Journal of Cardiovascular Computed Tomography
Volume 2, Issue 1 , Pages 26-32, January 2008

Automated multidetector computed tomography evaluation of subacutely infarcted myocardium

  • Balázs Ruzsics, MD

      Affiliations

    • Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA
    • ,
  • Pál Surányi, MD

      Affiliations

    • Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA
    • ,
  • Pál Kiss, MD

      Affiliations

    • Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA
    • ,
  • Brigitta C. Brott, MD

      Affiliations

    • Department of Medicine (Cardiovascular Disease), University of Alabama at Birmingham, Birmingham, AL 35294, USA
    • ,
  • Satinder S. Singh, MD

      Affiliations

    • Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
    • ,
  • Silvio Litovsky, MD

      Affiliations

    • Department of Anatomic Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
    • ,
  • Inmaculada Aban, PhD

      Affiliations

    • Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35294, USA
    • ,
  • Steven G. Lloyd, MD, PhD

      Affiliations

    • Department of Medicine (Cardiovascular Disease), University of Alabama at Birmingham, Birmingham, AL 35294, USA
    • ,
  • Tamas Simor, MD, PhD

      Affiliations

    • Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA
    • ,
  • Gabriel A. Elgavish, PhD

      Affiliations

    • Department of Medicine (Cardiovascular Disease), University of Alabama at Birmingham, Birmingham, AL 35294, USA
    • Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA
    • ,
  • Himanshu Gupta, MD

      Affiliations

    • Department of Medicine (Cardiovascular Disease), University of Alabama at Birmingham, Birmingham, AL 35294, USA
    • Corresponding Author InformationCorresponding author.

Received 30 May 2007; accepted 7 November 2007. published online 19 November 2007.

Background

Delayed enhanced (DE) multidetector computed tomography (MDCT) can identify acute and chronic myocardial infarct. To our knowledge, automated techniques for infarct quantification on DE-MDCT have not been used.

Objective

We evaluated an automated signal intensity (SI) threshold method for quantification of subacute myocardial infarct and identified and quantified microvascular obstruction (MO) in subacute infarct.

Methods

DE-MDCT imaging was performed on 5 pigs 6–7 days after mid left anterior descending artery occlusion-reperfusion. DE-MDCT images were compared with triphenyl tetrazolium chloride (TTC) staining for infarct quantification and with hematoxylin and eosin (H&E) staining for MO quantification. Pixels with SI more than the mean SI of a remote normal myocardial region (SIremote) plus 2 times the standard deviation (SIremote + 2 SD) value were considered infarct pixels. The ratio of infarct to total area of a given slice, the percentage of infarct area per slice (PIS), was calculated. MO as a percentage of total infarct area was also calculated.

Results

The average density values on DE-MDCT (5 minutes after contrast injection) were remote normal myocardium of 93 ± 19 Hounsfield units (HU), infarct myocardium of 159 ± 40 HU, blood of 140 ± 26 HU, and MO of 85 ± 30 HU. PISMDCT showed substantial agreement with PISTTC (y = 1.003x + 4.12; R = 0.90, P < 0.05). A relation was also shown between MO determined by MDCT compared with H&E staining (y = 0.74x + 3.4).

Conclusions

We show the feasibility of using a semiautomated SI threshold technique for quantification of subacute myocardial infarct. We also show the persistent MO in subacute myocardial infarct on DE-MDCT images.

Keywords: Delayed enhancement, Magnetic resonance imaging, Microvascular obstruction, Multidetector CT, Myocardial infarct, No-reflow zone

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 Conflict of interest: Dr. Surányi and Dr. Kiss were employees of Elgavish Paramagnetics Inc., Birmingham, AL. Dr. Elgavish is the president of Elgavish Paramagnetics Inc. The other authors report no conflicts of interest.

 Mailing address: BDB 101, CVMRI, University of Alabama at Birmingham, 1808 7th Ave. South, Birmingham, AL 35294.

PII: S1934-5925(07)00345-0

doi:10.1016/j.jcct.2007.11.003

Journal of Cardiovascular Computed Tomography
Volume 2, Issue 1 , Pages 26-32, January 2008

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