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Updated: Apr 4, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Myocardial hypoperfusion on conventional contrast computed tomography
1Division of Cardiology, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China.
Insights
Non–electrocardiogram (ECG)–gated computed tomography (CT) can detect myocardial hypoenhancement, an early sign of acute myocardial infarction, before ECG changes appear. This finding aids in earlier revascularization decisions for chest pain patients.
Area of Science:
- Radiology
- Cardiology
- Emergency Medicine
Background:
- Non–electrocardiogram (ECG)–gated contrast computed tomography (CT) is standard for diagnosing aortic dissection in patients with chest pain.
- Myocardial assessment for hypoenhancement, indicative of ischemia, is crucial alongside aortic evaluation.
Observation:
- Modern multidetector CT allows myocardial perfusion assessment with minimal artifact, even without ECG gating.
- Two cases presented with acute chest pain and initially nondiagnostic studies.
Findings:
- CT aortogram revealed myocardial hypoenhancement in the left anterior descending artery territory, a sign of acute myocardial infarction.
- This hypoenhancement preceded ST-segment elevation on ECG.
Implications:
- Recognizing CT-detected myocardial hypoenhancement can lead to earlier diagnosis of acute myocardial infarction.
- This may facilitate prompt revascularization decisions, improving patient outcomes.
Abstract:
Non–electrocardiogram (ECG)–gated contrast computed tomography (CT) is commonly performed to exclude aortic dissection in chest pain patients. Besides evaluating the aorta for dissection flap, attention should be paid to the myocardium for areas of hypoenhancement that may suggest ischemia. Current models of multidetector CT enable assessment of myocardial perfusion with minimal motion artifact even without ECG gating. Transmural hypoenhancement with preserved wall thickness in a coronary distribution is highly specific for acute myocardial infarction. We report 2 cases of acute chest pain with initial nondiagnostic studies that underwent CT aortogram to exclude dissection. Instead, the CT showed myocardial hypoenhancement in left anterior descending artery territory. Myocardial hypoenhancement occurred before ST-segment elevation on ECG, suggesting that recognition of this important finding may lead to earlier revascularization decisions.
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