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Updated: Apr 20, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Delayed uptake and washout of contrast in non-viable infarcted myocardium shown with dynamic computed tomography
Sebastian Udholm1, Sofie Laugesen1, Peter Agger1
11 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark.
Insights
Computed tomography (CT) enhancement can assess myocardial viability. Contrast uptake and washout patterns in pigs with myocardial infarction showed distinct differences between viable and infarcted tissue, indicating CT
Area of Science:
- Cardiovascular Imaging
- Myocardial Viability Assessment
- Computed Tomography
Background:
- Assessing ischemic but viable myocardium is crucial for revascularization planning.
- Traditional methods include SPECT, PET, and MRI.
- Computed tomography (CT) is increasingly used for coronary atherosclerosis diagnosis.
Purpose of the Study:
- To evaluate CT enhancement as a myocardial viability marker.
- Investigate myocardial contrast distribution over time in pigs with induced myocardial infarctions.
Main Methods:
- Induced antero-septal myocardial infarctions in 12 pigs.
- Performed dynamic cardiac CT after 6 weeks, assessing wall motion and contrast attenuation.
- Measured contrast attenuation (HU) in infarct and normal zones at various time points post-injection.
Main Results:
- Significant differences in contrast attenuation between infarct and normal zones at most time points.
- Normal myocardium exhibited higher contrast uptake and washout rates than the infarct zone.
- The ratio of early to late contrast uptake effectively distinguished viable from infarcted myocardium.
Conclusions:
- Delayed contrast uptake and washout in infarct-related regions show promise for CT.
- CT may offer a combined assessment of coronary atherosclerosis and myocardial viability.
- This approach could enhance clinical decision-making in cardiology.
Background:
Assessment of ischemic but potentially viable myocardium plays an important role in the planning of coronary revascularization. Until now SPECT, PET, and MRI have been used to identify viable myocardium. Computed tomography (CT) is increasingly used to diagnose coronary atherosclerosis.
Objective:
To evaluate the feasibility of CT enhancement as a viability marker by investigating myocardial contrast distribution over time in pigs with experimentally induced antero-septal myocardial infarctions.
Methods:
Twelve pigs were subjected to 60 min of balloon occlusion of the left anterior descending artery, followed by removal of the balloon and reperfusion. Four pigs died due to refractory ventricular fibrillation. After 6 weeks, dynamic cardiac CT was performed assessing both wall motion and contrast attenuation. Measurements of attenuation values in Hounsfield units (HU) in the infarct zone and the normal lateral wall were performed at 20 s, and 1, 3, 5, 8 and 12 min after contrast injection.
Results:
We found highly significant differences in attenuation values between the two zones at all-time points except t =1 min (ANOVA P=0.85). The normal myocardium showed higher uptake- and washout-rates of contrast than the infarct zone (84±15 vs. 58±8 at 20 s, P=0.0001 and 27±12 vs. 81±13 at 12 min, P=0.0001). Specifically, the ratio between early (20 s) and late (12 min) uptake is a valid marker of viable myocardium. In all animals this ration was above one in the normal zone and below one in the infarct zone.
Conclusions:
Delayed infarct related uptake and washout of contrast shows promise for future clinical application of CT in a combined assessment of coronary atherosclerosis and myocardial viability.
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