Differentiation of myocardial ischemia and infarction assessed by dynamic computed tomography perfusion imaging and comparison with cardiac magnetic resonance and single-photon emission computed tomography

Abstract

• CT-MBF accurately reflects the severity of myocardial perfusion abnormality. • CT-MBF provides good diagnostic accuracy for detecting myocardial perfusion abnormalities. • CT-MBF may assist in stratifying severe myocardial infarction in abnormal perfusion myocardium.

Infarct characterization using CT

“…Perfusion and viability may be assessed with CCT (66)(67)(68)(69). In the past decades, areas of suspected MI were mainly investigated by nuclear medicine techniques.…”

“…Authors retrospectively evaluated fifty-three patients who underwent stress dynamic CTP and either SPECT (n = 25) or CMR (n = 28) and found that for detecting the abnormal perfused myocardium, sensitivity and specificity were 80% (95% CI, 71-90) and 86% (95% CI, 76-91) in SPECT (cut-off MBF, 1.23), and 82% (95% CI, 76-88) and 87% (95% CI, [80][81][82][83][84][85][86][87][88][89][90][91][92] in CMR (cut-off MBF, 1.25) (69).…”

Optimal Scan Time for Single-Phase Myocardial Computed Tomography Perfusion to Detect Myocardial Ischemia – Derivation Cohort From Dynamic Myocardial Computed Tomography Perfusion –

“…13 A 256-slice multidetector row CT unit (Brilliance iCT, Philips Healthcare, Cleveland, OH, USA) and an automatic dual injector (Stellant DualFlow; Nihon Medrad KK, Osaka, Japan) were used. A timing bolus scan was performed at the proximal ascending aorta, with a bolus injection of 20% diluted solution (5.0 ml/s for 10 s) of contrast material (CM) (iopamidol 370 mg iodine/ml; Bayer Yakuhin, Ltd, Osaka, Japan) and saline, followed by a saline chaser (5.0 ml/s for 4 s).…”

“…In contrast, the wide-detector CT scanner we used enables data acquisition for the whole heart in every cardiac cycle without temporal or spatial gaps. 13 Thus, we aimed to investigate the optimal scan time and diagnostic performance of single-phase CTP for detecting myocardial ischemia by analyzing dynamic CTP series data for the whole heart in a derivation cohort study.…”

“…Using the 16-segment model excluding the apex, 15 all myocardial segments were classified into 2 groups: (1) normal segment, segment with normal perfusion on stress and rest images, and non-LGE; (2) ischemic segment, a segment with a PD (≥25% of the LV wall thickness) not contaminated by dark rim artifact, persisting for at least 10 frames in a stress image, and non-LGE. 13 …”