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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).

View larger version (113K): [in a new window]   Figure 1a. Images obtained in a 65-year-old man with anterior MI. LV = left ventricle.(a) Long-axis view (two cavities) obtained with delayed phase CT shows a late defect in the subendocardial part of the myocardium, along the anterior and apical wall of the left ventricle (arrows). This late defect is surrounded by a large area of hyperenhancement (arrowheads). Five segments (eg, segments 7, 8, 13, 14, and 17) were involved according to the 17-segment model analysis. (b) Short-axis view (two cavities) obtained 6 weeks later with SPECT shows persistent perfusion defect (arrows) in the anterior wall of the left ventricle corresponding to fixed MI. Five segments (eg, segments 7, 8, 13, 14, and 17) with residual defect were detected.

View larger version (62K): [in a new window]   Figure 1b. Images obtained in a 65-year-old man with anterior MI. LV = left ventricle.(a) Long-axis view (two cavities) obtained with delayed phase CT shows a late defect in the subendocardial part of the myocardium, along the anterior and apical wall of the left ventricle (arrows). This late defect is surrounded by a large area of hyperenhancement (arrowheads). Five segments (eg, segments 7, 8, 13, 14, and 17) were involved according to the 17-segment model analysis. (b) Short-axis view (two cavities) obtained 6 weeks later with SPECT shows persistent perfusion defect (arrows) in the anterior wall of the left ventricle corresponding to fixed MI. Five segments (eg, segments 7, 8, 13, 14, and 17) with residual defect were detected.

View larger version (142K): [in a new window]   Figure 2a. Images obtained in a 38-year-old man with inferoseptal MI. LV = left ventricle. (a) Short-axis view obtained with delayed phase CT shows late enhancement involving the whole thickness of the inferoseptal myocardium (arrows). Note the total absence of late defect within the hyperenhanced area. RV = right ventricle. (b) Short-axis view obtained 6 weeks later with SPECT imaging shows normal reperfusion of the muscle and recovery of the initial myocardial injury.

View larger version (130K): [in a new window]   Figure 2b. Images obtained in a 38-year-old man with inferoseptal MI. LV = left ventricle. (a) Short-axis view obtained with delayed phase CT shows late enhancement involving the whole thickness of the inferoseptal myocardium (arrows). Note the total absence of late defect within the hyperenhanced area. RV = right ventricle. (b) Short-axis view obtained 6 weeks later with SPECT imaging shows normal reperfusion of the muscle and recovery of the initial myocardial injury.