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Assessment of acute myocardial infarction using MDCT after percutaneous coronary intervention: comparison with MRI

Loïc Boussel1, Michael Ribagnac, Eric Bonnefoy

  • 1Department of Radiology, University of California at San Francisco, San Francisco, CA, USA. loic.boussel@gmail.com

AJR. American Journal of Roentgenology
|July 24, 2008
PubMed
Abstract

Insights

Delayed enhanced MDCT accurately visualizes myocardial infarct size post-PCI, offering a viable alternative to MRI. This technique simplifies infarct assessment in emergency settings without extra contrast.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Assessing myocardial infarct size in emergency settings is challenging due to limitations of current gold standards like MRI and nuclear medicine.
  • Delayed enhanced MDCT is a promising technique for evaluating contrast uptake in infarcted myocardium.

Purpose of the Study:

  • To compare the accuracy of delayed enhanced MDCT with delayed gadolinium-enhanced MRI in determining acute myocardial infarct size.
  • To evaluate MDCT's utility immediately after percutaneous coronary intervention (PCI) without additional contrast.

Main Methods:

  • Nineteen acute myocardial infarction patients underwent delayed enhanced MDCT post-PCI and delayed enhanced MRI within 8 days.
  • Patients selected had specific TIMI scores before and after angioplasty.
  • Three observers compared MDCT and MRI for involved segments, transmural enhancement, and infarct size.

Main Results:

  • A significant difference in signal intensity was observed between infarcted and healthy myocardium on MDCT (197 H vs. 71 H, p < 0.0001).
  • Strong agreement was found between MDCT and MRI for infarct size (r(2) = 0.67), involved segments (r(2) = 0.74), and transmural extent (r(2) = 0.76).
  • Good interobserver reproducibility (kappa = 0.8) was achieved.

Conclusions:

  • Delayed enhanced MDCT accurately visualizes early myocardial contrast uptake, comparable to delayed enhanced MRI.
  • MDCT is a valuable tool for assessing infarct size post-PCI without requiring an additional contrast injection.

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