Contrast-Enhanced C-arm Computed Tomography Imaging of Myocardial Infarction in the Interventional Suite. Issue 6 (June 2015)

• Record Type: Journal Article
• Authors: Girard, Erin E.; Al-Ahmad, Amin; Rosenberg, Jarrett; Luong, Richard; Moore, Teri; Lauritsch, Günter; Chan, Frandics; Lee, David P.; Fahrig, Rebecca
• Is Part Of: Investigative radiology. Volume 50:Issue 6(2015:Jun.)
• Publication Date: 2015-06
• Subjects: myocardial infarction -- imaging -- C-arm computed tomography; Diagnosis, Radioscopic -- Periodicals; Radiology, Medical -- Periodicals; 616.0757
• DOI: 10.1097/RLI.0000000000000138
• Languages: English
• ISSNs: 0020-9996

Abstract

Abstract : Objectives: Cardiac C-arm computed tomography (CT) uses a standard C-arm fluoroscopy system rotating around the patient to provide CT-like images during interventional procedures without moving the patient to a conventional CT scanner. We hypothesized that C-arm CT can be used to visualize and quantify the size of perfusion defects and late enhancement resulting from a myocardial infarction (MI) using contrast-enhanced techniques similar to previous CT and magnetic resonance imaging studies. Materials and Methods: A balloon occlusion followed by reperfusion in a coronary artery was used to study acute and subacute MI in 12 swine. Electrocardiographically gated C-arm CT images were acquired the day of infarct creation (n = 6) or 4 weeks after infarct creation (n = 6). The images were acquired immediately after contrast injection, then at 1 minute, and every 5 minutes up to 30 minutes with no additional contrast. The volume of the infarct as measured on C-arm CT was compared against pathology. Results: The volume of acute MI, visualized as a combined region of hyperenhancement with a hypoenhanced core, correlated well with pathologic staining (concordance correlation, 0.89; P < 0.0001; mean [SD] difference, 0.67 [2.98] cm 3 ). The volume of subacute MI, visualized as a region of hyperenhancement, correlated well with pathologic staining at imaging times 5 to 15 minutes after contrast injection (concordance correlation, 0.82; P < 0.001; mean difference, −0.64 [1.94] cm 3 ). Conclusions: C-arm CT visualization of acute and subacute MI is possible in a porcine model, but improvement in the imaging technique is important before clinical use. Visualization of MI in the catheterization laboratory may be possible and could provide 3-dimensional images for guidance during interventional procedures.