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Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction: characterization of myocyte death, microvascular obstruction, and chronic scar.

ABSTRACT: The ability to distinguish dysfunctional but viable myocardium from nonviable tissue has important prognostic implications after myocardial infarction. The purpose of this study was to validate the accuracy of contrast-enhanced multidetector computed tomography (MDCT) for quantifying myocardial necrosis, microvascular obstruction, and chronic scar after occlusion/reperfusion myocardial infarction.Ten dogs and 7 pigs underwent balloon occlusion of the left anterior descending coronary artery (LAD) followed by reperfusion. Contrast-enhanced (Visipaque, 150 mL, 325 mg/mL) MDCT (0.5 mm x 32 slice) was performed before occlusion and 90 minutes (canine) or 8 weeks (porcine) after reperfusion. MDCT images were analyzed to define infarct size/extent and microvascular obstruction and compared with postmortem myocardial staining (triphenyltetrazolium chloride) and microsphere blood flow measurements. Acute and chronic infarcts by MDCT were characterized by hyperenhancement, whereas regions of microvascular obstruction were characterized by hypoenhancement. MDCT infarct volume compared well with triphenyltetrazolium chloride staining (acute infarcts 21.1+/-7.2% versus 20.4+/-7.4%, mean difference 0.7%; chronic infarcts 4.15+/-1.93% versus 4.92+/-2.06%, mean difference -0.76%) and accurately reflected morphology and the transmural extent of injury in all animals. Peak hyperenhancement of infarcted regions occurred approximately 5 minutes after contrast injection. MDCT-derived regions of microvascular obstruction were also identified accurately in acute studies and correlated with reduced flow regions as measured by microsphere blood flow.The spatial extent of acute and healed myocardial infarction can be determined and quantified accurately with contrast-enhanced MDCT. This feature, combined with existing high-resolution MDCT coronary angiography, may have important implications for the comprehensive assessment of cardiovascular disease.

SUBMITTER: Lardo AC

PROVIDER: S-EPMC3410562 | biostudies-literature | 2006 Jan

REPOSITORIES: biostudies-literature

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Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction: characterization of myocyte death, microvascular obstruction, and chronic scar.

Lardo Albert C AC Cordeiro Marco A S MA Silva Caterina C Amado Luciano C LC George Richard T RT Saliaris Anastasios P AP Schuleri Karl H KH Fernandes Veronica R VR Zviman Menekhem M Nazarian Saman S Halperin Henry R HR Wu Katherine C KC Hare Joshua M JM Lima Joao A C JA

Circulation 20060101 3

<h4>Background</h4>The ability to distinguish dysfunctional but viable myocardium from nonviable tissue has important prognostic implications after myocardial infarction. The purpose of this study was to validate the accuracy of contrast-enhanced multidetector computed tomography (MDCT) for quantifying myocardial necrosis, microvascular obstruction, and chronic scar after occlusion/reperfusion myocardial infarction.<h4>Methods and results</h4>Ten dogs and 7 pigs underwent balloon occlusion of th ...[more]

PMID: 16432071

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Project description:BackgroundAlthough small bowel bleeding is relatively rare, it is a potentially fatal disease, and its diagnosis still faces challenges. Technetium 99m-labeled red blood cell computed single photon emission computed tomography/computed tomography (99mTc-RBC SPECT/CT) and contrast-enhanced multidetector computed tomography (MDCT) are common imaging methods for diagnosing small bowel bleeding, but there have been no studies comparing their diagnostic efficacy for this purpose. This study aims to compare the diagnostic value of 99mTc-RBC SPECT/CT and contrast-enhanced MDCT for small bowel bleeding.MethodsA total of 44 patients (30 males and 14 females, median age of 64 years) definitively diagnosed with small bowel bleeding and 15 non-small bowel bleeding patients (8 males and 7 females, median age of 66 years) were consecutively included in this study. All patients underwent 99mTc-RBC SPECT/CT and contrast-enhanced MDCT examinations at Beijing Friendship Hospital of Capital Medical University between January 2020 to September 2023. The definitive diagnosis had been made through surgery or colonoscopy, or through patient history, patient management, and clinical follow-up. We collected clinical data of the participants. 99mTc-RBC SPECT/CT and contrast-enhanced MDCT were reviewed in a blinded fashion for accuracy of detection of active bleeding as well as the active small bowel bleeding location.ResultsAmong the 59 patients, the accuracy, sensitivity, and specificity of 99mTc-RBC SPECT were 27.3%, 93.3%, and 92.3%; for 99mTc-RBC SPECT/CT they were 76.3%, 40.5%, and 93.3%; whereas for contrast-enhanced MDCT they were 45.8%, 27.3%, and 100%, respectively. The diagnostic accuracy of 99mTc-RBC SPECT/CT for jejunal and ileal bleeding was high, at 100% and 86.4%, respectively. Meanwhile, 99mTc-RBC SPECT/CT had a higher accuracy in diagnosing more causes of small bowel bleeding. In 59 patients, the combination of 99mTc-RBC SPECT/CT and contrast-enhanced MDCT accurately diagnosed small bowel bleeding and provided precise localization in 50 patients, resulting in the accuracy, sensitivity, and specificity of 84.7%, 79.5%, and 100.0%, respectively.Conclusions99mTc-RBC SPECT/CT has high diagnostic value in diagnosing small bowel bleeding and is superior to 99mTc-RBC SPECT and contrast-enhanced MDCT. The combination of 99mTc-RBC SPECT/CT and contrast-enhanced MDCT can further improve the diagnostic accuracy of diagnosis, and can accurately guide the diagnosis and treatment of small bowel bleeding.

Dataset Information

Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction: characterization of myocyte death, microvascular obstruction, and chronic scar.

Publications

Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction: characterization of myocyte death, microvascular obstruction, and chronic scar.

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