Acute myocardial infarction: early CT aspects of myocardial microcirculation obstruction after percutaneous coronary intervention

• Published in: European radiology Vol. 23; no. 9; pp. 2405 - 2412
• Main Authors: Amanieu, Charles, Sanchez, Ingrid, Arion, Simona, Bonnefoy, Eric, Revel, Didier, Douek, Philippe, Boussel, Loic
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2013; Springer Nature B.V; Springer Verlag
• Subjects: Adult; Aged; Angiography - methods; Angioplasty; Angioplasty - methods; Cardiac; Contrast agents; Coronary Circulation; Density; Diagnostic Radiology; Electrocardiography; Engineering Sciences; Female; Heart attacks; Humans; Image Processing, Computer-Assisted; Imaging; Internal Medicine; Interventional Radiology; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Microcirculation; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - diagnostic imaging; Myocardium - pathology; Neuroradiology; Observer Variation; Patients; Percutaneous Coronary Intervention - methods; Prognosis; Radiology; Sensitivity and Specificity; Signal and Image processing; Tomography; Tomography, X-Ray Computed - methods; Ultrasound; France; Myocardial infarction; Delayed enhancement; CT systems, X-Ray computed; Magnetic resonance imaging; Myocardial microvascular obstruction
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-013-2853-7

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. Conclusion DE-MDCT, performed immediately after PCI, allows for an accurate prediction of MVO formation. Key Points • 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.