• Chronic myocardial infarction detection and characterization during coronary artery calcium scoring acquisitions

    Journal of Cardiovascular Computed Tomography (2010) 4, 99-107

    Chronic myocardial infarction detection and characterization during coronary artery calcium scoring acquisitions


    Gastón A. Rodríguez-Granillo, MD, PhD, Miguel A. Rosales, MD, Paola Renes, MD, Eduardo Diez, MD, Jorge Pereyra, MD, Estela Gomez, MD, Gustavo De Lillo, MD, Elina Degrossi, MD, Alfredo E. Rodriguez, MD, PhD, FACC, Eugene P. McFadden, MD, FRCPI, FACC

    BACKGROUND: 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.

    OBJECTIVE: We explored whether regional myocardial hypoenhancement on contrast-enhanced MDCT could be identified with standard coronary artery calcium (CAC) scoring acquisitions with non-contrast CT.

    METHODS: 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.

    RESULTS: 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.

    CONCLUSIONS: Our findings suggest that chronic MI can be detected with standard CAC scoring acquisitions. © 2010 Society of Cardiovascular Computed Tomography. All rights reserved.