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CLINICAL RESEARCH: CARDIAC IMAGING

Characterization of Peri-Infarct Zone Heterogeneity by Contrast-Enhanced Multidetector Computed Tomography

A Comparison With Magnetic Resonance Imaging

Karl H. Schuleri, MD^_*, Marco Centola, MD^_*, Richard T. George, MD^_*, Luciano C. Amado, MD^_*, Kristine S. Evers, AA^_*, Kakuya Kitagawa, MD, PhD^_*, Andrea L. Vavere, MS^_*, Robert Evers, BSRT^_*, Joshua M. Hare, MD, Christopher Cox, PhD, Elliot R. McVeigh, PhD, João A.C. Lima, MD^_* and Albert C. Lardo, PhD^_*,,,_*

^_* Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
Department of Medicine, Division of Cardiology, University of Miami, Miami, Florida
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Manuscript received September 8, 2008; revised manuscript received January 9, 2009, accepted January 16, 2009.

^_* Reprint requests and correspondence: Dr. Albert C. Lardo, Image Guided Cardiotherapy Laboratory, Johns Hopkins School of Medicine, Division of Cardiology, 1042 Ross Building, Baltimore, Maryland 21205 (Email: al{at}jhmi.edu).

Objectives: This study examined whether multidetector computed tomography (MDCT) improves the ability to define peri-infarct zone (PIZ) heterogeneity relative to magnetic resonance imaging (MRI).

Background: The PIZ as characterized by delayed contrast-enhancement (DE)-MRI identifies patients susceptible to ventricular arrhythmias and predicts outcome after myocardial infarction (MI).

Methods: Fifteen mini-pigs underwent coronary artery occlusion followed by reperfusion. Both MDCT and MRI were performed on the same day approximately 6 months after MI induction, followed by animal euthanization and ex vivo MRI (n = 5). Signal density threshold algorithms were applied to MRI and MDCT datasets reconstructed at various slice thicknesses (1 to 8 mm) to define the PIZ and to quantify partial volume effects.

Results: The DE-MDCT reconstructed at 8-mm slice thickness showed excellent correlation of infarct size with post-mortem pathology (r² = 0.97; p < 0.0001) and MRI (r² = 0.92; p < 0.0001). The DE-MDCT and -MRI were able to detect a PIZ in all animals, which correlates to a mixture of viable and nonviable myocytes at the PIZ by histology. The ex vivo DE-MRI PIZ volume decreased with slice thickness from 0.9 ± 0.2 ml at 8 mm to 0.2 ± 0.1 ml at 1 mm (p = 0.01). The PIZ volume/mass by DE-MDCT increased with decreasing slice thickness because of declining partial volume averaging in the PIZ, but was susceptible to increased image noise.

Conclusions: A DE-MDCT provides a more detailed assessment of the PIZ in chronic MI and is less susceptible to partial volume effects than MRI. This increased resolution best reflects the extent of tissue mixture by histopathology and has the potential to further enhance the ability to define the substrate of malignant arrhythmia in ischemic heart disease noninvasively.

Key Words: MDCT • delayed contrast-enhancement • peri-infarct zone • MRI

Abbreviations and Acronyms   CNR = contrast-to-noise ratio   DE = delayed contrast-enhancement   LAD = left anterior descending coronary artery   LV = left ventricle/ventricular   MDCT = multidetector computed tomography   MI = myocardial infarction   MRI = magnetic resonance imaging   PIZ = peri-infarct zone   SEM = scanning electron microscopy   SNR = signal-to-noise ratio   TEM = transmission electron microscopy

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