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CLINICAL RESEARCH: CARDIAC IMAGING

Multislice Computed Tomography and Magnetic Resonance Imaging for the Assessment of Reperfused Acute Myocardial Infarction

Timo Baks, MD^_*,, Filippo Cademartiri, MD, PhD^_*,, Amber D. Moelker, MSc^_*, Annick C. Weustink, MD, Robert-Jan van Geuns, MD, PhD^_*,, Nico R. Mollet, MD, PhD^_*,, Gabriel P. Krestin, MD, PhD, Dirk J. Duncker, MD, PhD^_* and Pim J. de Feyter, MD, PhD, FACC^_*,,_*

^_* Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.

Manuscript received November 2, 2005; revised manuscript received February 10, 2006, accepted February 21, 2006.

^_* Reprint requests and correspondence: Dr. Pim J. de Feyter, Department of Cardiology and Radiology, Thorax Center–Room Ba 591, Erasmus Medical Center, Dr. Molewaterplein 40, 3000 GD Rotterdam, the Netherlands. (Email: p.j.defeyter{at}erasmusmc.nl).

OBJECTIVES: We evaluated the accuracy of in vivo delayed-enhancement multislice computed tomography (DE-MSCT) and delayed-enhancement magnetic resonance imaging (DE-MRI) for the assessment of myocardial infarct size using postmortem triphenyltetrazolium chloride (TTC) pathology as standard of reference.

BACKGROUND: The diagnostic value of DE-MSCT for the assessment of acute reperfused myocardial infarction is currently unclear.

METHODS: In 10 domestic pigs (25 to 30 kg), the circumflex coronary artery was balloon-occluded for 2 h followed by reperfusion. After 5 days (3 to 7 days), DE-MRI (1.5-T) was performed 15 min after administration of 0.2 mmol/kg gadolinium-DTPA using an inversion recovery gradient echo technique. On the same day, DE-MSCT (64-slice) was performed 15 min after administration of 1 gI/kg of iodinated contrast material. One day after imaging, hearts were excised, sectioned in 8 mm short-axis slices, and stained with TTC. Infarct size was defined as the hyperenhanced area on DE-MSCT and DE-MRI images and the TTC-negative area on TTC pathology slices. Infarct size was expressed as percentage of total slice area.

RESULTS: Infarct size determined by DE-MSCT and DE-MRI showed a good correlation with infarct size assessed with TTC pathology (R² = 0.96 [p < 0.001] and R² = 0.93 [p < 0.001], respectively). The correlation between DE-MSCT and DE-MRI was also good (R² = 0.96; p < 0.001). The relative difference in CT attenuation value of infarcted myocardium compared to remote myocardium was 191 ± 18%. The relative MR signal intensity between infarcted myocardium and remote myocardium was 554 ± 156%.

CONCLUSIONS: We demonstrated that DE-MSCT can assess acute reperfused myocardial infarction in good agreement with in vivo DE-MRI and TTC pathology.

Abbreviations and Acronyms   CT = computerized tomography   DE-MRI = delayed-enhancement magnetic resonance imaging   DE-MSCT = delayed-enhancement multislice computed tomography   HU = Hounsfield units   TTC = triphenyltetrazolium chloride

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