Coronary artery disease
Comparison of Multislice Computed Tomography to Gated Single-Photon Emission Computed Tomography for Imaging of Healed Myocardial Infarcts

https://doi.org/10.1016/j.amjcard.2007.07.084Get rights and content

The aim of the study was to evaluate the performance of multislice computed tomography (MSCT) for the detection and semiquantitative analysis of healed myocardial infarct in comparison to single-photon emission computed tomography (SPECT). Recently, MSCT was shown to allow detection of myocardial infarct by the presence of hypoenhanced areas. However, direct comparisons to other imaging modalities for infarct imaging were scarce. In 69 patients with healed myocardial infarct (>3 months), the presence of myocardial infarct and infarct score was assessed using SPECT and MSCT. In addition, regional and global left ventricular function was assessed using MSCT. In 62 of 69 patients (90%), a perfusion defect was detected using gated SPECT at rest. Using MSCT in these 62 patients (100%), hypoenhanced areas reflecting infarct were shown. In 3 of 7 patients (43%) without perfusion defects who underwent gated SPECT, MSCT identified regions of infarct. The infarct score on MSCT related well to the SPECT infarct score (12 ± 10% vs 16 ± 13%; r = 0.93, p <0.0001). In addition, good (inverse) correlations were shown for infarct score using MSCT and parameters of left ventricular function. In conclusion, healed myocardial infarct can be detected accurately using MSCT, with good correlation with SPECT.

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Patients and study protocol

Sixty-nine patients with previous myocardial infarct (>3 months before the study) who underwent 64-slice MSCT and gated myocardial perfusion SPECT to assess coronary artery disease were included in the study protocol. Myocardial infarct was documented as typical chest pain lasting >30 minutes, increased creatine kinase-MB protein and/or troponin-T, and typical electrocardiographic changes. Contraindications to MSCT included (supra) ventricular arrhythmias, renal insufficiency (serum creatinine

Results

The 69 patients included in the study had a history of 74 healed myocardial infarcts, and 5 patients had 2 previous infarcts. Clinical characteristics of the study population are listed in Table 1.

Discussion

The purpose of the present study was to evaluate the performance of MSCT in the detection and semiquantitative analysis of healed myocardial infarct in comparison to gated SPECT. Furthermore, relations between infarct score using MSCT and other parameters derived from MSCT (EDWT, WMSI, and LVEF) that also (indirectly) reflected infarct expansion were evaluated. In 62 patients (90%), regions of infarct were detected using gated SPECT at rest. Using MSCT, hypoenhanced areas could be shown in all

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1

J.D. Schuijf was supported by Grant No. 2002B105 from The Netherlands Heart Foundation, The Hague, The Netherlands.

2

Dr. Bax was supported by research grants from GE Healthcare, Milwaukee, Wisconsin, and BMS Medical Imaging, London, United Kingdom.

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