Infarct detection with a comprehensive cardiac CT protocol

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• 作者：Brian B. Ghoshhajra ; MD ; MBA^a ; Pal Maurovich-Horvat ; MD^a ; Tust Techasith ; BS^a ; Hector M. Medina ; MD^a ; Daniel Verdini ; MD^a ; Manavjot S. Sidhu ; MD^a ; ^{msidhu1@partners.org} ; Ron Blankstein ; MD^b ; Thomas J. Brady ; MD^a ; Ricardo C. Cury ; MD^a ; ^c
• 关键词：Diagnostic imaging ; Cardiovascular disease ; Myocardial perfusion ; Myocardial infarction ; X-ray computed tomography ; Myocardial perfusion imaging ; Cardiac-gated imaging techniques
• 刊名：Journal of Cardiovascular Computed Tomography
• 出版年：2012
• 出版时间：January-February, 2012
• 年：2012
• 卷：6
• 期：1
• 页码：14-23
• 全文大小：684 K

文摘

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Background

Cardiac CT has the potential to offer comprehensive infarct detection by assessing regional wall motion abnormalities (RWMAs), rest perfusion defects (RPDs), and delayed contrast enhancement (DCE). However, the diagnostic accuracy of these techniques for the detection of myocardial infarction (MI) is unknown.

Methods

Forty-eight patients with intermediate-to-high probability for coronary artery disease after single-photon emitting CT myocardial perfusion imaging were prospectively enrolled for a research comprehensive 64-detector row dual-source cardiac CT protocol that included cine images for RWMA, first-pass images for RPD, and delayed images for DCE. Blinded readers independently assessed each technique. Subsequently, a final combined analysis (cine + rest + DCE) was performed. The universal definition for MI by the 2007 American Heart Association task force was used as the ¡°gold standard.?h4 class=""h4"">Results

Twenty-four of 48 patients (50 % ) had infarct by the universal definition. The combined CT analysis was most accurate (90 % ) with the highest per-patient sensitivity (88 % ) and specificity (92 % ) versus individual assessments (RWMA, 79 % and 88 % ; RPD, 67 % and 92 % ; DCE, 79 % and 88 % ). Similar findings were observed on a per-vessel basis analysis. A combination of DCE and cine showed a good accuracy (85 % ) and high sensitivity (92 % ).

Conclusions

Infarct detection with CT is feasible with overall good diagnostic accuracy compared with the universal definition. A combined evaluation that included all techniques (cine, RPD, and DCE) had the highest diagnostic accuracy. These findings may have implications when designing future clinical and research CT protocols for optimal infarct detection.