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Assessment of Acute Myocardial Infarction Using MDCT After Percutaneous Coronary Intervention: Comparison with MRI

¹ Department of Radiology, University of California at San Francisco, San Francisco, CA.
² Department of Radiology, Louis Pradel Hospital, Lyon, France.
³ Present address: Department of Radiology, VA Medical Center, 4150 Clement St., San Francisco, CA 94121.
⁴ Department of Cardiology, Louis Pradel Hospital, Lyon, France.

View larger version (15K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Comparison of CT attenuation in Hounsfield units (gray bars) and MRI signal-to-noise ratio (SNR, white bars) of involved myocardium, left ventricular cavity, and healthy myocardium. Values are expressed as mean attenuation and standard error (SE) of mean. Scales have been calibrated so that values for involved myocardium are at same height. Mean involved-to-healthy myocardium signal ratio is smaller on CT than MRI (2.7 vs 5.2, respectively). Conversely, mean involved myocardium-to-left ventricular cavity signal ratio is greater on CT than MRI (1.9 vs 1.2).

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Comparison of delayed enhanced MDCT and delayed enhanced MRI findings. Correlation of number of involved segments (A; r2 = 0.74), grade of transmural extent (B; r2 = 0.76), and volume of infarcted myocardium (C; r2 = 0.67) between delayed enhanced MDCT and delayed enhanced MRI. Regression line (solid line) and 95% CIs (dashed lines) are also plotted. Grade of transmural extent for each patient and each technique corresponds to sum of score of transmural extent of enhancement of all segments (on 4-point grading scale).

View larger version (14K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Comparison of delayed enhanced MDCT and delayed enhanced MRI findings. Correlation of number of involved segments (A; r2 = 0.74), grade of transmural extent (B; r2 = 0.76), and volume of infarcted myocardium (C; r2 = 0.67) between delayed enhanced MDCT and delayed enhanced MRI. Regression line (solid line) and 95% CIs (dashed lines) are also plotted. Grade of transmural extent for each patient and each technique corresponds to sum of score of transmural extent of enhancement of all segments (on 4-point grading scale).

View larger version (17K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Comparison of delayed enhanced MDCT and delayed enhanced MRI findings. Correlation of number of involved segments (A; r2 = 0.74), grade of transmural extent (B; r2 = 0.76), and volume of infarcted myocardium (C; r2 = 0.67) between delayed enhanced MDCT and delayed enhanced MRI. Regression line (solid line) and 95% CIs (dashed lines) are also plotted. Grade of transmural extent for each patient and each technique corresponds to sum of score of transmural extent of enhancement of all segments (on 4-point grading scale).

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —44-year-old man. Comparison between delayed enhanced MDCT (A and C) and delayed enhanced MRI (B and D) in short-axis views (A and B) and two-chamber views (C and D). Transmural extent of enhancement of inferior left ventricular wall (arrows) visualized with delayed enhanced MDCT matches that of delayed enhanced MRI findings. Partial involvement of right ventricle (arrowhead, A and B) is also visible.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —44-year-old man. Comparison between delayed enhanced MDCT (A and C) and delayed enhanced MRI (B and D) in short-axis views (A and B) and two-chamber views (C and D). Transmural extent of enhancement of inferior left ventricular wall (arrows) visualized with delayed enhanced MDCT matches that of delayed enhanced MRI findings. Partial involvement of right ventricle (arrowhead, A and B) is also visible.

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —44-year-old man. Comparison between delayed enhanced MDCT (A and C) and delayed enhanced MRI (B and D) in short-axis views (A and B) and two-chamber views (C and D). Transmural extent of enhancement of inferior left ventricular wall (arrows) visualized with delayed enhanced MDCT matches that of delayed enhanced MRI findings. Partial involvement of right ventricle (arrowhead, A and B) is also visible.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —44-year-old man. Comparison between delayed enhanced MDCT (A and C) and delayed enhanced MRI (B and D) in short-axis views (A and B) and two-chamber views (C and D). Transmural extent of enhancement of inferior left ventricular wall (arrows) visualized with delayed enhanced MDCT matches that of delayed enhanced MRI findings. Partial involvement of right ventricle (arrowhead, A and B) is also visible.

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —40-year-old man. Comparison between delayed enhanced MDCT (A and C) and delayed enhanced MRI (B and D) in short-axis views (A and B) and vertical long-axis views (C and D). Good visual correlation is found between delayed enhanced MDCT and delayed enhanced MRI for myocardial contrast uptake (arrows). Nevertheless, no-reflow zone (arrowhead, A) is underestimated by delayed enhanced MDCT because lack of contrast enhancement within immediate subendocardial myocardium is smaller on delayed enhanced MDCT than delayed enhanced MRI (arrowheads, B and D).

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —40-year-old man. Comparison between delayed enhanced MDCT (A and C) and delayed enhanced MRI (B and D) in short-axis views (A and B) and vertical long-axis views (C and D). Good visual correlation is found between delayed enhanced MDCT and delayed enhanced MRI for myocardial contrast uptake (arrows). Nevertheless, no-reflow zone (arrowhead, A) is underestimated by delayed enhanced MDCT because lack of contrast enhancement within immediate subendocardial myocardium is smaller on delayed enhanced MDCT than delayed enhanced MRI (arrowheads, B and D).

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —40-year-old man. Comparison between delayed enhanced MDCT (A and C) and delayed enhanced MRI (B and D) in short-axis views (A and B) and vertical long-axis views (C and D). Good visual correlation is found between delayed enhanced MDCT and delayed enhanced MRI for myocardial contrast uptake (arrows). Nevertheless, no-reflow zone (arrowhead, A) is underestimated by delayed enhanced MDCT because lack of contrast enhancement within immediate subendocardial myocardium is smaller on delayed enhanced MDCT than delayed enhanced MRI (arrowheads, B and D).

View larger version (187K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —40-year-old man. Comparison between delayed enhanced MDCT (A and C) and delayed enhanced MRI (B and D) in short-axis views (A and B) and vertical long-axis views (C and D). Good visual correlation is found between delayed enhanced MDCT and delayed enhanced MRI for myocardial contrast uptake (arrows). Nevertheless, no-reflow zone (arrowhead, A) is underestimated by delayed enhanced MDCT because lack of contrast enhancement within immediate subendocardial myocardium is smaller on delayed enhanced MDCT than delayed enhanced MRI (arrowheads, B and D).

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Comparison of delayed enhanced MDCT and biologicaI findings. Correlation between admission creatine kinase (A–C) and maximum troponin (D–F) levels with number of involved segments (A and D), grade of transmural extent (B and E), and volume of infarcted myocardium (C and F). For creatine kinase and maximum troponin levels, r2 values are 0.53, 0.53, 0.57, 0.58, and 0.46, 0.44, respectively, for number of involved segments, transmural grade extent, and volume of infarcted myocardium analysis.

View larger version (14K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Comparison of delayed enhanced MDCT and biologicaI findings. Correlation between admission creatine kinase (A–C) and maximum troponin (D–F) levels with number of involved segments (A and D), grade of transmural extent (B and E), and volume of infarcted myocardium (C and F). For creatine kinase and maximum troponin levels, r2 values are 0.53, 0.53, 0.57, 0.58, and 0.46, 0.44, respectively, for number of involved segments, transmural grade extent, and volume of infarcted myocardium analysis.

View larger version (15K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —Comparison of delayed enhanced MDCT and biologicaI findings. Correlation between admission creatine kinase (A–C) and maximum troponin (D–F) levels with number of involved segments (A and D), grade of transmural extent (B and E), and volume of infarcted myocardium (C and F). For creatine kinase and maximum troponin levels, r2 values are 0.53, 0.53, 0.57, 0.58, and 0.46, 0.44, respectively, for number of involved segments, transmural grade extent, and volume of infarcted myocardium analysis.

View larger version (14K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —Comparison of delayed enhanced MDCT and biologicaI findings. Correlation between admission creatine kinase (A–C) and maximum troponin (D–F) levels with number of involved segments (A and D), grade of transmural extent (B and E), and volume of infarcted myocardium (C and F). For creatine kinase and maximum troponin levels, r2 values are 0.53, 0.53, 0.57, 0.58, and 0.46, 0.44, respectively, for number of involved segments, transmural grade extent, and volume of infarcted myocardium analysis.

View larger version (14K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5E —Comparison of delayed enhanced MDCT and biologicaI findings. Correlation between admission creatine kinase (A–C) and maximum troponin (D–F) levels with number of involved segments (A and D), grade of transmural extent (B and E), and volume of infarcted myocardium (C and F). For creatine kinase and maximum troponin levels, r2 values are 0.53, 0.53, 0.57, 0.58, and 0.46, 0.44, respectively, for number of involved segments, transmural grade extent, and volume of infarcted myocardium analysis.

View larger version (15K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5F —Comparison of delayed enhanced MDCT and biologicaI findings. Correlation between admission creatine kinase (A–C) and maximum troponin (D–F) levels with number of involved segments (A and D), grade of transmural extent (B and E), and volume of infarcted myocardium (C and F). For creatine kinase and maximum troponin levels, r2 values are 0.53, 0.53, 0.57, 0.58, and 0.46, 0.44, respectively, for number of involved segments, transmural grade extent, and volume of infarcted myocardium analysis.

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