title: Identification and viability assessment of infarcted myocardium with late enhancement multidetector computed tomography: comparison with thallium single photon emission computed tomography and echocardiography.
abstract: BACKGROUND
  Recent studies revealed that multidetector computed tomography late enhancement (MDCT-LE) is a reliable technique for detecting necrotic and scarred myocardial tissue. The aims of the study were to identify infarcted myocardium using MDCT-LE protocol in patients after myocardial infarction (MI) and assess viability in resting wall motion abnormalities.
  
  
  METHODS
  One hundred one patients with previous MI (62 +/- 13 years, 1-6 months after MI) underwent MDCT-LE (15 minutes after contrast medium administration), rest-redistribution thallium single photon emission computed tomography (Tl-SPECT), and dobutamine echocardiography (DbE). In a 17-segment model, infarcted myocardium detected by MDCT-LE was categorized as none, 1%-25%, 26%-50%, 51%-75%, or >75% segmental extent and was compared with decreased uptake of Tl-SPECT and contractile function by DbE on per patient and segmental basis in a blinded fashion.
  
  
  RESULTS
  By per patient analysis, MDCT-LE identified the presence of infarcted myocardium in 97 patients (96%), and Tl-SPECT decreased uptake in 88 patients (87%), (P = .02). By per segment analysis, the concordance for detecting infarcted myocardium was good (kappa value = 0.792). In segments with resting wall motion abnormalities (N = 486), there was moderate concordance in assessing viability (kappa value between MDCT and Tl-SPECT = 0.555, MDCT and DbE = 0.498, Tl-SPECT and DbE = 0.478) with predefined MDCT-LE threshold of 50% segmental extent. Among segments with MDCT-LE >75% segmental extent, the proportion designated nonviable by Tl-SPECT and DbE reached 87.8% and 92.2%, respectively.
  
  
  CONCLUSIONS
  Multidetector computed tomography late enhancement is accurate in identifying the presence and extent of infarcted myocardium. Its segmental extent has good correlation with the magnitude of thallium decreased uptake and can predict contractile reserve. Multidetector computed tomography late enhancement can be an alternative to assess viability.
authors: Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.
authors: Kuan-Rau
authors: KR
authors: Chiou
authors: Chun-Peng
authors: CP
authors: Liu
authors: Nan-Jing
authors: NJ
authors: Peng
authors: Wei-Chun
authors: WC
authors: Huang
authors: Shih-Hung
authors: SH
authors: Hsiao
authors: Yi-Luan
authors: YL
authors: Huang
authors: Kuen-Huang
authors: KH
authors: Chen
authors: Ming-Ting
authors: MT
authors: Wu
mesh_terms: D000368:Aged; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D012680:Sensitivity and Specificity; D013794:Thallium Radioisotopes / Q000378:metabolism; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
chemical_list: D013794:Thallium Radioisotopes