Comprehensive assessment of myocardial perfusion defects, regional wall motion, and left ventricular function by using 64-section multidetector CT.
OBJECTIVE
To evaluate the accuracy of 64-section multidetector computed tomography (CT) for the assessment of perfusion defects (PDs), regional wall motion (RWM), and global left ventricular (LV) function.


METHODS
All myocardial infarction (MI) patients signed informed consent. The IRB approved the study and it was HIPAA-compliant. Cardiac multidetector CT was performed in 102 patients (34 with recent acute MI and 68 without). Multidetector CT images were analyzed for myocardial PD, RWM abnormalities, and LV function. Global LV function and RWM were compared with transthoracic echocardiography (TTE) by using multidetector CT. PD was detected by using multidetector CT and was correlated with cardiac biomarkers and single photon emission CT (SPECT) myocardial perfusion imaging. Multidetector CT diagnosis of acute MI was made on the basis of matching the presence of PD with RWM abnormalities compared with clinical evaluation.


RESULTS
Correlation between multidetector CT and TTE for global function (r = 0.68) and RWM (kappa = 0.79) was good. The size of PD on multidetector CT had a moderate correlation against SPECT (r = 0.48, -7% +/- 9). There was good to excellent correlation between cardiac biomarkers and the percentage infarct size by using multidetector CT (r = 0.82 for creatinine phosphokinase, r = 0.76 for creatinine phosphokinase of the muscle band, and r = 0.75 for troponin). For detection of acute MI in patients, multidetector CT sensitivity was 94% (32 of 34) and specificity was 97% (66 of 68). Multidetector CT had an excellent interobserver reliability for ejection fraction quantification (r = 0.83), as compared with TTE (r = 0.68).


CONCLUSIONS
Patients with acute MI can be identified by using multidetector CT on the basis of RWM abnormalities and PD.
Cury
Ricardo C
RC
Department of Radiology, Cardiac MR-PET-CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge St, Suite 400, Boston, MA 02114, USA. rcury@partners.org
Nieman
Koen
K
Shapiro
Michael D
MD
Butler
Javed
J
Nomura
Cesar H
CH
Ferencik
Maros
M
Hoffmann
Udo
U
Abbara
Suhny
S
Jassal
Davinder S
DS
Yasuda
Tsunehiro
T
Gold
Herman K
HK
Jang
Ik-Kyung
IK
Brady
Thomas J
TJ
D015415:Biomarkers / Q000032:analysis; D016009:Chi-Square Distribution; D003287:Contrast Media; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014283:Triiodobenzoic Acids; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology
D015415:Biomarkers; D003287:Contrast Media; D019275:Radiopharmaceuticals; D014283:Triiodobenzoic Acids; D017256:Technetium Tc 99m Sestamibi; C044834:iodixanol