Dual-phase multi-detector computed tomography assesses jeopardized and infarcted myocardium subtending infarct-related artery early after acute myocardial infarction

Kuan-Rau Chiou ¹, Wei-Chun Huang ¹, Nan-Jing Peng ², Yi-Luan Huang ³, Shih-Hung Hsiao ¹, Kuen-Huang Chen ³ and Ming-Ting Wu ^3*

¹ Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan
² Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Taiwan
³ Department of Radiology, Kaohsiung Veterans General Hospital, Taiwan

^* To whom correspondence should be addressed. E-mail: wu.mingting{at}gmail.com.

Accepted 12 May 2009

Abstract

Objectives: To investigate dual-phase multi-detector computed tomography (MDCT) for assessing extent and severity of jeopardized and infarcted myocardium subtended by infarct-related artery (IRA), and its functional relevance after acute myocardial infarction (AMI).

Designs, setting and patients: Prospective, single centre study included 107 patients with uncomplicated post-AMI 3-7 days, who met criteria and underwent dual-phase 64-slice MDCT. IRA, culprit lesion and extent of jeopardized/infarcted myocardium were assessed by 3-D volume rendered images with myocardium maps and CT angiography (CTA), compared with stress-redistribution thallium-201 single-photon emission computed tomography (SPECT) plus conventional coronary angiography (CCA). MDCT-jeopardized score (severity of jeopardized myocardium) was defined as extent of jeopardized myocardium multiplied by the weighted factor dependent on culprit lesion severity compared with SPECT-SRS (summation of segmental reversible score). Functional relevance of IRA indicating for revascularization was evaluated by MDCT-jeopardized score plus CTA. SPECT-SRS2 plus CCA-culprit lesion50% was standard reference.

Results: Presence of MDCT-delayed enhancement was found in 101 (94.4%) patients. IRA and culprit lesion was identified in 99 (92.5%) by MDCT-myocardium maps plus CTA. Concordance between MDCT and SPECT for detecting infarcted myocardium was good (kappa=0.702). Correlation between MDCT-jeopardized score and SPECT-SRS was 0.741. Correlation between CTA and CCA for culprit lesion severity was 0.85. Sensitivity, specificity, negative and positive predictive values of CTA plus MDCT-jeopardized score2.5 for indicating revascularization were 90.2%, 80.4%, 86.0%, and 85.9%.

Conclusions: Dual-phase MDCT has good accuracy for assigning IRA, assessing infarcted/jeopardized myocardium, and functional relevance. It provides an alternative for triage and therapeutic planning in post-AMI.