Coronary artery diseaseDifferentiation of Recent and Chronic Myocardial Infarction by Cardiac Computed Tomography
Section snippets
Patient population
Using the radiology referral system we identified patients who underwent CT coronary angiography between November 2004 and April 2005 and had a history of MI. From medical records (i.e., serum markers, electrocardiograms, and coronary catheterization reports) the age of the MI was determined. Patients with a recent MI (within 1 week without further history of symptomatic heart disease) or long-standing MI (≥1 year previously and without reported cardiac events in the previous year) were
CT attenuation of infarcted myocardium
Regions of decreased CT attenuation (Hounsfield units [HU]) could be identified in long-standing and recent MIs. Lowest CT attenuation values were found in long-standing versus recent MIs (Figure 2 and Table 2). Although the minimum CT attenuation in normal (remote) myocardium varied substantially, even in patients without MIs, there was no significant difference across the 3 groups. In consequence, the difference between infarcted and remote myocardium was larger in long-standing than in
Discussion
The ability to distinguish recent MI from (previously unknown) long-standing MI has clinical value. In this study, we demonstrated that significantly lower CT attenuation values are measured in old infarctions compared with more recent myocardial injury. In a comparable study with 4-slice multidetector-row computed tomography, Nikolaou et al12 demonstrated a borderline significant difference in CT attenuation between recent (<1 month) and long-standing (>1 month) MI (44 ± 17 vs 63 ± 19 HU, p =
References (30)
- et al.
Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography
J Am Coll Cardiol
(2005) - et al.
Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomographya comparative study with quantitative coronary angiography and intravascular ultrasound
J Am Coll Cardiol
(2005) - et al.
Imaging of acute myocardial infarction in man with contrast-enhanced computed transmission tomography
Am Heart J
(1984) - et al.
Subendocardial fatan unusual finding
Clin Radiol
(2003) - et al.
Assessment of myocardial viability in reperfused acute myocardial infarction using 16-slice computed tomography in comparison to magnetic resonance imaging
J Am Coll Cardiol
(2005) - et al.
Accuracy of MSCT coronary angiography with 64-slice technologyfirst experience
Eur Heart J
(2005) - et al.
High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography
Circulation
(2005) - et al.
Computerized tomographic (CT) appearance of the myocardium after reversible and irreversible ischemic injury
Invest Radiol
(1982) - et al.
In vivo evaluation of experimental myocardial infarcts by ungated computed tomography
AJR
(1981) - et al.
In vivo estimation of myocardial infarct size and left ventricular function by prospectively gated computerized transmission tomography
Circulation
(1983)
The usefulness of x-ray computed tomography for the diagnosis of myocardial infarction
Circulation
Conventional and ultrafast computed tomography in the detection of viable versus infarcted myocardium
Am J Card Imaging
Measurement of myocardial infarct size by electron beam computed tomographya comparison with 99mTc sestamibi
Invest Radiol
Assessment of myocardial infarctions using multidetector-row computed tomography
J Comput Assist Tomogr
Acute myocardial infarctioncontrast-enhanced multi-detector row CT in a porcine model
Radiology
Cited by (100)
ACR Appropriateness Criteria® Chronic Chest Pain-High Probability of Coronary Artery Disease: 2021 Update
2022, Journal of the American College of RadiologyAcute myocardial infarction on Nongated chest computed tomography
2020, Radiology Case ReportsCitation Excerpt :Last, both acute and chronic MI can be detected as areas of hypodensity or perfusion defects in a coronary artery territory. Even though it has been suggested that longstanding MI can have ventricular dilation and significantly lower CT attenuation compared with an acute MI, these findings have only been reported in cardiac CT studies [8]. Therefore, although contrast-enhanced CT findings look promising and may be useful, especially in patients who present with atypical chest pain, further studies are needed to assess the complete role and significance of contrast-enhanced chest CT in the evaluation of acute M
Chronic Infarcts and Mimickers of Infarcts
2019, Radiologic Clinics of North AmericaAcute Myocardial Infarct
2019, Radiologic Clinics of North AmericaChest pain CT in the emergency department: Watch out for the myocardium
2018, European Journal of Radiology OpenCitation Excerpt :Acute and chronic MI differs in regard to the attenuation of HM and myocardial thickness, with larger differences between affected and healthy myocardium and with thinner segments in chronic MI. It is well known that HM correlates with MI [14], and that acute and chronic MI can be differentiated based on myocardial attenuation values and by assessing myocardial thickness [18]. Various previous studies in different patient populations showed moderate to good sensitivities and good specificity in the detection of MI by assessing hypodense myocardium ranging between 67–88% and 85–98% respectively [19–21].
- 1
Dr. Nieman was supported by the Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands.
- 2
Dr. Ferencik was supported by grant 1T32 HL076136-02 from the National Institutes of Health, Bethesda, Maryland.