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Three-dimensional maximum principal strain using cardiac computed tomography for identification of myocardial infarction

  • Computed Tomography
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Abstract

Objectives

To evaluate the feasibility of three-dimensional (3D) maximum principal strain (MP-strain) derived from cardiac computed tomography (CT) for detecting myocardial infarction (MI).

Methods

Forty-three patients who underwent cardiac CT and magnetic resonance imaging (MRI) were retrospectively selected. Using the voxel tracking of motion coherence algorithm, the peak CT MP-strain was measured using the 16-segment model. With the trans-mural extent of late gadolinium enhancement (LGE) and the distance from MI, all segments were classified into four groups (infarcted, border, adjacent, and remote segments); infarcted and border segments were defined as MI with LGE positive. Diagnostic performance of MP-strain for detecting MI was compared with per cent systolic wall thickening (%SWT) assessed by MRI using receiver-operating characteristic curve analysis at a segment level.

Results

Of 672 segments excluding16 segments influenced by artefacts, 193 were diagnosed as MI. Sensitivity and specificity of peak MP-strain to identify MI were 81 % [95 % confidence interval (95 % CI): 74-88 %] and 86 % (81-92 %) compared with %SWT: 76 % (60-95 %) and 68 % (48-84 %), respectively. The area under the curve of peak MP-strain was superior to %SWT [0.90 (0.87-0.93) vs. 0.80 (0.76-0.83), p < 0.05].

Conclusions

CT MP-strain has a potential to provide incremental value to coronary CT angiography for detecting MI.

Key Points

• CT MP-strain allows for three-dimensional assessment of regional cardiac function.

• CT-MP strain has high diagnostic accuracy for detecting myocardial infarction.

• CT-MP strain may assist in tissue characterisation of myocardium assessed by LGE-MRI.

• CT-MP strain provides incremental values to coronary CTA for detecting myocardial infarction.

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Abbreviations

MI:

myocardial infarction

LGE:

late gadolinium enhancement

MRI:

magnetic resonance imaging

2D:

two-dimensional

3D:

three-dimensional

MP-strain:

maximum principal strain

CT:

computed tomography

LV:

left ventricular

CAD:

coronary artery disease

CM:

contrast media

ECG:

electrocardiogram

%SWT:

per cent systolic wall thickening

SD:

standard deviations

ROC:

receiver-operating characteristic

AUC:

area under the curve

PPV:

positive predictive values

NPV:

negative predictive values

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Acknowledgement

We greatly appreciate Yasuhiro Kondo (Ziosoft Inc., Tokyo, Japan) for valuable technical comments. The scientific guarantor of this publication is Teruhito Mochizuki. 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. Yasuhiro Kondo declares relationships with the following companies: Ziosoft Inc., Tokyo, Japan. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. We also asked for a statistical review and advice for this manuscript from StaGen Co. Ltd. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan

    Yuki Tanabe, Teruhito Kido, Akira Kurata, Shun Sawada, Hiroshi Suekuni, Tomoyuki Kido, Takahiro Yokoi, Masao Miyagawa & Teruhito Mochizuki

  2. Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan

    Teruyoshi Uetani & Katsuji Inoue

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  1. Yuki Tanabe
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Correspondence to Yuki Tanabe.

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Tanabe, Y., Kido, T., Kurata, A. et al. Three-dimensional maximum principal strain using cardiac computed tomography for identification of myocardial infarction. Eur Radiol 27, 1667–1675 (2017). https://doi.org/10.1007/s00330-016-4550-9

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  • DOI: https://doi.org/10.1007/s00330-016-4550-9

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