Cardiac CT progresses
in evaluating myocardium
Low-dose protocol matches MRI
for assessing infarction, while color-coded maps
improve sensitivity
By: C. P. Kaiser
Cardiac CT is moving closer
to competing with MR in imaging damage to the
myocardium caused by infarction. A group of
researchers from Aachen University of Technology
in Germany presented three studies related to
this ongoing race.
Dr. Andreas H. Mahnken, a radiologist at
Aachen, and colleagues found that 16-slice CT
can reliably assess left ventricular volumes and
regional wall motion at rest. They reached this
conclusion by comparing multislice CT with MRI
in pigs. But 16-slice CT cannot assess
functional parameters that directly depend on
temporal resolution, Mahnken said.
In a second study, the Aachen group performed
reperfused contrast-enhanced cardiac multislice
CT (16 slice, 50 kVp, 500 mAs) and
late-enhancement 1.5T MRI in 28 myocardial
infarction patients. The results showed good
agreement between MRI and late-enhancement CT.
The findings were poorer but still within a good
range when MRI and early-phase CT were compared,
Mahnken said.
On early- and late-phase CT, density values
of infarcted myocardium were significantly
different from those of viable myocardium.
"We routinely use coronary CT angiography,
but for this study, we wanted to determine what
other information could be obtained with a lower
CT dose," Mahnken said. "We found that delayed
contrast-enhanced CT at a lower dose is as
reliable as delayed contrast-enhanced MR to
assess infarct size."
The third study determined that
perfusion-weighted color maps from cardiac CT
data improve detection of acute myocardial
infarction. The researchers developed a software
tool for semiautomated detection of the long
axis of the left ventricle and assignment of
left-ventricular segments. The software
color-codes changes in the myocardial contrast
enhancement pattern. Normal myocardium is
encoded in green and infarction in blue.
The group used cardiac CT (120 kVp, 550 mAs)
and late-enhancement MR to examine 15 patients.
MRI showed acute MI in 78 of 255 myocardial
segments. Routine CT correctly detected MI in 58
segments (74% sensitivity, 96% specificity).
Using the color-coded maps, observers increased
sensitivity to 83%, identifying MI in 65
segments.
|