Assessment of myocardial infarctions using multidetector-row computed tomography

Objective: To evaluate the diagnostic power of contrast-enhanced multi detector-row computed tomography (MDCT) in assessing the presence, age, and size of myocardial infarctions. Methods: One hundred six patients underwent standard MDCT coronary angiography without additional changes in the protocol. In all patients, a complete patient history and left heart catheterization with biplane contrast ventriculography were available. The MDCT images were reviewed for the presence and age of myocardial infarctions in a blinded fashion. Infarct areas were detected as regions of reduced uptake of contrast in the early arterial phase and/or regional wall-thinning. Reviewing the computed tomography (CT) images, CT density values (Hounsfield units [HU]) were measured at the site of infarcted and noninfarcted myocardium, and a volumetric assessment of the infarct size was performed. Results: In 27 of 106 patients, myocardial infarctions were present. Multi detector-row computed tomography detected 23 of 27 infarctions (sensitivity of 85%, specificity of 91%, and accuracy of 90%). Comparing the HU of infarcted versus noninfareted myocardium, the mean HU of infarcted areas was 54 19 HU versus 117 28 HU for noninfarcted myocardium (P < 0.01). Multidetector-row computed tomography was able to differentiate between recent and chronic infarctions. The infarct volumes of recent infarctions (6.3 +/- 3.6 cm(3)) showed a negative correlation to the ejection fraction (EF) according to contrast ventriculography (ie, the larger the infarct volumes as measured using MDCT, the worse was the EF [r = -0.72, P < 0.0 1]). Conclusions: Performing standard MDCT coronary angiography, areas of infarcted myocardium can be identified with moderate to high sensitivity, without additional scanning or contrast administration. Infarct localization can be assessed accurately as compared with cineventriculography. To some degree, infarct age and infarct volume can be estimated.