Myocardial Contractility, Perfusion, and Viability Analysis Using Multidetector CT in Patients with Ischemic Heart Disease

Sung Min Ko

doi:10.5124/jkma.2007.50.2.143

J Korean Med Assoc > Volume 50(2); 2007 > Article

Ko: Myocardial Contractility, Perfusion, and Viability Analysis Using Multidetector CT in Patients with Ischemic Heart Disease

Focused Issue of This Month

Coronary Artery Disease and Multidetector CT

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2007; 50(2): 143-150.

Published online: February 28, 2007

DOI: http://dx.doi.org/10.5124/jkma.2007.50.2.143

Myocardial Contractility, Perfusion, and Viability Analysis Using Multidetector CT in Patients with Ischemic Heart Disease

Sung Min Ko, MD

Department of Radiology, Keimyung University College of Medicine, Korea. ksm9723@yahoo.co.kr

Abstract

The imaging technique that can provide detailed information on the left ventricular function, myocardial perfusion and viability at the same time will not only be helpful for the prognostic assessment of patients with ischemic heart disease but also be valuable in choosing appropriate therapeutic strategies. In recent years, multidetector CT (MDCT) has been proposed as a useful non-invasive imaging method of evaluating both coronary artery stenoses and cardiac morphology at the same time. MDCT has proved to be in excellent agreement with echocardiography and magnetic resonance imaging in the assessment of the left ventricular function. In addition, MDCT can provide information on myocardial viability, which can be assessed from the left ventricular wall thickness, myocardial perfusion, and a delayed contrast enhancement pattern. Despite several shortcomings to be the first-line modality for the assessment of ischemic heart disease, MDCT can provide valuable additional dynamic information in patients undergoing MDCT coronary angiography.

Multidetector CT; Myocardial contractility; Myocardial perfusion; Myocardial viability

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Figure 1

Screen-shot from Leonardo workstation(Siemens, Forchheim, Germany) displaying dedicated analysis software for MDCT left ventricular function.

Figure 2

Short axis reformats from retrospectively ECG-gated MDCT allow circulation of end-systolic (A) and end-diastolic (B) images for assessment of ventricular function.

Figure 3

Images obtained in a 63-year-old man with acute myocardial infarction.

MR perfusion image (A) shows low signal area in the mid-inferior wall of left ventricle.

Delayed enhanced MR image (B) shows subendocardial dark zone (arrow) surrounded by hyperenhancement (arrowhead) in the same area.

Two-phase contrast enhanced MDCT shows early transmural perfusion defect (arrow) (C) and subendocardial residual perfusion defect (arrow) with subepicardial late enhancement (arrowhead) (D) in the mid inferior wall of left ventricle. This myocardial enhancement pattern correlates well with contrast-enhanced MR imaging

Figure 4

Images obtained in a 72-year-old man with reperfused acute myocardial infarction.

Catheter coronary angiogram (A) shows multiple significant stenoses in the proximal and middle (arrows) right coronary artery and total occlusion at the distal segment (arrowhead) of the right coronary artery. Two-phase contrast enhanced MDCT shows early transmural perfusion defect (B) and subendocardial residual perfusion defect (arrow) with subepicardial late enhancement (arrowhead) (C) in the mid-inferior wall of left ventricle.