Comprehensive assessment of myocardial perfusion defects, regional wall motion, and left ventricular function by using 64-section multidetector CT

Abstract

Purpose: To evaluate the accuracy of 64-section multidetector computed tomography (CT) for the assessment of perfusion defects (PDs), regional wall motion (RWM), and global left ventricular (LV) function.

Materials and methods: All myocardial infarction (MI) patients signed informed consent. The IRB approved the study and it was HIPAA-compliant. Cardiac multidetector CT was performed in 102 patients (34 with recent acute MI and 68 without). Multidetector CT images were analyzed for myocardial PD, RWM abnormalities, and LV function. Global LV function and RWM were compared with transthoracic echocardiography (TTE) by using multidetector CT. PD was detected by using multidetector CT and was correlated with cardiac biomarkers and single photon emission CT (SPECT) myocardial perfusion imaging. Multidetector CT diagnosis of acute MI was made on the basis of matching the presence of PD with RWM abnormalities compared with clinical evaluation.

Results: Correlation between multidetector CT and TTE for global function (r = 0.68) and RWM (kappa = 0.79) was good. The size of PD on multidetector CT had a moderate correlation against SPECT (r = 0.48, -7% +/- 9). There was good to excellent correlation between cardiac biomarkers and the percentage infarct size by using multidetector CT (r = 0.82 for creatinine phosphokinase, r = 0.76 for creatinine phosphokinase of the muscle band, and r = 0.75 for troponin). For detection of acute MI in patients, multidetector CT sensitivity was 94% (32 of 34) and specificity was 97% (66 of 68). Multidetector CT had an excellent interobserver reliability for ejection fraction quantification (r = 0.83), as compared with TTE (r = 0.68).

Conclusion: Patients with acute MI can be identified by using multidetector CT on the basis of RWM abnormalities and PD.

Figures

Figure 1a:

Images of 59-year-old man after ST segment elevation MI in left anterior descending artery distribution. (a) Cardiac multidetector CT short-axis image shows PD in antero- and inferoseptal walls. (b) Cine cardiac CT short-axis image obtained during systole demonstrates akinesia of these segments (Movie E1, [http://radiology.rsnajnls.org/cgi/content/full/248/2/466/DC1]). (c) TTE image in short-axis view obtained during systole confirms akinesia in left anterior descending artery territory (Movie E2, [http://radiology.rsnajnls.org/cgi/content/full/248/2/466/DC1]). (d) SPECT technetium 99m-sestamibi image shows PD defect in antero- and inferoseptal walls.

Figure 1b:

Images of 59-year-old man after ST segment elevation MI in left anterior descending artery distribution. (a) Cardiac multidetector CT short-axis image shows PD in antero- and inferoseptal walls. (b) Cine cardiac CT short-axis image obtained during systole demonstrates akinesia of these segments (Movie E1, [http://radiology.rsnajnls.org/cgi/content/full/248/2/466/DC1]). (c) TTE image in short-axis view obtained during systole confirms akinesia in left anterior descending artery territory (Movie E2, [http://radiology.rsnajnls.org/cgi/content/full/248/2/466/DC1]). (d) SPECT technetium 99m-sestamibi image shows PD defect in antero- and inferoseptal walls.

Figure 1c:

Images of 59-year-old man after ST segment elevation MI in left anterior descending artery distribution. (a) Cardiac multidetector CT short-axis image shows PD in antero- and inferoseptal walls. (b) Cine cardiac CT short-axis image obtained during systole demonstrates akinesia of these segments (Movie E1, [http://radiology.rsnajnls.org/cgi/content/full/248/2/466/DC1]). (c) TTE image in short-axis view obtained during systole confirms akinesia in left anterior descending artery territory (Movie E2, [http://radiology.rsnajnls.org/cgi/content/full/248/2/466/DC1]). (d) SPECT technetium 99m-sestamibi image shows PD defect in antero- and inferoseptal walls.

Figure 1d:

Images of 59-year-old man after ST segment elevation MI in left anterior descending artery distribution. (a) Cardiac multidetector CT short-axis image shows PD in antero- and inferoseptal walls. (b) Cine cardiac CT short-axis image obtained during systole demonstrates akinesia of these segments (Movie E1, [http://radiology.rsnajnls.org/cgi/content/full/248/2/466/DC1]). (c) TTE image in short-axis view obtained during systole confirms akinesia in left anterior descending artery territory (Movie E2, [http://radiology.rsnajnls.org/cgi/content/full/248/2/466/DC1]). (d) SPECT technetium 99m-sestamibi image shows PD defect in antero- and inferoseptal walls.

Figure 2a:

(a) Quantitative LV EF by using multidetector CT with threshold level–based method had good correlation as compared with echocardiography in 102 patients (y = 1.02x, r = 0.68, P < .001). (b) Bland-Altman analysis shows trend toward slight underestimation of LV EF by using multidetector CT in comparison with echocardiography (mean difference, −2% ± 12). SD = standard deviation.

Figure 2b:

(a) Quantitative LV EF by using multidetector CT with threshold level–based method had good correlation as compared with echocardiography in 102 patients (y = 1.02x, r = 0.68, P < .001). (b) Bland-Altman analysis shows trend toward slight underestimation of LV EF by using multidetector CT in comparison with echocardiography (mean difference, −2% ± 12). SD = standard deviation.

Figure 3a:

(a) Interobserver reproducibility of global LV EF by using multidetector CT was excellent (y = 1.01×, r = 0.83, P < .001). (b) Interobserver reproducibility of global LV EF by using echocardiography was good (y = 0.99×, r = 0.68, P < .001).

Figure 3b:

(a) Interobserver reproducibility of global LV EF by using multidetector CT was excellent (y = 1.01×, r = 0.83, P < .001). (b) Interobserver reproducibility of global LV EF by using echocardiography was good (y = 0.99×, r = 0.68, P < .001).

Figure 4a:

(a) Of 20 patients who underwent both multidetector CT and SPECT after acute MI, correlation of infarct size (percentage of LV mass) was moderate (y = 0.55x, r = 0.48, P = .01). (b) Bland-Altman analysis showed trend toward underestimation of percentage of infarct size by using multidetector CT as compared with SPECT (mean difference, −7% ± 9), specifically for larger infarcts (>10% of myocardium mass). SD = standard deviation.

Figure 4b:

(a) Of 20 patients who underwent both multidetector CT and SPECT after acute MI, correlation of infarct size (percentage of LV mass) was moderate (y = 0.55x, r = 0.48, P = .01). (b) Bland-Altman analysis showed trend toward underestimation of percentage of infarct size by using multidetector CT as compared with SPECT (mean difference, −7% ± 9), specifically for larger infarcts (>10% of myocardium mass). SD = standard deviation.

Figure 5a:

Images of 67-year-old man with substernal chest pain and 4-mm ST segment elevation on echocardiogram. (a) Coronary angiogram shows total occlusion of proximal right coronary artery (arrow) that was successfully stented. (b) Multidetector CT study 5 days later reveals area of hypoperfusion (arrows) in inferoseptal and inferior walls, representing MI. Patient also underwent SPECT myocardial perfusion imaging at rest for determination of infarct size on same day of CT. (c) Short-axis and (d) vertical long-axis images did not reveal PD.

Figure 5b:

Images of 67-year-old man with substernal chest pain and 4-mm ST segment elevation on echocardiogram. (a) Coronary angiogram shows total occlusion of proximal right coronary artery (arrow) that was successfully stented. (b) Multidetector CT study 5 days later reveals area of hypoperfusion (arrows) in inferoseptal and inferior walls, representing MI. Patient also underwent SPECT myocardial perfusion imaging at rest for determination of infarct size on same day of CT. (c) Short-axis and (d) vertical long-axis images did not reveal PD.

Figure 5c:

Images of 67-year-old man with substernal chest pain and 4-mm ST segment elevation on echocardiogram. (a) Coronary angiogram shows total occlusion of proximal right coronary artery (arrow) that was successfully stented. (b) Multidetector CT study 5 days later reveals area of hypoperfusion (arrows) in inferoseptal and inferior walls, representing MI. Patient also underwent SPECT myocardial perfusion imaging at rest for determination of infarct size on same day of CT. (c) Short-axis and (d) vertical long-axis images did not reveal PD.

Figure 5d:

Images of 67-year-old man with substernal chest pain and 4-mm ST segment elevation on echocardiogram. (a) Coronary angiogram shows total occlusion of proximal right coronary artery (arrow) that was successfully stented. (b) Multidetector CT study 5 days later reveals area of hypoperfusion (arrows) in inferoseptal and inferior walls, representing MI. Patient also underwent SPECT myocardial perfusion imaging at rest for determination of infarct size on same day of CT. (c) Short-axis and (d) vertical long-axis images did not reveal PD.