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Assessment of Myocardial Edema by Computed Tomography in Myocardial Infarction

Andreas H. Mahnken, MD, MBA^_*,,_*, Philipp Bruners, MD^_*,, Christoph M. Bornikoel, MD^_*, Nils Krämer, MD^_*, Rolf W. Guenther, MD^_*

^_* Department of Diagnostic Radiology, RWTH Aachen University, Aachen, Germany
Department of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany

^_* Reprint requests and correspondence: Dr. Andreas H. Mahnken, Department of Diagnostic Radiology, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, Aachen D-52070, Germany (Email: mahnken{at}rad.rwth-aachen.de).

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 (_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 (_c = 0.9356) and delayed enhanced CMR (_c = 0.9248) with TTC staining. There was substantial agreement between unenhanced DSCT and T2-weighted CMR (_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.

Key Words: myocardial infarction • computed tomography • cardiac magnetic resonance

Abbreviations and Acronyms   CMR = cardiac magnetic resonance   CNR = contrast-to-noise ratio   CT = computed tomography   DSCT = dual-source computed tomography   ECG = electrocardiogram   LV = left ventricular   MI = myocardial infarction   SNR = signal-to-noise ratio   TTC = 2,3,5-triphenyltetrazolin chloride

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