Differentiation of Recent and Chronic Myocardial Infarction by Cardiac Computed Tomography

doi:10.1016/j.amjcard.2006.01.101

The American Journal of Cardiology

Volume 98, Issue 3, 1 August 2006, Pages 303-308

https://doi.org/10.1016/j.amjcard.2006.01.101 Get rights and content

Clinical use of cardiac computed tomography is rapidly expanding, and its purpose may reach beyond noninvasive coronary angiography. We investigated the ability of 64-slice multidetector computed tomography to differentiate between recent and long-standing myocardial infarction (MI). Contrast-enhanced coronary computed tomographic (CT) scans (Siemens Sensation 64) of patients with a recent MI (<7 days, n = 16), long-standing MI (>12 months, n = 13), and no MI (n = 13) were retrospectively evaluated. To anticipate transmural variation of myocardial perfusion and to neutralize image noise, a series of thin, overlapping slices was created in parallel alignment to the myocardial wall. Within each of these slices, a small region of interest was placed at a constant in-plane position to measure the CT attenuation (Hounsfield units [HU]) at consecutive transmural locations of injured and normal remote myocardium. In addition, wall thickness and the myocardial cavity were measured. Significantly lower CT attenuation values were found in patients with long-standing MI (−13 ± 37 HU) than in those with acute MI (26 ± 26HU) and normal controls (73 ± 14 HU, p <0.001). The attenuation difference between infarcted and remote myocardia was larger in patients with long-standing MI than in patients with recent MI (89 ± 41 and 55 ± 33 HU, respectively, p <0.001). In addition, long-standing MI was associated with wall thinning (p <0.01), and ventricular dilation (p <0.05), whereas recent MI was not (p >0.05). In conclusion, recent and long-standing MIs may be differentiated by computed tomography based on myocardial CT attenuation values and ventricular dimensions.

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 =

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Citation 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
Contrast-enhanced chest computed tomography (CT) is not considered part of the evaluation of myocardial infarction. However, acute myocardial infarction has been detected on contrast-enhanced chest CT as areas of decreased myocardial enhancement in patients evaluated for other indications, such as pulmonary embolism and aortic dissection. We present a case of acute myocardial infarction on a nongated chest CT in a 67-year-old male who presented with atypical chest pain and initial nondiagnostic electrocardiogram. This case highlights that acute myocardial infarction may be detectable on contrast-enhanced CT. When evaluating contrast-enhanced chest CT's for other etiologies of chest pain, radiologists should look for potential myocardial perfusion abnormalities that can provide clues to the presence of myocardial infarction.
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This study sought to evaluate the association between contrast-enhanced multidetector computed tomography (CE-MDCT) attenuation and local epicardial conduction speed (ECS) and electrographic abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and ventricular tachycardia (VT).
CE-MDCT is a widely available and fast imaging technology with high spatial resolution that is less prone to defibrillator generator−related safety issues and image artifacts. However, the association between hypoattenuation on MDCT and VT substrates in ARVC remains unknown.
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A total of 17,311 epicardial and 5,204 endocardial points were included. In multivariable regression analysis clustered by patient, RV myocardial attenuation was associated with epicardial bipolar voltage amplitude (2.5% decrease in amplitude per 10 HU decrease in attenuation; p < 0.001), with endocardial unipolar voltage amplitude (0.9% decrease in amplitude per 10 HU decrease in attenuation; p < 0.001), and with ECS (0.4% decrease in ECS per 10 HU decrease in attenuation; p = 0.001).
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Citation 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].
To evaluate the frequency and relevance of hypodense myocardium (HM) encountered in patients undergoing chest-pain CT in the emergency department (ED).
In this IRB-approved retrospective study, ECG-gated chest-pain CT examinations of 300 consecutive patients (mean age 60 ± 17 years) presenting with acute chest-pain to our ED were evaluated. Once ST-segment elevation infarction was excluded, chest-pain CT including the coronary arteries (rule-out acute coronary syndrome (ACS), pulmonary embolism (PE) and acute aortic syndrome (AAS): chest-pain CT_coronary, n = 121) or not including the coronary arteries was performed (rule-out PE and AAS: chest-pain CT_{w/o coronary}, n = 179). Each myocardial segment was assessed for the presence of HM; attenuation was measured and compared to normal myocardium.
HM was identified in 27/300 patients (9%): 12/179 in chest-pain CT_{w/o coronary} (7%) and 15/121 in chest-pain CT_coronary (12%). Mean attenuation of HM (40 ± 17 HU) was significantly lower than that of healthy myocardium (103 ± 18 HU, p < 0.001), with a mean difference of 61 ± 19 HU. In 15/27 patients (55.6%) with HM, the final diagnosis was acute MI, and in the remaining 12/27 patients (44.4%) previous MI was found in the patients’ history. Chest-pain CT_{w/o coronary} identified HM in 10/15 patients (66.6%) with a final diagnosis of acute MI.
HM indicating acute MI are often encountered in chest pain CT in the ED, also in chest-pain CT_{w/o coronary} when MI is not suspected. This indicates that the myocardium should always be analyzed for hypodense regions even when MI not suspected.

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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.

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Coronary artery diseaseDifferentiation of Recent and Chronic Myocardial Infarction by Cardiac Computed Tomography

Section snippets

Patient population

CT attenuation of infarcted myocardium

Discussion

J Am Coll Cardiol

J Am Coll Cardiol

Am Heart J

Clin Radiol

J Am Coll Cardiol

Accuracy of MSCT coronary angiography with 64-slice technologyfirst experience

Eur Heart J

High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography

Circulation

Computerized tomographic (CT) appearance of the myocardium after reversible and irreversible ischemic injury

Invest Radiol

In vivo evaluation of experimental myocardial infarcts by ungated computed tomography

AJR

In vivo estimation of myocardial infarct size and left ventricular function by prospectively gated computerized transmission tomography

Circulation

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

Coronary artery disease
Differentiation of Recent and Chronic Myocardial Infarction by Cardiac Computed Tomography