Sixty-four-MSCT in the characterization of porcine acute and subacute myocardial infarction: Determination of transmurality in comparison to magnetic resonance imaging and histopathology

Brodoefel, H.; Klumpp, B.; Reimann, A.; Fenchel, M.; Heuschmid, M.; Miller, S.; Schroeder, S.; Claussen, C.; Scheule, A.M.; Kopp, A.F.

doi:10.1016/j.ejrad.2006.11.031

« Previous Next »European Journal of Radiology
Volume 62, Issue 2 , Pages 235-246, May 2007

Sixty-four-MSCT in the characterization of porcine acute and subacute myocardial infarction: Determination of transmurality in comparison to magnetic resonance imaging and histopathology☆

H. Brodoefel
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
- Corresponding author. Tel.: +49 7071 2987212; fax: +49 7071 295845.
B. Klumpp
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
A. Reimann
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
M. Fenchel
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
M. Heuschmid
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
S. Miller
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
S. Schroeder
- Department of Cardiology, Eberhard-Karls-University, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
C. Claussen
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
A.M. Scheule
- Department of Thoracic, Cardiac and Vascular Surgery, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
- These authors contributed equally.
A.F. Kopp
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
- These authors contributed equally.

Received 19 September 2006; received in revised form 22 November 2006; accepted 24 November 2006.

Abstract

Objective

The aim of this study was to assess the accuracy of MSCT in characterizing myocardial infarction (MI) and, thereby, determine the extent of early perfusion defect (ED), microvascular obstruction (MO) and transmural depth of late enhancement (LE) in comparison to MRI and histology.

Materials and methods

Seven pigs were studied with MSCT (Somatom Sensation 64) and MRI (Magnetom Sonata) a median 1 and 21 days following temporary occlusion of a diagonal branch and creation of small reperfused infarction.

For depiction of ED, CT images were acquired in the early arterial phase and following 35s; LE and MO were evaluated on images obtained at 3, 5, 10 and 15min. Thereby, a bolus/low-flow contrast injection protocol was used. Triphenyltetrazolium-chloride (TTC) stain and histology were obtained. Volumes of enhancement patterns were assessed as percentage of the ventricle and compared by Bland–Altman analysis. Segmental co-localization and graded transmurality was evaluated with weighted-kappa-test.

Results

Close spatial agreement was observed for MRI–MO and MSCT–MO (bias=0.55; CI=−1.49 to 2.60 at 5min MSCT), TTC and MSCT–LE (bias=−1.28; CI=−3.76 to 1.19) or MRI–LE and MSCT–LE (bias=−0.79; CI=−4.19 to 2.60). There was good segmental co-localization for MO (weighted kappa=0.93) and high agreement for transmural extent of TTC, MRI–LE and MSCT–LE (weighted kappa=0.84 TTC versus MSCT; 0.86 MRI versus MSCT). Arterial and 35s ED significantly underestimated infarct size and showed poor segmental or transmural agreement (weighted kappa=0.33; 0.44).

Conclusions

MSCT late-scans not only reliably depict size of MO and LE in acute or subacute infarct phases but, moreover, allow for accurate determination of LE transmurality.

Keywords: Myocardial viability, Porcine model, Transmural extent, MSCT, MRI