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Late Defect on Delayed Contrast-enhanced Multi–Detector Row CT Scans in the Prediction of SPECT Infarct Size after Reperfused Acute Myocardial Infarction: Initial Experience¹

¹ From the Departments of Radiology (J.F.P., A.S.C., C.A.), Nuclear Medicine (M.W.), and Cardiology (C.C., B.L., G.D.), Centre Chirurgical Marie Lannelongue, 133 Avenue de la Résistance, 92350 Le Plessis-Robinson, France. Received January 26, 2004; revision requested April 6; revision received August 6; accepted September 8, 2004. Address correspondence to J.F.P. (e-mail: pauljf{at}ccml.com).

PURPOSE: To prospectively assess the accuracy of multi–detector row computed tomography (CT) in the prediction of infarct size after successful reperfusion of acute myocardial infarction (MI) by using single photon emission computed tomography (SPECT) images obtained 6 weeks later as the reference standard.

MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. A total of 34 patients (29 men and five women; mean age, 56 years ± 13) underwent dual-phase 16-detector row CT within 3 days ± 3 after successful reperfusion of acute MI. Iodinated contrast medium (1.5 mL per kilogram of body weight) was injected at a flow rate of 3.5 mL/sec. A first arterial phase acquisition was followed 5 minutes later by a late acquisition, without reinjection of contrast medium. A radiologist and a cardiologist used a 17-segment model in a blind analysis of images obtained during late acquisition. For each segment, presence of late defect or late enhancement was recorded. Findings were compared with SPECT studies analyzed by a nuclear medicine physician and a cardiologist 6 weeks after the acute event. CT defects were compared with SPECT defects on a segmental and per-patient basis. Mean number of segments with late defects on multi–detector row CT scans was compared with infarct size on SPECT images by using the t test.

RESULTS: All patients had late enhancement in the infarcted myocardium. In 27 of 34 patients, a late defect surrounded by a subepicardial late enhancement was detected. Segments with late defect on CT scans were predictive of residual perfusion defects at 6-week follow-up, with sensitivity of 78%, specificity of 91%, and accuracy of 90%. On a per-patient basis, sensitivity was 93%, specificity was 100%, and accuracy was 94%. Mean number of segments with late defects on multi–detector row CT scans (ie, 3.1 segments) was not significantly different from infarct size on SPECT images (eg, 2.5 segments) (P = .2).

CONCLUSION: Late defect on multi–detector row CT scans indicates residual perfusion SPECT defect and infarct size after successfully reperfused MI, with sensitivity of 93%, specificity of 100%, and accuracy of 94%.

© RSNA, 2005

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