Francone Marco, Carbone Iacopo, Danti Massimiliano, Lanciotti Katia, Cavacece Mario, Mirabelli Francesca, Gaudio Carlo, Catalano Carlo, Passariello Roberto
Department of Radiological Sciences, University of Rome La Sapienza, V.le Regina Elena 324, 00161, Rome, Italy.
Eur Radiol. 2006 Jan;16(1):15-24. doi: 10.1007/s00330-005-2800-3. Epub 2005 Jun 14.
Our objective was to retrospectively evaluate the ability of multidetector-row computed tomography (MDCT) to detect previous myocardial infarctions (MIs) and to correlate necrosis with the status of coronary arteries supplying the infarcted territory. After having clinically evaluated 187 patients referred for ECG-gated MDCT of the coronary arteries, 30 previous MIs were identified in 29 patients (9 recent and 21 chronic). MDCT data were evaluated qualitatively and quantitatively by measuring attenuation values and wall thickness within the infarcted region and normal adjacent myocardium. Each MI was also assigned to the distribution territory of a coronary vessel, and morphological data were combined with MDCT angiographic findings. MDCT was able to detect 25/30 MIs showing an overall sensitivity and specificity of 83 and 91%, respectively. Quantitative analysis revealed a statistically significant difference in attenuation values between normal and infarcted regions (38.9+/-14 HU vs. 104.0+/-16 HU). Regional wall thinning was observed in chronic MIs (4.1+/-2 mm vs. 10.5+/-3.8 mm), and not in patients with recent event (7.9+/-1.6 mm vs 9.1+/-4 mm). In 22/25 cases, MDCT angiographic findings showed the presence of suspicious critical lumen narrowing (n=3), previous coronary stenting (n=14) and surgical revascularization (n=5) in the infarct-related coronary. During a single examination, MDCT might provide comprehensive imaging of MI offering a combined morphological and angiographic assessment.
我们的目的是回顾性评估多排螺旋计算机断层扫描（MDCT）检测既往心肌梗死（MI）的能力，并将坏死情况与梗死区域供血冠状动脉的状况相关联。在对187例因冠状动脉心电图门控MDCT检查而转诊的患者进行临床评估后，在29例患者中发现了30处既往心肌梗死（9例近期梗死和21例陈旧性梗死）。通过测量梗死区域及相邻正常心肌的衰减值和壁厚度，对MDCT数据进行定性和定量评估。每例心肌梗死还被分配到某一冠状动脉的分布区域，并将形态学数据与MDCT血管造影结果相结合。MDCT能够检测出30处心肌梗死中的25处，总体敏感性和特异性分别为83%和91%。定量分析显示，正常区域与梗死区域的衰减值存在统计学显著差异（38.9±14 HU对104.0±16 HU）。在陈旧性心肌梗死患者中观察到局部室壁变薄（4.1±2 mm对10.5±3.8 mm），而近期发病患者未观察到（7.9±1.6 mm对9.1±4 mm）。在25例中的22例中，MDCT血管造影结果显示梗死相关冠状动脉存在可疑的严重管腔狭窄（n = 3）、既往冠状动脉支架置入（n = 14）和外科血运重建（n = 5）。在一次检查中，MDCT可能提供心肌梗死的综合成像，提供形态学和血管造影的联合评估。
