The Value of Low-Dose Dynamic Myocardial Perfusion CT for Accurate Evaluation of Microvascular Obstruction in Patients With Acute Myocardial Infarction.
AJR Am J Roentgenol. 2019 Jun 05;:1-9
Authors: Yu M, Chen X, Dai X, Pan J, Wang Y, Lu B, Zhang J
OBJECTIVE. The purpose of this study was to investigate the diagnostic performance of quantitative parameters generated from dynamic myocardial perfusion CT for assessment of acute myocardial infarction (AMI) and microvascular obstruction (MVO) using cardiac MRI as a reference standard. SUBJECTS AND METHODS. Patients who underwent successful reperfusion treatment within 1 week after AMI between January 1, 2018, and May 31, 2018, were prospectively enrolled. All patients were referred for cardiac MRI and dynamic myocardial perfusion CT on the same day. Various quantitative parameters and late iodine enhancement (LIE) were analyzed for the evaluation of AMI and MVO using cardiac MRI findings as a reference standard. RESULTS. Twenty-seven patients with 442 vascular segments were ultimately included in the analysis. The mean radiation doses ± SD for dynamic myocardial perfusion CT and LIE were 3.3 ± 1.1 mSv and 2.0 ± 0.6 mSv, respectively. Myocardial blood flow (MBF) was significantly lower in segments with MVO than in those without MVO and in reference segments (23.08 ± 7.95 mL/min/100 mL vs 44.60 ± 14.97 mL/min/100 mL and 75.07 ± 7.34 mL/min/100 mL; p < 0.001). According to ROC curve analysis, MBF had the largest AUC of all parameters for identifying AMI with and without MVO as determined by late gadolinium enhancement (LGE) (AUC = 0.941 and 0.996; p < 0.001). The diagnostic accuracy of MBF-based assessment for identifying MVO was 99.2%, which outperformed other quantitative parameters and LIE. We found good correlation between the AMI area and MVO area estimated by MBF and LGE (r = 0.95 and 0.99; p < 0.001). CONCLUSION. MBF derived from dynamic myocardial perfusion CT is accurate and outperforms other quantitative parameters and LIE in diagnosis of AMI and MVO. Area of AMI and MVO can also be accurately estimated using MBF.
PMID: 31166762 [PubMed - as supplied by publisher]