Skip to main content
SpringerLink
Log in
Book cover

CT Imaging of Myocardial Perfusion and Viability pp 173–184Cite as

CT Approaches for the Assessment of Myocardial Viability

  • Chapter
  • First Online:

  • 1281 Accesses

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Abstract

Coronary artery disease is one of the most common causes of death. Treatment of coronary artery disease and its sequelae is costly and may pose an unnecessary risk to the patient if performed needlessly. Imaging of myocardial viability became well established for optimizing indication an resource allocation in patients suffering from myocardial infarction. While myocardial viability imaging is routinely performed using 18Fluorodeoxyglucose-positron emission tomography, single photon emission computed tomography or magnetic resonance imaging, multislice-spiral computed tomography (MSCT) techniques emerged as new tool for visualization of myocardial infarction. This chapter describes different concepts of MSCT viability imaging such as unenhanced CT for assessing calcifications and fatty infiltrations. The focus will be direct visualization of nonviable myocardium by depiction of delayed myocardial contrast enhancement. The clinical relevance of the different MSCT techniques is described. Basic concepts on how to perform late phase MSCT are introduced.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  • Adams DF, Hessel SJ, Judy PF, Stein JA, Abrams HL (1976) Computed tomography of the normal and infarcted myocardium. AJR Am J Roentgenol 126:786–791

    Article  PubMed  CAS  Google Scholar 

  • Ahn SS, Kim YJ, Hur J, Lee HJ, Kim TH, Choe KO, Choi BW (2009) CT detection of subendocardial fat in myocardial infarction. AJR Am J Roentgenol 192:532–537

    Article  PubMed  Google Scholar 

  • Baer FM, Voth E, Schneider CA, Theissen P, Schicha H, Sechtem U (1995) Comparison of low-dose dobutamine-gradient-echo magnetic resonance imaging and positron emission tomography with 18F-fluorodeoxyglucose in patients with chronic coronary artery disease. A functional and morphological approach to the detection of residual myodardial viability. Circulation 91:1006–1015

    Article  PubMed  CAS  Google Scholar 

  • Baks T, Cademartiri F, Moelker AD, Weustink AC, van Geuns RJ, Mollet NR, Krestin GP, Duncker DJ, de Feyter PJ (2006) Multislice computed tomography and magnetic resonance imaging for the assessment of reperfused acute myocardial infarction. J Am Coll Cardiol 48:144–152

    Article  PubMed  Google Scholar 

  • Bax JJ, Visser FC, Poldermans D, Elhendy A, Cornel JH, Boersma E, van Lingen A, Fioretti PM, Visser CA (2001) Time course of functional recovery of stunned and hibernating segments after surgical revascularization. Circulation 104(12 Suppl 1):I314–I318

    PubMed  CAS  Google Scholar 

  • Bolli R, Marban E (1999) Molecular and cellular mechanisms of myocardial stunning. Physiol Rev 79:609–634

    PubMed  CAS  Google Scholar 

  • Braunwald E, Kloner RA (1982) The stunned myocardium: prolonged, postischemic ventricular dysfunction. Circulation 66:1146–1149

    Article  PubMed  CAS  Google Scholar 

  • Brodoefel H, Reimann A, Klumpp B, Fenchel M, Ohmer M, Miller S, Schroeder S, Claussen C, Scheule A, Kopp AF (2007) Assessment of myocardial viability in a reperfused porcine model: evaluation of different MSCT contrast protocols in acute and subacute infarct stages in comparison with MRI. J Comput Assist Tomogr 31:290–298

    Article  PubMed  Google Scholar 

  • Buecker A, Katoh M, Krombach GA, Spuentrup E, Bruners P, Gunther RW, Niendorf T, Mahnken AH (2005) A feasibility study of contrast enhancement of acute myocardial infarction in multislice computed tomography: comparison with magnetic resonance imaging and gross morphology in pigs. Invest Radiol 40:700–704

    Article  PubMed  Google Scholar 

  • Carlsson E, Lipton MJ, Berninger WH, Doherty P, Redington RW (1977) Selective left coronary myocardiography by computed tomography in living dogs. Invest Radiol 12:559–562

    Article  PubMed  CAS  Google Scholar 

  • Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T (2002) American Heart Association writing group on myocardial segmentation and registration for cardiac imaging. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the American Heart Association. Circulation 105:539–542

    Article  PubMed  Google Scholar 

  • Choi KM, Kim RJ, Gubernikoff G, Vargas JD, Parker M, Judd RM (2001) Transmural extent of acute myocardial infarction predicts long-term improvement in contractile function. Circulation 104:1101–1107

    Article  PubMed  CAS  Google Scholar 

  • Cohn JN, Ferrari R, Sharpe N (2000) Cardiac remodeling-concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an international forum on cardiac remodeling. J Am Coll Cardiol 35:569–582

    Article  PubMed  CAS  Google Scholar 

  • Dambrin G, Laissy JP, Serfaty JM, Caussin C, Lancelin B, Paul JF (2007) Diagnostic value of ECG-gated multidetector computed tomography in the early phase of suspected acute myocarditis. A preliminary comparative study with cardiac MRI. Eur Radiol 17:331–338

    Article  PubMed  Google Scholar 

  • Diamond GA, Forrester JS, deLuz PL, Wyatt HL, Swan HJ (1978) Post-extrasystolic potentiation of ischemic myocardium by atrial stimulation. Am Heart J 95:204–209

    Article  PubMed  CAS  Google Scholar 

  • Gerber BL, Belge B, Legros GJ, Lim P, Poncelet A, Pasquet A, Gisellu G, Coche E, Vanoverschelde JLJ (2006) Characterization of acute and chronic myocardial infarcts by multidetector computed tomography: comparison with contrast-enhanced magnetic resonance. Circulation 113:823–833

    Article  PubMed  Google Scholar 

  • Gersh BJ, Anderson JL (1993) Thrombolysis and myocardial salvage. Results of clinical trials and the animal paradigm-paradoxic or predictable? Circulation 88:296–306

    Article  PubMed  CAS  Google Scholar 

  • Gupta M, Kadakia J, Hacioglu Y, Ahmadi N, Patel A, Choi T, Yamada G, Budoff M (2011) Non-contrast cardiac computed tomography can accurately detect chronic myocardial infarction: validation study. J Nucl Cardiol 18:96–103

    Article  PubMed  Google Scholar 

  • Habis M, Capderou A, Ghostine S, Daoud B, Caussin C, Riou JY, Brenot P, Angel CY, Lancelin B, Paul JF (2007) Acute myocardial infarction early viability assessment by 64-slice computed tomography immediately after coronary angiography: comparison with low-dose dobutamine echocardiography. J Am Coll Cardiol 49:1178–1185

    Article  PubMed  Google Scholar 

  • Habis M, Capderou A, Sigal-Cinqualbre A, Ghostine S, Rahal S, Riou JY, Brenot P, Angel CY, Paul JF (2009) Comparison of delayed enhancement patterns on multislice computed tomography immediately after coronary angiography and cardiac magnetic resonance imaging in acute myocardial infarction. Heart 95:624–629

    Article  PubMed  CAS  Google Scholar 

  • Hamada S, Naito H, Takamiya M (1992) Evaluation of myocardium in ischemic heart disease by ultrafast computed tomography. Jpn Circ J 56:627–631

    Article  PubMed  CAS  Google Scholar 

  • Higgins CB, Sovak M, Schmidt W, Siemers PT (1978) Uptake of contrast materials by experimental acute myocardial infarctions: a preliminary report. Invest Radiol 13:337–339

    Article  PubMed  CAS  Google Scholar 

  • Ho KT, Chua KC, Klotz E, Panknin C (2010) Stress and rest dynamic myocardial perfusion imaging by evaluation of complete time-attenuation curves with dual-source CT. JACC Cardiovasc Imaging 3:811–820

    Article  PubMed  Google Scholar 

  • Ichikawa Y, Kitagawa K, Chino S, Ishida M, Matsuoka K, Tanigawa T, Nakamura T, Hirano T, Takeda K, Sakuma H (2009) Adipose tissue detected by multislice computed tomography in patients after myocardial infarction. JACC Cardiovasc Imaging 2:548–555

    Article  PubMed  Google Scholar 

  • Kaminaga T, Naito H, Takamiya M, Hamada S, Nishimura T (1994) Myocardial damage in patients with dilated cardiomyopathy: CT evaluation. J Comput Assist Tomogr 18:393–397

    Article  PubMed  CAS  Google Scholar 

  • Kato M, Dote K, Sasaki S, Ueda K, Goto K, Takemoto H, Habara S, Hasegawa D, Matsuda O, Nakano Y, Naganuma T (2006) Plain computed tomography for assessment of early coronary microcirculatory damage after revascularization therapy in acute myocardial infarction. Circ J 70:1475–1480

    Article  PubMed  Google Scholar 

  • Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM (2000) The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 343:1445–1453

    Article  PubMed  CAS  Google Scholar 

  • Kim T, Choi BJ, Kang DK, Sun JS (2012) Assessment of myocardial viability using multidetector computed tomography in patients with reperfused acute myocardial infarction. Clin Radiol 67:754–765

    Article  PubMed  CAS  Google Scholar 

  • Kloner RA, Bolli R, Marban E, Reinlib L, Braunwald E (1998) Medical and cellular implications of stunning, hibernation, and preconditioning: an NHLBI workshop. Circulation 97:1848–1867

    Article  PubMed  CAS  Google Scholar 

  • Ko SM, Kim YW, Han SW, Seo JB (2007) Early and delayed myocardial enhancement in myocardial infarction using two-phase contrast-enhanced multidetector-row CT. Korean J Radiol 8:94–102

    Article  PubMed  Google Scholar 

  • Koyama Y, Matsuoka H, Mochizuki T, Higashino H, Kawakami H, Nakata S, Aono J, Ito T, Naka M, Ohashi Y, Higaki J (2005) Assessment of reperfused acute myocardial infarction with two-phase contrast-enhanced helical CT: prediction of left ventricular function and wall thickness. Radiology 235:804–811

    Article  PubMed  Google Scholar 

  • Lessick J, Dragu R, Mutlak D, Rispler S, Beyar R, Litmanovich D, Engel A, Agmon Y, Kapeliovich M, Hammerman H, Ghersin E (2007) Is functional improvement after myocardial infarction predicted with myocardial enhancement patterns at multidetector CT? Radiology 244:736–744

    Article  PubMed  Google Scholar 

  • Mahnken AH, Koos R, Katoh M, Wildberger JE, Spuentrup E, Buecker A, Günther RW, Kühl HP (2005) Assessment of myocardial viability in reperfused acute myocardial infarction using 16-slice computed tomography in comparison to magnetic resonance imaging. J Am Coll Cardiol 45:2042–2047

    Article  PubMed  Google Scholar 

  • Mahnken AH, Bruners P, Mühlenbruch G, Emmerich M, Hohl C, Günther RW, Wildberger JE (2007) Low tube voltage improves computed tomography imaging of delayed myocardial contrast enhancement in an experimental acute myocardial infarction model. Invest Radiol 42:123–129

    Article  PubMed  Google Scholar 

  • Mahnken AH, Jost G, Bruners P, Sieber M, Seidensticker PR, Günther RW, Pietsch H (2009) Multidetector computed tomography (MDCT) evaluation of myocardial viability: intraindividual comparison of monomeric vs. dimeric contrast media in a rabbit model. Eur Radiol 19:290–297

    Article  PubMed  Google Scholar 

  • Mahnken AH, Bruners P, Friman O, Hennemuth A (2010) The culprit lesion and its consequences: combined visualization of the coronary arteries and delayed myocardial enhancement in dual-source CT: a pilot study. Eur Radiol 20:2834–2843

    Article  PubMed  Google Scholar 

  • Masuda Y, Yoshida H, Morooka N, Watanabe S, Inagaki Y (1984) The usefulness of X-ray computed tomography for the diagnosis of myocardial infarction. Circulation 70:217–225

    Article  PubMed  CAS  Google Scholar 

  • Myers JH, Stirling MC, Choy M, Buda AJ, Gallagher KP (1986) Direct measurement of inner and outer wall thickening dynamics with epicardial echocardiography. Circulation 74:164–172

    Article  PubMed  CAS  Google Scholar 

  • Naito H, Saito H, Ohta M, Takamiya M (1990) Significance of ultrafast computed tomography in cardiac imaging: usefulness in assessment of myocardial characteristics and cardiac function. Jpn Circ J 54:322–327

    Article  PubMed  CAS  Google Scholar 

  • Newell JD, Higgins CB, Abraham JL (1982) Uptake of iodinated contrast material by the ischemically damaged myocardial cell. Invest Radiol 17:61–65

    Article  PubMed  CAS  Google Scholar 

  • Nieman K, Cury RC, Ferencik M, Nomura CH, Abbara S, Hoffmann U, Gold HK, Jang IK, Brady TJ (2006) Differentiation of recent and chronic myocardial infarction by cardiac computed tomography. Am J Cardiol 98:303–308

    Article  PubMed  Google Scholar 

  • Rahimtoola SH (1985) A perspective on the three large multicenter randomized clinical trials of coronary bypass surgery for chronic stable angina. Circulation 72:V123–V135

    Article  PubMed  CAS  Google Scholar 

  • Rees G, Bristow JD, Kremkau EL, Green GS, Herr RH, Griswold HE, Starr A (1971) Influence of aortocoronary bypass surgery on left ventricular performance. N Engl J Med 284:1116–1120

    Article  PubMed  CAS  Google Scholar 

  • Reimer KA, Lowe JE, Rasmussen MM, Jennings RB (1977) The wavefront phenomenon of ischemic cell death. 1. Myocardial infarct size vs duration of coronary occlusion in dogs. Circulation 56:786–794

    Article  PubMed  CAS  Google Scholar 

  • Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D (2012) American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation 125:e2–e220

    Article  PubMed  Google Scholar 

  • Sandstede J, Bertsch G, Beer M, Kenn W, Werner E, Pabst T, Lipke C, Kretschmer S, Neubauer S, Hahn D (1999) Detection of myocardial viability by low-dose dobutamine cine MR imaging. Magn Reson Imaging 17:1437–1443

    Article  PubMed  CAS  Google Scholar 

  • Sarwar A, Shapiro MD, Nasir K, Nieman K, Nomura CH, Brady TJ, Cury RC (2009) Evaluating global and regional left ventricular function in patients with reperfused acute myocardial infarction by 64-slice multidetector CT: a comparison to magnetic resonance imaging. J Cardiovasc Comput Tomogr 3:170–177

    Article  PubMed  Google Scholar 

  • Sato A, Hiroe M, Nozato T, Hikita H, Ito Y, Ohigashi H, Tamura M, Takahashi A, Isobe M, Aonuma K (2008) Early validation study of 64-slice multidetector computed tomography for the assessment of myocardial viability and the prediction of left ventricular remodeling after acute myocardial infarction. Eur Heart J 29:490–498

    Article  PubMed  Google Scholar 

  • Sato A, Nozato T, Hikita H, Akiyama D, Nishina H, Hoshi T, Aihara H, Kakefuda Y, Watabe H, Hiroe M, Aonuma K (2012) Prognostic value of myocardial contrast delayed enhancement with 64-slice multidetector computed tomography after acute myocardial infarction. J Am Coll Cardiol 59:730–738

    Article  PubMed  Google Scholar 

  • Scanlan JG, Gustafson DE, Chevalier PA, Robb RA, Ritman EL (1980) Evaluation of ischemic heart disease with a prototype volume imaging computed tomographic (CT) scanner: preliminary experiments. Am J Cardiol 46:1263–1268

    Article  PubMed  CAS  Google Scholar 

  • Schwarz ER, Schoendube FA, Kostin S, Schmiedtke N, Schulz G, Buell U, Messmer BJ, Morrison J, Hanrath P, vom Dahl J (1998) Prolonged myocardial hibernation exacerbates cardiomyocyte degeneration and impairs recovery of function after revascularization. J Am Coll Cardiol 31:1018–1026

    Article  PubMed  CAS  Google Scholar 

  • Shen YT, Vatner SF (1995) Mechanism of impaired myocardial function during progressive coronary stenosis in conscious pigs. Hibernation versus stunning? Circ Res 76:479–488

    Article  PubMed  CAS  Google Scholar 

  • Shivalkar B, Flameng W, Szilard M, Pislaru S, Borgers M, Vanhaecke J (1999) Repeated stunning precedes myocardial hibernation in progressive multiple coronary artery obstruction. J Am Coll Cardiol 34:2126–2136

    Article  PubMed  CAS  Google Scholar 

  • Smedema JP, Truter R, de Klerk PA, Zaaiman L, White L, Doubell AF (2006) Cardiac sarcoidosis evaluated with gadolinium-enhanced magnetic resonance and contrast-enhanced 64-slice computed tomography. Int J Cardiol 112:261–263

    Article  PubMed  Google Scholar 

  • Su L, Siegel JE, Fishbein MC (2004) Adipose tissue in myocardial infarction. Cardiovasc Pathol 13:98–102

    Article  PubMed  Google Scholar 

  • Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O’Gara P (2010) American College of Cardiology Foundation Appropriate Use Criteria Task Force; Society of Cardiovascular Computed Tomography; American College of Radiology; American Heart Association; American Society of Echocardiography; American Society of Nuclear Cardiology; North American Society for Cardiovascular Imaging; Society for Cardiovascular Angiography and Interventions; Society for Cardiovascular Magnetic Resonance. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. Circulation 122:e525–e555

    Article  PubMed  Google Scholar 

  • Thompson BH, Stanford W (1994) Evaluation of cardiac function with ultrafast computed tomography. Radiol Clin North Am 32:537–551

    PubMed  CAS  Google Scholar 

  • Tillisch J, Brunken R, Marshall R, Schwaiger M, Mandelkern M, Phelps M, Schelbert H (1986) Reversibility of cardiac wall motion abnormalities predicted by positron emission tomography. N Engl J Med 314:884–888

    Article  PubMed  CAS  Google Scholar 

  • Wagner A, Mahrholdt H, Holly TA, Elliott MD, Regenfus M, Parker M, Klocke FJ, Bonow RO, Kim RJ, Judd RM (2003) Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet 361:374–379

    Article  PubMed  Google Scholar 

  • Wang R, Zhang Z, Xu L, Ma Q, He Y, Lu D, Yu W, Fan Z (2011) Low dose prospective ECG-gated delayed enhanced dual-source computed tomography in reperfused acute myocardial infarction comparison with cardiac magnetic resonance. Eur J Radiol 80:326–330

    Article  PubMed  Google Scholar 

  • Wu KC, Zerhouni EA, Judd RM, Lugo-Olivieri CH, Barouch LA, Schulman SP, Blumenthal RS, Lima JA (1998) Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 97:765–772

    Article  PubMed  CAS  Google Scholar 

  • Zafar HM, Litt HI, Torigian DA (2008) CT imaging features and frequency of left ventricular myocardial fat in patients with CT findings of chronic left ventricular myocardial infarction. Clin Radiol 63:256–262

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Marburg University Hospital, Philipps University, Marburg, Germany

    Andreas H. Mahnken

Authors
  1. Andreas H. Mahnken
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas H. Mahnken .

Editor information

Editors and Affiliations

  1. Center for Advanced Imaging Research (CAIR), Medical University of South Carolina Dept. Radiology, Charleston, South Carolina, USA

    U. Joseph Schoepf

  2. Ludwig-Maximilians-University Munich, Munich, Bayern, Germany

    Fabian Bamberg

  3. Department of Cardiology, Royal Liverpool and Broadgreen Universit, Liverpool, United Kingdom

    Balazs Ruzsics

  4. University Medical Center Groningen Center for Medical Imaging, Groningen, The Netherlands

    Rozemarijn Vliegenthart

  5. Sunnybrook Health Sciences Centre, Cardiothoracic Imaging Division, Department of Medical Imaging, Toronto, Ontario, Canada

    Gorka Bastarrika

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Mahnken, A.H. (2012). CT Approaches for the Assessment of Myocardial Viability. In: Schoepf, U., Bamberg, F., Ruzsics, B., Vliegenthart, R., Bastarrika, G. (eds) CT Imaging of Myocardial Perfusion and Viability. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2012_764

Download citation

  • DOI: https://doi.org/10.1007/174_2012_764

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-33878-6

  • Online ISBN: 978-3-642-33879-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation