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Assessment of Reperfused Acute Myocardial Infarction with Two-Phase Contrast-enhanced Helical CT: Prediction of Left Ventricular Function and Wall Thickness¹

¹ From the Departments of Cardiology (Y.K., H.M., H.K., J.A., T.I.) and Radiology (H.H.), Ehime Prefectural Imabari Hospital, 4–5-5 Ishii-chou, Imabari, 794-0006, Ehime, Japan; Department of Radiology (T.M., S.N.) and Second Department of Internal Medicine (J.H.), Ehime University School of Medicine, Ehime, Japan; and Department of Biostatistics/Epidemiology and Preventive Health Sciences, School of Health Sciences and Nursing, University of Tokyo, Tokyo, Japan (M.N., Y.O.). From the 2002 RSNA Annual Meeting. Received March 22, 2003; revision requested June 13; final revision received July 27, 2004; accepted August 16. Address correspondence to Y.K. (e-mail: yasushi@koyamasan.com).

View larger version (17K): [in a new window]   Figure 1. Protocol for two-phase contrast-enhanced CT.

View larger version (27K): [in a new window]   Figure 2. Schematic representation of double-oblique method for acquiring short-axis images. The CT images are reversals in white and black. 1, Transaxial image obtained at end diastole shows the first oblique plane (line) in the long axis of the transaxial image; from this we obtained the long-axis view in 2. 2, The second image was then obliqued at the line connecting the apex and the posterior base of the aortic valve (line); from this we obtained the four-chamber image in 3. 3, On the four-chamber image, we "cut" the heart from its base (line) to the apex to obtain two-dimensional short-axis images.

View larger version (36K): [in a new window]   Figure 3. Schematic representation of the enhancement pattern observed on short-axis two-phase contrast-enhanced CT images in each group. The dark gray circles indicate the left ventricular wall; the light gray circles indicate the left ventricular cavity. Group 1 had no early perfusion defect (ED; black regions in left column) on the early image and had late enhancement (LE; white regions) without a residual perfusion defect (RD; black region in right column) on the late image, group 2 had an early perfusion defect and late enhancement without a residual perfusion defect, and group 3 had both an early and a residual perfusion defect with partial late enhancement.

View larger version (63K): [in a new window]   Figure 4. Short-axis contrast-enhanced helical CT images show the typical enhancement patterns in the three groups. Images obtained in 56-year-old man in group 1 with acute MI (arrows) in the territory of the left anterior descending coronary artery show no early perfusion defect and late enhancement without a residual defect. Images obtained in 62-year-old woman in group 2 with acute MI (arrows) in the territory of the right coronary artery show an early perfusion defect and late enhancement without a residual defect. Images obtained in 60-year-old man in group 3 with acute MI (arrows) in the territory of the circumflex coronary artery show an early defect and late enhancement with a residual defect.

View larger version (34K): [in a new window]   Figure 5. Short-axis contrast-enhanced helical CT images obtained in same patients as in Figure 4 show typical early phase findings in the three groups at the long-term study. In group 1, wall thickness in the infarcted area (arrows) did not change between the acute phase (as seen in upper left image of Figure 4) and the long-term studies. In group 2, wall thickness in the infarcted area (arrows) at the long-term study was moderately decreased compared with the thickness at the acute phase study (as seen in upper middle image of Figure 4). In group 3, wall thickness in the infarcted area (arrows) at the long-term study was significantly decreased compared with the thickness at the acute phase study (as seen in upper right image of Figure 4). In group 3, areas of transmural early defect with residual defect in the acute phase (as seen in group 3 images of Fig 4) changed to areas of scar formation at the long-term study.