Characterization of acute and chronic myocardial infarcts by multidetector computed tomography : Comparison with contrast-enhanced magnetic resonance

• Published in: Circulation (New York, N.Y.) Vol. 113; no. 6; pp. 823 - 833
• Main Authors: GERBER, Bernhard L, BEIGE, Bénédicte, LEGROS, Gabin J, LIM, Pascal, PONCELET, Alain, PASQUET, Agnès, GISELLU, Giovanna, COCHE, Emmanuel, VANOVERSCHELDE, Jean-Louis J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 14-02-2006
• Subjects: Acute Disease; Aged; Animals; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular system; Chronic Disease; Contrast Media; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Gadolinium DTPA; Heart; Humans; Iopamidol - analogs & derivatives; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - pathology; Pharmacology. Drug treatments; Rabbits; Swine; Tomography, X-Ray Computed - methods; Vascular wall; Myocardial infarction; magnetic resonance imaging; Magnetic resonance; Cardiovascular disease; Myocardial disease; Nuclear magnetic resonance imaging; imaging; Chronic; Multidetector scanner; multigated computed tomography; Heart disease; Computerized axial tomography; Comparative study; Contrast media
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.104.529511

We evaluated whether contrast-enhanced multidetector computed tomography (CE-MDCT) might characterize myocardial infarct (MI) with patterns similar to those obtained by contrast-enhanced magnetic resonance (CE-MR) and studied the underlying mechanisms.
In vivo infarct characterization by CE-MDCT was shown to be feasible between 4 and 20 minutes after contrast injection in 7 pigs with MI. Subsequently, in 16 patients with acute MI and 21 patients with chronic MI, contrast patterns by CE-MDCT were related to CE-MR. Eighteen patients had hypoenhanced regions on early CE-MDCT images at the time of coronary imaging, and 34 patients had hyperenhanced regions on images acquired 10 minutes later. On a segmental basis, there was moderately good concordance of early hypoenhanced regions (92%, kappa=0.54, P<0.001) and late hyperenhanced regions (82%, kappa=0.61, P<0.001) between CE-MDCT and CE-MR. Absolute sizes of early hypoenhanced (6+/-16 versus 7+/-16 g, P=0.25) and late hyperenhanced (36+/-34 versus 31+/-40 g, P=0.14) regions were similar on CE-MDCT and CE-MR and were highly correlated (r=0.93, P<0.001 and r=0.89, P<0.001 respectively). In 8 retrogradely perfused infarcted rabbit hearts, contrast kinetics of iomeprol were similar to gadodiamide, ie, slow wash in (8.7+/-6.7 versus 1.2+/-0.3 minutes, P<0.001) in infarct core and slow washout (20+/-12 versus 2.5+/-0.5 minutes, P<0.001) in both infarct core and rim compared with the remote region.
Because iodated contrast agents have similar kinetics in infarcted and noninfarcted myocardium as gadolinium DPTA, CE-MDCT can characterize acute and chronic MI with contrast patterns similar to CE-MR. CE-MDCT may thus provide important information on infarct size and viability at the time of noninvasive coronary imaging.