Original articles

Cardiac imaging and non-invasive testing

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

K-R Chiou^1,2, W-C Huang^1,2, N-J Peng^2,3, Y-L Huang^2,4, S-H Hsiao^1,2, K-H Chen^2,4, M-T Wu^2,4

¹ Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China
² School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
³ Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China
⁴ Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China

^{Correspondence to} Dr Ming-Ting Wu, Section of Thoracic and Circulation Imaging, Department of Radiology; Kaohsiung Veterans General Hospital, No 386, Ta-Chung 1st Road, Kaohsiung, Taiwan 813, Republic of China; wu.mingting{at}gmail.com

Objectives: To investigate dual-phase multi-detector computed tomography (MDCT) for assessing extent and severity of jeopardised and infarcted myocardium subtended by infarct-related artery (IRA), and its indication for revascularisation 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 jeopardised/infarcted myocardium were assessed by three-dimensional (3D) volume-rendered images with myocardium maps and computed tomography angiography (CTA), compared with stress-redistribution thallium-201 single-photon emission computed tomography (SPECT) plus conventional coronary angiography (CCA). MDCT-jeopardised score (severity of jeopardised myocardium) was defined as extent of jeopardised myocardium multiplied by the weighted factor dependent on culprit lesion severity compared with SPECT-SRS (summation of segmental reversible score). The IRA indication for revascularisation was evaluated by MDCT-jeopardised score plus CTA. SPECT-SRS 2 plus CCA-culprit lesion 50% was the standard reference.

Results: The presence of MDCT-delayed enhancement was found in 101 (94.4%) patients. The IRA and culprit lesion were identified in 99 (92.5%) patients by MDCT-myocardium maps plus CTA. The concordance between MDCT and SPECT for detecting infarcted myocardium was good (kappa = 0.702). The correlation between MDCT-jeopardised score and SPECT-SRS was 0.741. The correlation between CTA and CCA for culprit lesion severity was 0.85. The sensitivity, specificity, negative and positive predictive values of MDCT-jeopardised score 2.5 plus CTA for indicating revascularisation were 90.2%, 80.4%, 86.0% and 85.9%, respectively.

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

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