Volume 4, Issue 2 , Pages 99-107, March 2010
Chronic myocardial infarction detection and characterization during coronary artery calcium scoring acquisitions
Background
Hypoenhanced regions on multidetector CT (MDCT) coronary angiography correlate with myocardial hyperperfusion. In addition to a limited capillary density, chronic myocardial infarction (MI) commonly contains a considerable amount of adipose tissue.
Objective
We explored whether regional myocardial hypoenhancement on contrast-enhanced MDCT could be identified with standard coronary artery calcium (CAC) scoring acquisitions with noncontrast CT.
Methods
Consecutive patients with a history of MI who were referred for contrast-enhanced MDCT from November 2006 until March 2009 were studied. Noncontrast CT for CAC scoring was also performed. The correlation between regional myocardial hypoenhancement on contrast-enhanced CT and regional myocardial hypoattenuated areas on noncontrast CT was defined.
Results
Eighty-three patients (mean age, 61.5
±
12.5 years; n
=
67; 81% male) with previous MI were studied. A total of 1411 myocardial segments were evaluated. Two hundred thirty-nine segments (17%) showed myocardial hypoenhancement by MDCT and 140 segments (9.6%) by CAC. On a patient level, noncontrast CT showed a sensitivity, specificity, positive predictive value, (PPV) and negative predictive value (NPV) of 66% (95% CI, 0.53–0.77), 100% (95% CI, 0.76–1.00), 100% (95% CI, 0.90–1.00), and 41% (95% CI, 0.26–0.58), respectively, to detect myocardial hypoenhancement. On a per segment level, noncontrast CT showed a sensitivity, specificity, PPV, and NPV of 58% (95% CI, 0.51–0.64), 100% (95% CI, 0.99–1.00), 99% (95% CI, 0.94–1.00), and 92% (95% CI, 0.90–0.93), respectively, to detect myocardial hypoenhancement.
Conclusions
Our findings suggest that chronic MI can be detected with standard CAC scoring acquisitions.
Keywords: Computed tomography, Infarct extension, Necrosis, Perfusion defect
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Conflict of interest: The authors report no conflicts of interest.
Dr Rodriguez-Granillo received a research grant from Philips Healthcare.
PII: S1934-5925(09)00639-X
doi:10.1016/j.jcct.2009.12.003
© 2010 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
Volume 4, Issue 2 , Pages 99-107, March 2010
