Blankstein, R., Rogers, I. S. & Cury, R. C. Practical tips and tricks in cardiovascular computed tomography: diagnosis of myocardial infarction. J. Cardiovasc. Comput. Tomogr. 3, 104-111

Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Journal of cardiovascular computed tomography (Impact Factor: 2.29). 03/2009; 3(2):104-11. DOI: 10.1016/j.jcct.2008.10.014
Source: PubMed


In addition to accurately diagnosing coronary artery disease, cardiac CT (CCT) has the potential to provide information on myocardial function, perfusion, and viability. As ongoing research continues to support the utility of such noncoronary uses of CCT, this information is increasingly being integrated into clinical practice. An emerging important use of CCT is the ability to accurately identify areas of infarcted myocardium. From a clinical perspective, detecting and quantifying infarct size has important prognostic and therapeutic implications. This article provides a brief overview on the use of CT to diagnose myocardial infarction (MI) and provide practical "tips and tricks" that can aid in the CT-based detection of MI.

8 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: During cardiac ischemia, intracellular calcium (Ca²⁺) overload occurs which can result in cell death. MRI T₁ shortening contrast agent manganese (Mn²⁺) acts as a surrogate marker for Ca²⁺. Cardiac T₁-mapping manganese-enhanced MRI (MEMRI) techniques were applied to study the efflux of Mn²⁺ from both healthy mice and mice post-myocardial infarction (MI) surgery. Temporal changes in the myocardial relaxation rate, ∆R₁, post-MnCl₂ infusion were shown to be linearly correlated to the absolute Mn content. The relative importance of individual efflux mechanisms in healthy mice was investigated by inhibiting the sodium-calcium exchanger (NCX) with SEA0400, following infusion of MnCl₂, with SEA0400 reducing the rate of Mn²⁺ efflux. Regional alterations in Mn²⁺ uptake and efflux were also studied post-myocardial infarction, allowing for the identification of potentially salvageable myocardium in the peri-infarcted zone surrounding the necrosed tissue. Application of pharmacokinetic models to in vivo and elemental analysis data from both the healthy and MI mice groups suggested that the NCX was more active in Mn²⁺ efflux than for Ca²⁺ and that there was an increase in Mn²⁺ uptake due to the disease condition, consistent with Ca²⁺ overloading. Studying Mn²⁺ efflux using these protocols could provide a pre-clinical model for examining alterations in relative Ca²⁺ fluxes and to potentially monitor disease progression.
    Preview · Article · Jan 2009
  • [Show abstract] [Hide abstract]
    ABSTRACT: The ability to simultaneously visualize both coronary atherosclerosis and myocardial perfusion may enable the assessment of the anatomical burden and physiological significance of coronary lesions in a single exam. In this paper we introduce a novel use of the dual source CT: pharmacologically induced stress myocardial perfusion imaging, (SP-DSCT). We describe an experimental protocol by which we used the DSCT to assess both stress and rest myocardial perfusion in order to identify areas of infarcted and ischemic myocardium. Based on our initial investigations, this protocol is feasible and can be used to identify hemodynamically significant stenosis. Nevertheless, further studies are required to determine the incremental value of this technique to traditional coronary CT angiography and/or nuclear stress myocardial perfusion imaging.
    No preview · Article · Mar 2009 · The International Journal of Cardiovascular Imaging
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Cardiac computed-tomographic angiography (CTA) has gained widespread acceptance as a useful non-invasive technique in the assessment of coronary artery disease. Although most interest has focused on coronary vessels, analysis of myocardial perfusion, left ventricular wall motion, ejection fraction and left ventricular structure can easily be performed at the same time allowing comprehensive assessment of anatomy and function in a single examination. We present a case of acute ST elevation myocardial infarction where cardiac catheterization was deferred, but assessment by CTA permitted a management plan to be constructed using rest perfusion and blood pool inversion analyses of the dataset obtained during the coronary artery study. Conclusion Coronary CT angiography can provide a comprehensive assessment of coronary arteries, myocardial perfusion and structural features in those not suitable for coronary angiography after myocardial infarction.
    No preview · Article · Aug 2009 · Irish Journal of Medical Science
Show more