Korean J Radiol.  2007 Apr;8(2):94-102. 10.3348/kjr.2007.8.2.94.

Early and Delayed Myocardial Enhancement in Myocardial Infarction Using Two-Phase Contrast-Enhanced Multidetector-Row CT

• Ko SM
• Kim YW
• Han SW
• Seo JB

• KMID: 1126832
• DOI: http://doi.org/10.3348/kjr.2007.8.2.94

Abstract

OBJECTIVE
The purpose of this study was to describe the myocardial enhancement patterns in patients with myocardial infarction using two-phase contrast-enhanced multidetector-row computed tomography (MDCT). MATERIALS AND METHODS: Twenty-three patients with clinically proven myocardial infarction (17 acute myocardial infarction [AMI] and 6 chronic myocardial infarction [CMI]) were examined with two-phase contrast-enhanced ECG-gated MDCT. The presence, location, and patterns of myocardial enhancement on two-phase MDCT images were compared with infarcted myocardial territories determined by using electrocardiogram, echocardiography, thallium-201 single photon emission computed tomography, catheter and MDCT coronary angiography. RESULTS: After clinical assessment, the presence of myocardial infarctions were found in 27 territories (19 AMI and 8 CMI) of 23 patients. Early perfusion defects were observed in 30 territories of all 23 patients. Three territories not corresponding to a myocardial infarction were detected in three patients with AMI and were associated with artifacts. Fourteen of perfusion defects were in the left anterior descending artery territory, four in the left circumflex artery territory, and nine in the right coronary artery territory. Delayed enhancement was observed in 25 territories (17 AMI and 8 CMI) of 21 patients. Delayed enhancement patterns were variable. Transmural early perfusion defects (n =12) were closely associated with transmural late enhancement (n = 5) and subendocardial residual defect with subepicardial late enhancement (n = 5). CONCLUSION: Myocardial infarction showed early perfusion defects and variable delayed enhancement patterns on two-phase contrast-enhanced MDCT. Delayed enhancement technique of MDCT could provide additional information of the location and extent of infarcted myocardium, and could be useful to plan appropriate therapeutic strategies in patients with AMI.

Keyword

Computed tomography (CT), multidetector-row; Ischemic heart disease; Myocardium, Infarction; Myocardium, CT; Heart, CT

MeSH Terms

Adult
Aged
Aged, 80 and over
Contrast Media
Coronary Angiography
Echocardiography
Electrocardiography
Female
Humans
Iohexol/analogs & derivatives/diagnostic use
Male
Middle Aged
Myocardial Infarction/*radiography
Tomography, Emission-Computed, Single-Photon
Tomography, X-Ray Computed/*methods

Figure

• 

  Fig. 1 Images obtained in a 57-year-old man with chronic myocardial infarction. A. The short-axis multiplanar reformation image obtained with early-phase multidetector CT shows a subendocardial hypoenhancement involving the mid-inferolateral myocardium with mild wall thinning (arrow), which corresponds to chronic myocardial infarction of the left circumflex coronary artery territory. B. The short-axis multiplanar reformation image obtained with late-phase multidetector CT shows subendocardial late enhancement in the same area (arrow). C. The volume rendered image shows occlusion of the left circumflex artery (large arrow) and significant stenosis of the obtuse marginal artery (small arrow). A T-graft with the radial artery (open arrow) from the left internal mammary artery to the obtuse marginal artery and the distal anastomosis are open.

• 

  Fig. 2 Images obtained in a 73-year-old man with reperfused acute myocardial infarction. A. The short-axis multiplanar reformation image obtained with early-phase multidetector CT shows an early perfusion defect involving the whole thickness of the mid-anterolateral myocardium (arrow), which corresponds to significant stenosis of the left circumflex coronary artery. B. The short-axis multiplanar reformation image obtained with late-phase multidetector CT shows transmural late enhancement in the same area (arrow). Note the total absence of residual perfusion defect within the hyperenhanced area. C. Right oblique caudal projection of the left coronary angiogram shows total occlusion with bridge collateral flow at the proximal segment of the left circumflex coronary artery (arrow).

• 

  Fig. 3 Images obtained in a 72-year-old man with reperfused acute myocardial infarction. A. The short-axis multiplanar reformation image obtained with early phase multidetector CT shows a transmural perfusion defect involving the mid-inferior myocardium (arrow), and this corresponds to significant stenosis of the right coronary artery. B. The short-axis multiplanar reformation image obtained with late phase multidetector CT shows subendocardial residual perfusion defect (arrow) with subepicardial late enhancement (arrowhead) in the same area. C. The left oblique projection of the right coronary angiogram shows multiple stenoses in the proximal and middle (arrows) right coronary artery and total occlusion at the distal segment (arrowhead) of the right coronary artery.

• 

  Fig. 4 The images obtained in a 63-year-old woman with reperfused acute myocardial infarction. A. The short-axis multiplanar reformation image obtained with early phase multidetector CT shows a subendocardial perfusion defect involving the mid-anterior and anterolateral myocardium (arrow), and this corresponds to significant stenosis of the left circumflex coronary artery. B. The short-axis multiplanar reformation image obtained with late phase multidetector CT shows transmural late enhancement in the same area (arrow). C. The right anterior oblique caudal projection of the left coronary angiogram shows minimal lesion at the middle segment of the left circumflex coronary artery (arrow).

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