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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Delayed enhancement cardiac computed tomography for the assessment of myocardial infarction: from bench to bedside
1Department of Cardiovascular Imaging, Diagnóstico Maipú, Buenos Aires, Argentina.
Insights
Cardiac CT delayed enhancement (CTDE) shows promise for assessing myocardial infarction (MI) and fibrosis. CTDE offers a viable alternative to cardiac magnetic resonance (CMR) due to safety and logistical advantages.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Delayed enhancement (DE) imaging, a marker for myocardial fibrosis, is increasingly recognized for its prognostic value across various etiologies.
- Cardiac magnetic resonance (CMR) and cardiac computed tomography (CT) utilize contrast agents with similar kinetics for myocardial characterization.
- Concerns regarding CMR safety and gadolinium agents, alongside CTDE's logistical benefits, warrant consideration.
Purpose of the Study:
- To review the evidence for cardiac CT delayed enhancement (CTDE) in assessing myocardial infarction (MI).
- To compare CTDE with CMR for DE imaging, considering safety and practical aspects.
Main Methods:
- Review of existing animal and clinical studies on DE imaging using cardiac CT (CTDE).
- Evaluation of evidence from various CT systems, including 16-slice CT and dual-energy CT (DECT).
- Comparison of CTDE with CMR, focusing on contrast agents, safety profiles, and logistical factors.
Main Results:
- Gadolinium and iodinated contrast agents enable comparable myocardial characterization in both CMR and CT.
- CTDE demonstrates potential for assessing MI and fibrosis, similar to DE-CMR.
- CTDE presents advantages over CMR regarding patient claustrophobia, implantable devices, cost, scan time, and breath-holding capability.
Conclusions:
- CTDE is a valuable tool for assessing myocardial infarction and fibrosis.
- CTDE may serve as a practical and safe alternative to DE-CMR in specific patient populations.
- Further investigation into CTDE's role in cardiovascular imaging is supported by current evidence.
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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