed during the end-diastolic phase of the cardiac cycle. Areas with DE, no reflow and remote myocardium [remote left ventricular (LV)] were calculated. CT values expressed in Hounsfield units (HU) were measured using five regions of interest (ROI): DE, no reflow, remote LV, LV cavity (LV lumen) and in air, respectively. Differences, correlations, image quality [signal-to-noise ratio (SNR)] and contrast resolution [contrast-to-noise ratio (CNR)] were calculated. RESULTS Significant differences were found between attenuation of areas of DE, no reflow and remote LV (p<0.001) within the different scans. There was a fair correlation between DE and no-reflow attenuation (r=0.6; p<0.001). In DE(1) vs. DE(2), areas of DE and no reflow were not significantly different (p>0.05). The SNR and CNR were not significantly different in DE(1) vs. DE(2) (p>0.05). CONCLUSIONS Tube current does not significantly affect infarction area, image quality or contrast resolution of DE imaging with CT.
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Affiliation(s)
- C Martini
- Department of Radiology and Cardiology, Academic Hospital/Azienda Ospedaliero-Universitaria, Parma, Italy
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Csonka C, Kupai K, Kocsis GF, Novák G, Fekete V, Bencsik P, Csont T, Ferdinandy P. Measurement of myocardial infarct size in preclinical studies. J Pharmacol Toxicol Methods 2010; 61:163-70. [PMID: 20188845 DOI: 10.1016/j.vascn.2010.02.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 02/19/2010] [Accepted: 02/20/2010] [Indexed: 12/18/2022]
Abstract
Ischemic heart disease is a major cause of morbidity and mortality worldwide. Myocardial ischemia followed by reperfusion results in tissue injury termed ischemia/reperfusion injury which is characterized by decreased myocardial contractile function, occurrence of arrhythmias, and development of tissue necrosis (infarction). These pathologies are all relevant as clinical consequences of myocardial ischemia/reperfusion injury and they are also important as experimental correlates and endpoints. The most critical determinant of acute and long-term mortality after myocardial infarction is the volume of the infarcted tissue. Therefore, development of cardioprotective therapies aims at reducing the size of the infarct developing due to myocardial ischemia/reperfusion injury. Different techniques are available to measure myocardial infarct size in humans and in experimental settings, however, accurate determination of the extent of infarction is necessary to evaluate interventions that may delay the onset of necrosis and/or limit the total extent of infarct size during ischemia/reperfusion. This paper highlights recent advances of the different techniques to measure infarct size.
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Affiliation(s)
- Csaba Csonka
- Cardiovascular Research Group, Department of Biochemistry, University of Szeged, Szeged, Hungary.
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Prevalence of first-pass myocardial perfusion defects detected by contrast-enhanced dual-source CT in patients with non-ST segment elevation acute coronary syndromes. Eur Radiol 2010; 20:1607-14. [PMID: 20155270 DOI: 10.1007/s00330-010-1725-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 12/02/2009] [Accepted: 12/09/2009] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the prevalence and diagnostic value of first-pass myocardial perfusion defects (PD) visualised by contrast-enhanced multidetector computed tomography (MDCT) in patients admitted for a first acute coronary syndrome (ACS). METHODS Thirty-eight patients with non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina (UA) and scheduled for percutaneous coronary intervention underwent dual-source CT immediately before catheterisation. CT images were analysed for the presence of any PD by using a 17-segment model. Results were compared with peak cardiac troponin-I (cTnI) and angiography findings. RESULTS PD were seen in 21 of the 24 patients with NSTEMI (median peak cTnI level 7.07 ng/mL; range 0.72-37.07 ng/mL) and in 2 of 14 patients with UA. PD corresponded with the territory of the infarct-related artery in 20 out of 22 patients. In a patient-based analysis, sensitivity, specificity, negative and positive predictive values of any PD for predicting NSTEMI were 88%, 86%, 80% and 91%. Per culprit artery, the respective values were 86%, 75%, 80% and 83%. CONCLUSION In patients with non-ST segment elevation ACS, first-pass myocardial PD in contrast-enhanced MDCT correlate closely with the presence of myocardial necrosis, as determined by increases in cTnI levels.
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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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Abstract
Noninvasive imaging of the coronary arteries using multidetector CT (MDCT) represents one of the most promising diagnostic imaging advances in contemporary cardiology. This challenging application has driven a rapid and impressive advancement in CT technology over the past 10 years; leading to increased spatial and temporal resolution, decreased scan times and substantial reductions in radiation dose. Recent technological improvements have not only improved the status of CT coronary angiography but have also enabled new functional myocardial applications that are gaining a foothold in clinical practice as adjuncts or replacements for conventional coronary angiographic studies. Wide-detector CT designs along with prospective ECG-triggered protocols have opened the possibility of performing multiple complementary myocardial measurements during a coronary CT exam with acceptable radiation and contrast exposure. In this Review, we discuss recent technical developments in cardiac MDCT and outline newly enabled noncoronary cardiac applications including viability assessment, myocardial perfusion and molecular imaging.
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Rodríguez-Granillo GA, Rosales MA, Renes P, Diez E, Pereyra J, Gomez E, De Lillo G, Degrossi E, Rodriguez AE, McFadden EP. Chronic myocardial infarction detection and characterization during coronary artery calcium scoring acquisitions. J Cardiovasc Comput Tomogr 2009; 4:99-107. [PMID: 20060800 DOI: 10.1016/j.jcct.2009.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 12/08/2009] [Accepted: 12/09/2009] [Indexed: 01/08/2023]
Abstract
BACKGROUND Hypoenhanced regions on multidetector CT (MDCT) coronary angiography correlate with myocardial hyperperfusion. In addition to a limited capillary density, chronic myocardial infarction (MI) commonly contains a considerable amount of adipose tissue. OBJECTIVE We explored whether regional myocardial hypoenhancement on contrast-enhanced MDCT could be identified with standard coronary artery calcium (CAC) scoring acquisitions with noncontrast CT. METHODS Consecutive patients with a history of MI who were referred for contrast-enhanced MDCT from November 2006 until March 2009 were studied. Noncontrast CT for CAC scoring was also performed. The correlation between regional myocardial hypoenhancement on contrast-enhanced CT and regional myocardial hypoattenuated areas on noncontrast CT was defined. RESULTS Eighty-three patients (mean age, 61.5+/-12.5 years; n=67; 81% male) with previous MI were studied. A total of 1411 myocardial segments were evaluated. Two hundred thirty-nine segments (17%) showed myocardial hypoenhancement by MDCT and 140 segments (9.6%) by CAC. On a patient level, noncontrast CT showed a sensitivity, specificity, positive predictive value, (PPV) and negative predictive value (NPV) of 66% (95% CI, 0.53-0.77), 100% (95% CI, 0.76-1.00), 100% (95% CI, 0.90-1.00), and 41% (95% CI, 0.26-0.58), respectively, to detect myocardial hypoenhancement. On a per segment level, noncontrast CT showed a sensitivity, specificity, PPV, and NPV of 58% (95% CI, 0.51-0.64), 100% (95% CI, 0.99-1.00), 99% (95% CI, 0.94-1.00), and 92% (95% CI, 0.90-0.93), respectively, to detect myocardial hypoenhancement. CONCLUSIONS Our findings suggest that chronic MI can be detected with standard CAC scoring acquisitions.
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Martini C, Maffei E, Palumbo A, Weustink A, Baks T, Moelker A, Dunker D, Emiliano E, Cuttone A, Mollet N, Krestin G, De Feyter P, Cademartiri F. Impact of contrast material volume on quantitative assessment of reperfused acute myocardial infarction using delayed-enhancement 64-slice CT: experience in a porcine model. Radiol Med 2009; 115:22-35. [PMID: 20017004 DOI: 10.1007/s11547-009-0481-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 02/27/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Our purpose in this study was to compare the impact of contrast material volume in delayed-enhancement computer tomography (CT) imaging for assessing acute reperfused myocardial infarction. MATERIALS AND METHODS In five domestic pigs (20-30 kg), the circumflex coronary artery (CX) was balloon-occluded for 2 h followed by reperfusion. After 5 days, CT imaging was performed after intravenous administration of iodinated contrast material (Iomeprol 400 mgI/ml; Bracco, Italy). A 64-slice multidetector CT (MDCT) (Sensation 64, Siemens) scanner was used for imaging, with standard angiography characteristics. Three scans were performed: first, coronary angiography at first pass with 1.25 gI/kg of contrast material (ART); and remaining delayed-enhancement (DE(1)-DE(2)) 15 min after administration of 1.25 (DE(1)) and 15 min after additional administration of 2.50 gI/kg (=total 3.75 gI/kg - DE(2)). Mean heart rate decreased to 51+/-9 bpm after intravenous administration of Zatebradine (10 mg/kg). Data sets were reconstructed during the end-diastolic phase of the cardiac cycle. Areas of infarction-enhanced (DE), no-reflow (no-reflow) and remote myocardial [remote left ventricle (LV)] were manually contoured. CT attenuation values (Hounsfield units) were measured using five regions of interest: DE, no-reflow, remote LV, left ventricular cavity (lumen LV) and in air. Differences, correlations, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. RESULTS We found significant differences between the attenuation of DE, no-reflow and remote LV (p<0.001). DE and no-reflow size were assessed accurately with DEMDCT. In particular, SNR and CNR showed higher values in DE(2) (approximately 6.0 and 3.5, respectively; r(2)=0.90) vs. DE(1) (approximately 4.0 and 2.2, respectively; r(2)=0.85). CONCLUSIONS The increase of contrast material volume determines a significant improvement in myocardial infarction image quality with DE-MDCT.
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Affiliation(s)
- C Martini
- Department of Radiology and Cardiology, c/o Piastra Tecnica-Piano 0, Azienda Ospedaliero-Universitaria, Parma, Italy
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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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