Acute myocardial infarction: early CT aspects of myocardial microcirculation obstruction after percutaneous coronary intervention

Eur Radiol. 2013 Sep;23(9):2405-12. doi: 10.1007/s00330-013-2853-7. Epub 2013 May 8.


Objective: To evaluate the capabilities of delayed enhanced multidetector CT (DE-MDCT), performed immediately after percutaneous coronary intervention (PCI), in predicting myocardial microvascular obstruction (MVO) formation assessed by delayed enhanced MRI (DE-MRI).

Methods: Thirty-two patients presenting with a primary acute myocardial infarction, successfully recanalised by PCI, underwent a DE-MDCT immediately after PCI and a DE-MRI within 1 week. The left ventricle was split into 64 subsegments, rated as "healthy", "infarcted" or "MVO" on DE-MRI. Their mean density was measured on DE-MDCT and calculated relative to the patient's mean healthy myocardium density. Hypoenhanced DE-MDCT subsegments, termed "CT early MVO", were also recorded. Sensitivity and specificity of DE-MDCT for MRI-assessed "MVO" subsegments detection was calculated for mean CT relative density (threshold determined from a ROC analysis), "CT early MVO" and both.

Results: Mean CT relative density was higher in MRI-assessed "MVO" than in "infarcted" and "healthy" subsegments (1.82 ± 0.46, 1.43 ± 0.36 and 1.0 ± 0.13 respectively; P < 0.001) leading to a sensitivity and specificity of 94.3 % and 89.2 % for a cutoff of 1.36. Sensitivity and specificity were respectively 16.9 % and 99.8 % for "CT early MVO" and 95.3 % and 89.3 % when considering the two patterns.

Conclusion: DE-MDCT, performed immediately after PCI, allows for an accurate prediction of MVO formation.

Key points: • Myocardial microvascular obstruction (MVO) is an important prognostic sequel following myocardial infarction. • MVO can be accurately predicted by multidector CT (MDCT). • Both hypo- and hyperenhanced myocardial areas can be analysed by MDCT. • MDCT may become a useful prognostic tool for acute MI outcome.

MeSH terms

  • Adult
  • Aged
  • Angiography / methods
  • Angioplasty / methods
  • Coronary Circulation
  • Female
  • Humans
  • Image Processing, Computer-Assisted
  • Magnetic Resonance Imaging / methods*
  • Male
  • Microcirculation
  • Middle Aged
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / diagnostic imaging*
  • Myocardium / pathology
  • Observer Variation
  • Percutaneous Coronary Intervention / methods*
  • Prognosis
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / methods*