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Imaging of myocardial infarcts by multidetector CT Volume 3, issue 4, Juillet-Août 2007

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Service de cardiologie, Département des maladies cardiovasculaires, Cliniques universitaires St. Luc, Université Catholique de Louvain, Bruxelles, Belgique

In recent years, multidetector CT (MDCT) technology has made impressive progress. It allows not only imaging of coronary arteries, but also cine imaging of cardiac function. Recently, it has been demonstrated that MDCT has also the ability to visualize myocardial infarcts. Indeed, iodated contrast agents employed for MDCT have extravascular distribution similar to Gd-DTPA. Therefore, similar to contrast enhanced MR, the injection of these contrast agents allows characterization of infarcts by two contrast patterns: 1) perfusion defects on early images immediately after contrast injection, identifying microvascular obstruction and the no-reflow phenomenon in acute infarcts, and 2) hyperenhancement on late images, identifying myocardial necrosis. The ability to identify myocardial infarcts might allow MDCT to be useful for the detection of myocardial viability and thus allow decisions as to whether patients with coronary artery disease and contractile dysfunction should undergo revascularization not to improve cardiac function. It may also allow the differentiation of ischemic from non-ischemic origins of dilated cardiomyopathy. MDCT might thus become an alternative to contrast enhanced MR. The ability to combine coronary imaging, cardiac function and viability in a single exam makes the technique particularly attractive for the integrated assessment of patients with cardiac disease.