Department of Cardiovascular Imaging, Otamendi Hospital, Azcuenaga 870 (C1115AAB), Buenos Aires, Argentina.
J Cardiovasc Comput Tomogr. 2010 Mar-Apr;4(2):99-107. doi: 10.1016/j.jcct.2009.12.003. Epub 2009 Dec 21.
Hypoenhanced regions on multidetector CT (MDCT) coronary angiography correlate with myocardial hyperperfusion. In addition to a limited capillary density, chronic myocardial infarction (MI) commonly contains a considerable amount of adipose tissue.
We explored whether regional myocardial hypoenhancement on contrast-enhanced MDCT could be identified with standard coronary artery calcium (CAC) scoring acquisitions with noncontrast CT.
Consecutive patients with a history of MI who were referred for contrast-enhanced MDCT from November 2006 until March 2009 were studied. Noncontrast CT for CAC scoring was also performed. The correlation between regional myocardial hypoenhancement on contrast-enhanced CT and regional myocardial hypoattenuated areas on noncontrast CT was defined.
Eighty-three patients (mean age, 61.5+/-12.5 years; n=67; 81% male) with previous MI were studied. A total of 1411 myocardial segments were evaluated. Two hundred thirty-nine segments (17%) showed myocardial hypoenhancement by MDCT and 140 segments (9.6%) by CAC. On a patient level, noncontrast CT showed a sensitivity, specificity, positive predictive value, (PPV) and negative predictive value (NPV) of 66% (95% CI, 0.53-0.77), 100% (95% CI, 0.76-1.00), 100% (95% CI, 0.90-1.00), and 41% (95% CI, 0.26-0.58), respectively, to detect myocardial hypoenhancement. On a per segment level, noncontrast CT showed a sensitivity, specificity, PPV, and NPV of 58% (95% CI, 0.51-0.64), 100% (95% CI, 0.99-1.00), 99% (95% CI, 0.94-1.00), and 92% (95% CI, 0.90-0.93), respectively, to detect myocardial hypoenhancement.
Our findings suggest that chronic MI can be detected with standard CAC scoring acquisitions.
多排 CT（MDCT）冠状动脉造影上的低增强区域与心肌过度灌注相关。除了毛细血管密度有限外，慢性心肌梗死（MI）通常包含相当数量的脂肪组织。
我们探讨了在无对比 CT 上是否可以用标准冠状动脉钙（CAC）评分采集来识别对比增强 MDCT 上的区域性心肌低增强。
研究了 2006 年 11 月至 2009 年 3 月因对比增强 MDCT 就诊的有 MI 病史的连续患者。还进行了 CAC 评分的非对比 CT。定义了对比增强 CT 上的区域性心肌低增强与非对比 CT 上的区域性心肌低衰减区域之间的相关性。
共研究了 83 例（平均年龄 61.5±12.5 岁；n=67；81%为男性）有 MI 病史的患者。共评估了 1411 个心肌节段。MDCT 显示 239 个节段（17%）存在心肌低增强，CAC 显示 140 个节段（9.6%）存在心肌低增强。在患者水平上，非对比 CT 显示出 66%（95%CI，0.53-0.77）的敏感性、100%（95%CI，0.76-1.00）的特异性、100%（95%CI，0.90-1.00）的阳性预测值（PPV）和 41%（95%CI，0.26-0.58）的阴性预测值（NPV），以检测心肌低增强。在节段水平上，非对比 CT 显示出 58%（95%CI，0.51-0.64）的敏感性、100%（95%CI，0.99-1.00）的特异性、99%（95%CI，0.94-1.00）的 PPV 和 92%（95%CI，0.90-0.93）的 NPV，以检测心肌低增强。
我们的发现表明可以用标准的 CAC 评分采集来检测慢性 MI。
