Functional CT assessment of extravascular contrast distribution volume and myocardial perfusion in acute myocardial infarction. (1st September 2018)

• Record Type: Journal Article
• Authors: So, Aaron; Wisenberg, Gerald; Teefy, Patrick; Yadegari, Andrew; Bagur, Rodrigo; Hadway, Jennifer; Morrison, Laura; MacDonald, Anna; Gaskin, Dave; Butler, John; Biernaski, Heather; Skanes, Stephanie; Park, Stella DohYeoun; Islam, Ali; Hsieh, Jiang; Lee, Ting-Yim
• Is Part Of: International journal of cardiology. Volume 266(2018)
• Page Start: 15
• Page End: 23
• Publication Date: 2018-09-01
• Subjects: AMI acute myocardial infarction -- AU Arbitrary unit -- CMR cardiac magnetic resonance -- DCE dynamic contrast-enhanced -- DECT Dual-energy CT -- ECDV extravascular contrast distribution volume -- HLA horizontal long-axis -- JWL Johnson-Wilson-Lee (model) -- LAD left anterior descending artery -- LCx left circumflex artery -- MAR myocardium at risk -- MP myocardial perfusion -- PCI percutaneous coronary intervention -- RC right coronary -- ROI Region of interest -- T2W T2 weighted -- TEC time-enhancement curve -- TTC triphenyltetrazolium chloride; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.02.101
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Purpose: In a pig model of acute myocardial infarction (AMI), we validated a functional computed tomography (CT) technique for concomitant assessment of myocardial edema and ischemia through extravscualar contrast distribution volume (ECDV) and myocardial perfusion (MP) measurements from a single dynamic imaging session using a single contrast bolus injection. Methods: In seven pigs, balloon catheter was used to occlude the distal left anterior descending artery for one hour followed by reperfusion. CT and cardiac magnetic resonance (CMR) imaging studies were acquired on 3 days and 12 ± 3 day post ischemic insult. In each CT study, 0.7 ml/kg of iodinated contrast was intravenously injected at 3–4 ml/s before dynamic contrast-enhanced (DCE) cardiac images were acquired with breath-hold using a 64-row CT scanner. DCE cardiac images were analyzed with a model-based deconvolution to generate ECDV and MP maps. ECDV as an imaging marker of edema was validated against CMR T2 weighted imaging in normal and infarcted myocardium delineated from ex-vivo histological staining. Results: ECDV in infarcted myocardium was significantly higher (p < 0.05) than that in normal myocardium on both days post AMI and was in agreement with the findings of CMR T2 weighted imaging. MP was significantly lower (p < 0.05) in the infarcted region compared to normal on both days post AMI. Conclusion: This imaging technique can rapidly and simultaneously assess myocardial edema and ischemia through ECDV and MP measurements, and may be useful for delineation of salvageable tissue within at-risk myocardium to guide reperfusion therapy. Highlights: A novel CT imaging technique for concomitant measurement of extravascular contrast distribution volume (ECDV) and myocardial perfusion; ECDV can be a surrogate marker of myocardial edema in acute infarction setting; This technique may be useful for assessment of viability within myocardium at risk to guide cardiac catheterization.