CT Assessment of Myocardial Viability: Quantitive Imaging
Accurate quantification of myocardial-infarct size is critical for clinical decision making. Transmural extent of myocardial infarct predicts whether or not a patient will benefit substantially from revascularization therapy. To date, delayed-enhancement
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Contents
Abstract
Accurate quantification of myocardial-infarct size is critical for clinical decision making. Transmural extent of myocardial infarct predicts whether or not a patient will benefit substantially from revascularization therapy. To date, delayed-enhancement cardiac magnetic resonance (DE-CMR) imaging is the clinical standard for quantification of myocardial viability. Multidetector CT is reported by numerous authors to be a useful tool for characterizing and, more importantly, quantifying myocardial-infarct size. Thus, cardiac CT is a promising future tool for a complete coronary artery disease diagnostic workup. This chapter reviews the role of different CT-based imaging methods in precisely quantifying myocardial-infarct size.
1 Background .......................................................................... 193 1.1 Myocardial Infarction: Imaging Perspective ........................ 193 2 2.1 2.2 2.3 2.4
Technical Principles of Visualizing and Quantifying Infarcted Myocardium ........................................................ Contrast Administration ........................................................ Time of Image Acquisition ................................................... Reconstruction and Evaluation Parameters .......................... Quantification Parameters .....................................................
194 194 194 195 195
3
Cardiac CT: Evidence of Quantification of Myocardial Viability....................................................... 195 3.1 Single Energy for Quantifying MI ....................................... 196 3.2 Dual Energy for Quantifying MI .......................................... 201 4
Radiation Protection............................................................ 202
5
Future Perspective............................................................... 202
References...................................................................................... 203
B. Ruzsics (&) Royal Liverpool and Broadgreen University Hospital, UK e-mail: [email protected]
1
Background
1.1
Myocardial Infarction: Imaging Perspective
Prolonged myocardial ischemic injury due to significant coronary artery disease leads to irreversible tissue damage and myocardial cell loss that manifest as myocardial infarction (MI). The infarcted-tissue ‘‘wave front’’ extends from the subendocardium toward the epicardial region. Visualization and, more importantly, accurate quantification of the MI extent facilitate clinical planning of therapeutic management by assessing the risk–benefit ratio of revascularization. Transmurality (i.e., transmural extent of MI) is dependent on the size and duration of ischemic insult. In the acute-phase, cell swelling (oncosis) appears with microangiopathy and edema in an injury response that ultimately causes myocardial dysfunction and irreversible injury. The process of resorption, the recovery of myocardial edema and condensation of necrosis, replaces the acutely injured/ infarcted necrotic myocardium. Scar formation occur
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