title: Acute myocardial infarction: early CT aspects of myocardial microcirculation obstruction after percutaneous coronary intervention.
abstract: OBJECTIVE
  To evaluate the capabilities of delayed enhanced multidetector CT (DE-MDCT), performed immediately after percutaneous coronary intervention (PCI), in predicting myocardial microvascular obstruction (MVO) formation assessed by delayed enhanced MRI (DE-MRI).
  
  
  METHODS
  Thirty-two patients presenting with a primary acute myocardial infarction, successfully recanalised by PCI, underwent a DE-MDCT immediately after PCI and a DE-MRI within 1 week. The left ventricle was split into 64 subsegments, rated as "healthy", "infarcted" or "MVO" on DE-MRI. Their mean density was measured on DE-MDCT and calculated relative to the patient's mean healthy myocardium density. Hypoenhanced DE-MDCT subsegments, termed "CT early MVO", were also recorded. Sensitivity and specificity of DE-MDCT for MRI-assessed "MVO" subsegments detection was calculated for mean CT relative density (threshold determined from a ROC analysis), "CT early MVO" and both.
  
  
  RESULTS
  Mean CT relative density was higher in MRI-assessed "MVO" than in "infarcted" and "healthy" subsegments (1.82 ± 0.46, 1.43 ± 0.36 and 1.0 ± 0.13 respectively; P < 0.001) leading to a sensitivity and specificity of 94.3 % and 89.2 % for a cutoff of 1.36. Sensitivity and specificity were respectively 16.9 % and 99.8 % for "CT early MVO" and 95.3 % and 89.3 % when considering the two patterns.
  
  
  CONCLUSIONS
  DE-MDCT, performed immediately after PCI, allows for an accurate prediction of MVO formation.
  
  
  CONCLUSIONS
  • Myocardial microvascular obstruction (MVO) is an important prognostic sequel following myocardial infarction. • MVO can be accurately predicted by multidector CT (MDCT). • Both hypo- and hyperenhanced myocardial areas can be analysed by MDCT. • MDCT may become a useful prognostic tool for acute MI outcome.
authors: Department of Radiology, Louis Pradel Hospital, CREATIS, CNRS UMR 5220, INSERM U1044, Lyon, France.
authors: Charles
authors: C
authors: Amanieu
authors: Ingrid
authors: I
authors: Sanchez
authors: Simona
authors: S
authors: Arion
authors: Eric
authors: E
authors: Bonnefoy
authors: Didier
authors: D
authors: Revel
authors: Philippe
authors: P
authors: Douek
authors: Loic
authors: L
authors: Boussel
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D017130:Angioplasty / Q000379:methods; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D009206:Myocardium / Q000473:pathology; D015588:Observer Variation; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
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