Assessment of Myocardial Edema by Computed Tomography in Myocardial Infarction

OBJECTIVES: The aim of this study was to analyze whether cardiac computed tomography (CT) permits the assessment of myocardial edema in acute myocardial infarction (MI). Background: Several studies proved the value of detecting myocardial edema from T2-weighted cardiac magnetic resonance (CMR) for differentiating acute from chronic MI. Computed tomography is suited for depicting MI, but there are no data on CT imaging of myocardial edema. We hypothesized that areas of reduced attenuation in acute MI may correspond to edema.

METHODS: In 7 pigs (55.2 +/- 7.3 kg), acute MI was induced using a closed chest model. Animals underwent unenhanced arterial and late-phase dual source computed tomography (DSCT) followed by T2-weighted and delayed contrast-enhanced CMR. Animals were sacrificed, and the excised hearts were stained with 2,3,5-triphenyltetrazolin chloride (TTC). Size of MI, contrast-to-noise ratio, and percent signal difference were compared among the different imaging techniques with concordance-correlation coefficients (rho(c)), Bland-Altman plots, and analysis of variance for repeated measures.

RESULTS: Infarction was transmural on all slices. On unenhanced, arterial, and late-phase DSCT, mean sizes of MI were 27.2 +/- 8.5%, 20.1 +/- 6.9%, and 23.1 +/- 8.2%, respectively. Corresponding values on T2-weighted and delayed enhanced CMR were 28.5 +/- 7.8% and 22.2 +/- 7.7%. Size of MI on TTC staining was 22.6 +/- 7.8%. Best agreement was observed when comparing late-phase CT (rho(c) = 0.9356) and delayed enhanced CMR (rho(c) = 0.9248) with TTC staining. There was substantial agreement between unenhanced DSCT and T2-weighted CMR (rho(c) = 0.8629). Unenhanced DSCT presented with the lowest percent signal difference (46.0 +/- 18.3) and the lowest contrast-to-noise ratio (4.7 +/- 2.0) between infarcted and healthy myocardium.

CONCLUSIONS: Unenhanced DSCT permits the detection of myocardial edema in large acute MI. Further studies including smaller MI in different coronary artery territories and techniques for improving the contrast-to-noise ratio are needed. 

PMID: 19833305

Posted in Computed Tomography and tagged , , .

One Comment

  1. Very interesting concept! While it does not appear to be a robust technique for detecting edema, more work needs to be done to fully understand its real capacity.
    The one example presented in Figure 1 is striking. However, it comes to my attention that on the non-enhanced images, the myocardium appears significantly hyperdense when compared with the adjacent blood pool, a sign that has been described in anemic patients. Are pigs physiologically anemic? Would this finding be harder to detect in humans?

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