MSCT and MRI for the assessment of reperfused acute myocardial infarction

This article, by Timo Baks et al from Erasmus in Rotterdam, in the July issue of JACC, is an attempt to show that delayed enhanced, multislice CT (DE-MSCT) is as good as delayed hyperenhanced MRI (DE-MRI) in the assessment of infarction.

This is an animal study and the conclusion drawn is that at 15 minutes after injection of intravenous contrast, simulating the dose and other conditions as in humans, infarcts between 3 and 7 days old can be easily seen with DE-MSCT. Though the contrast resolution is less than with DE-MRI, the performance as compared to DE-MRI and TTC staining was good and offset by the improved spatial resolution.

There have already been reports of the use of DE-MSCT in the evaluation of infarct in humans (Mahnken AH, Gerber BL, Nikolaou ), and animals (Lardo AC)  including one case published a few months ago on this blog as well.

The issue in the end I guess is going to be radiation dose, because already with the noise being made about the radiation from the angiogram itself, this is an additional run, with almost the same radiation dose, though for DE-MSCT, tube modulation can probably be used more effectively.

Though this case is in a human, we can see the defect in the first-pass angiogram study (Figs. 1, 3) in the anterior wall and septum, which shows delayed hyperenhancement (Figs. 2, 4), with subendocardial distribution in the septum (red arrowhead) and full-thickness infarction in the anterior wall.

Comments

[Dr. Sunil P Thomas]

I am a Radiologist working with NMC Abu Dhabi. We have just installed a 64 slice Brilliance Philips scanner and have started preliminary cardiac patients.
The image quality is largely dependant on patient compliance and satisfactory results require heart rate of 70bpm.
Calcium scoring is great though and as a screening tool it is nice.
We are however not giving up and will install a dual source SOMATOM Definition in the near future in our Dubai specialty hopital.
That will hopefully nail the problem and I will get back to you after we get images.