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[Diagnostic evaluation of ischemic heart disease by X-ray computed tomography and magnetic resonance imaging]
Y Masuda1, S Kobayashi, J Takasu
1Third Department of Internal Medicine, Chiba University School of Medicine.
Insights
Enhanced CT and MRI show promise for detecting myocardial infarction. While CT identifies infarcts via filling defects and late enhancement, MRI excels at visualizing chronic changes and complications like aneurysms and thrombi.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Ischemic heart disease diagnosis relies on imaging modalities.
- Computed tomography (CT) and magnetic resonance imaging (MRI) are key tools.
- Evaluating their efficacy in detecting myocardial infarction is crucial.
Purpose of the Study:
- To assess the diagnostic utility of enhanced CT and MRI for ischemic heart disease.
- To compare the capabilities of CT and MRI in identifying myocardial infarction and its complications.
Main Methods:
- 180 patients underwent enhanced CT; 38 patients underwent MRI.
- Patients had transmural infarction, subendocardial infarction, or angina pectoris.
- Specific CT findings (filling defects, late enhancement) and MRI techniques (ECG-gated, spin echo) were analyzed.
Main Results:
- Enhanced CT identified myocardial infarction via filling defects (recent anterior) and late enhancement (anterior).
- CT findings were less effective for inferoposterior and subendocardial infarction.
- MRI detected acute infarction by high signal intensity; chronic changes (thinning, motion, aneurysms, thrombi) were evident.
- Neither modality showed characteristic findings for angina pectoris.
Conclusions:
- Enhanced CT and MRI offer valuable insights into myocardial infarction.
- CT is useful for acute anterior infarcts, while MRI excels in chronic changes and complications.
- Both modalities have limitations, particularly for certain infarct locations and angina pectoris.
Abstract:
To assess the usefulness of X-ray computed tomography (CT) and magnetic resonance imaging (MRI) in detecting and evaluating ischemic heart disease, conventional and enhanced CT were performed for 180 patients (150 with transmural infarction, 12 with subendocardial infarction, and 18 with angina pectoris). MRI examinations were performed for 38 patients (31 with transmural infarction, three with subendocardial infarction, and four with angina pectoris). With enhanced CT, two findings in the myocardium were direct evidence of myocardial infarction: 1. filling defects on the early scans, and 2. late enhancement of the myocardium on the delayed scans. The former were observed mainly at the sites of recent anterior myocardial infarction and the latter were seen in about half of the patients with recent and remote anterior myocardial infarctions. However, these findings were inadequately imaged in patients with inferoposterior infarction and subendocardial infarction. Among 137 patients with transmural infarction, enhanced CT revealed left ventricular aneurysms in 51 (37%) and ventricular thrombi in 26 (19%). ECG-gated MRI apparatus having a superconducting magnetic operating at 0.25 Tesla was used, and data for this study were collected using the single-slice spin echo technique. In eight of nine patients with acute myocardial infarction, gated MRI demonstrated the infarcted myocardium as regions of high signal intensity relative to that of the adjacent normal myocardium. Such a difference in MRI signal intensity was scarcely recognized in the chronic stage of myocardial infarction, but the indirect findings of infarction, such as regional wall thinning, wall motion disturbances, left ventricular aneurysms, and ventricular thrombi were easily detected using MRI. No characteristic finding was obtained by CT or MRI in patients with angina pectoris.