title: Post-mortem cardiac diffusion tensor imaging: detection of myocardial infarction and remodeling of myofiber architecture.
abstract: OBJECTIVE
  To investigate the accuracy of post-mortem diffusion tensor imaging (DTI) for the detection of myocardial infarction (MI) and to demonstrate the feasibility of helix angle (HA) calculation to study remodelling of myofibre architecture.
  
  
  METHODS
  Cardiac DTI was performed in 26 deceased subjects prior to autopsy for medicolegal reasons. Fractional anisotropy (FA) and mean diffusivity (MD) were determined. Accuracy was calculated on per-segment (AHA classification), per-territory, and per-patient basis, with pathology as reference standard. HAs were calculated and compared between healthy segments and those with MI.
  
  
  RESULTS
  Autopsy demonstrated MI in 61/440 segments (13.9 %) in 12/26 deceased subjects. Healthy myocardial segments had significantly higher FA (p < 0.01) and lower MD (p < 0.001) compared to segments with MI. Multivariate logistic regression demonstrated that FA (p < 0.10) and MD (p = 0.01) with the covariate post-mortem time (p < 0.01) predicted MI with an accuracy of 0.73. Analysis of HA distribution demonstrated remodelling of myofibre architecture, with significant differences between healthy segments and segments with chronic (p < 0.001) but not with acute MI (p > 0.05).
  
  
  CONCLUSIONS
  Post-mortem cardiac DTI enables differentiation between healthy and infarcted myocardial segments by means of FA and MD. HA assessment allows for the demonstration of remodelling of myofibre architecture following chronic MI.
  
  
  CONCLUSIONS
  • DTI enables post-mortem detection of myocardial infarction with good accuracy. • A decrease in right-handed helical fibre indicates myofibre remodelling following chronic myocardial infarction. • DTI allows for ruling out myocardial infarction by means of FA. • Post-mortem DTI may represent a valuable screening tool in forensic investigations.
authors: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
authors: Sebastian
authors: S
authors: Winklhofer
authors: Christian T
authors: CT
authors: Stoeck
authors: Nicole
authors: N
authors: Berger
authors: Michael
authors: M
authors: Thali
authors: Robert
authors: R
authors: Manka
authors: Sebastian
authors: S
authors: Kozerke
authors: Hatem
authors: H
authors: Alkadhi
authors: Paul
authors: P
authors: Stolzmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016880:Anisotropy; D001344:Autopsy; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D005554:Forensic Medicine / Q000379:methods; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D009206:Myocardium / Q000473:pathology*; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult