A Feasibility Study of Contrast Enhancement of Acute Myocardial Infarction in Multislice Computed Tomography

Abstract

Late enhancement magnetic resonance imaging (MRI) of myocardial infarction (MI) is clinically established. There are no reports on MI assessment using state-of-the-art multislice CT technology. For this reason, animal experiments were conducted to examine the applicability of contrast-enhanced ECG-gated multislice computed tomography (MSCT) for the detection of acute MI. The results were correlated with MRI and postmortem tissue staining. Acute MI was induced in 14 pigs by balloon occlusion of the LAD. In 8 animals, the LAD was reperfused after 45 minutes. In 6 animals, the LAD was permanently blocked. MR imaging was performed 15 minutes after the administration of 0.2 mmol Gd-DTPA/kg/bodyweight. Subsequently, 16-slice MSCT was performed at various timepoints after injecting 120 mL of iodinated contrast medium. 2,3,5-Triphenyltetrazolin-chloride (TTC) staining was acquired for all hearts investigated. Correlation analysis was applied to compare the area of MI derived from MRI, MSCT, and TTC. The reperfused infarcts were compared with the nonreperfused infarcts using an unpaired t test. Mean infarct area as measured by TTC staining was 18.3% ± 7.8% of the left ventricular area. Good correlation of the spatial extent of the infarcted area was found for TTC and MRI as well as for TTC and MSCT data obtained 5 minutes postcontrast injection. MSCT imaging demonstrated a significant difference in density (P < 0.001) between nonreperfused (47.0 ± 6.6 HU) and reperfused (116.4 ± 19.8 HU) infarction. In our pilot study, contrast-enhanced MSCT was feasible to assess myocardial viability in pigs. MSCT also affords differentiation of nonreperfused and reperfused acute MI. MI sizes derived from MSCT imaging correlate well to those obtained with MRI and TTC.