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Post-mortem cardiac diffusion tensor imaging: detection of myocardial infarction and remodeling of myofiber architecture

  • Forensic Medicine
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To investigate the accuracy of post-mortem diffusion tensor imaging (DTI) for the detection of myocardial infarction (MI) and to demonstrate the feasibility of helix angle (HA) calculation to study remodelling of myofibre architecture.

Methods

Cardiac DTI was performed in 26 deceased subjects prior to autopsy for medicolegal reasons. Fractional anisotropy (FA) and mean diffusivity (MD) were determined. Accuracy was calculated on per-segment (AHA classification), per-territory, and per-patient basis, with pathology as reference standard. HAs were calculated and compared between healthy segments and those with MI.

Results

Autopsy demonstrated MI in 61/440 segments (13.9 %) in 12/26 deceased subjects. Healthy myocardial segments had significantly higher FA (p < 0.01) and lower MD (p < 0.001) compared to segments with MI. Multivariate logistic regression demonstrated that FA (p < 0.10) and MD (p = 0.01) with the covariate post-mortem time (p < 0.01) predicted MI with an accuracy of 0.73. Analysis of HA distribution demonstrated remodelling of myofibre architecture, with significant differences between healthy segments and segments with chronic (p < 0.001) but not with acute MI (p > 0.05).

Conclusions

Post-mortem cardiac DTI enablesdifferentiation between healthy and infarcted myocardial segments by means of FA and MD. HA assessment allows for the demonstration of remodelling of myofibre architecture following chronic MI.

Key Points

• DTI enables post-mortem detection of myocardial infarction with good accuracy.

• A decrease in right-handed helical fibre indicates myofibre remodelling following chronic myocardial infarction.

• DTI allows for ruling out myocardial infarction by means of FA.

• Post-mortem DTI may represent a valuable screening tool in forensic investigations.

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Abbreviations

CI:

Confidence interval

DTI:

Diffusion tensor imaging

FA:

Fractional anisotropy

HA:

Helix angle

HE:

Hematoxylin and eosin

ICC:

Intraclass correlation coefficients

MD:

Mean diffusivity

MI:

Myocardial infarction

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

PD:

Proton density

PPV:

Positive predictive value

ROC:

Receiver operating characteristics

ROI:

Region of interest

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Acknowledgments

The scientific guarantor of this publication is Paul Stolzmann. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was not required for this study, as informed consent was not applicable due to the post-mortem nature of the study. Methodology: prospective diagnostic or prognostic study, performed at one institution.

Conflict on interest

No conflict of interest declared.

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Authors and Affiliations

  1. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Sebastian Winklhofer, Nicole Berger, Robert Manka, Hatem Alkadhi & Paul Stolzmann

  2. Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland

    Sebastian Winklhofer, Nicole Berger, Michael Thali & Paul Stolzmann

  3. Institute for Biomedical Engineering University and ETH Zurich, Zurich, Switzerland

    Christian T. Stoeck, Robert Manka & Sebastian Kozerke

  4. Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland

    Robert Manka

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  1. Sebastian Winklhofer
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  2. Christian T. Stoeck
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  3. Nicole Berger
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  4. Michael Thali
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  5. Robert Manka
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  8. Paul Stolzmann
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Correspondence to Paul Stolzmann.

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Winklhofer, S., Stoeck, C.T., Berger, N. et al. Post-mortem cardiac diffusion tensor imaging: detection of myocardial infarction and remodeling of myofiber architecture. Eur Radiol 24, 2810–2818 (2014). https://doi.org/10.1007/s00330-014-3322-7

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  • DOI: https://doi.org/10.1007/s00330-014-3322-7

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