Skip to main content
SpringerLink
Log in

Comparison of the different imaging time points in delayed phase cardiac CT for myocardial scar assessment and extracellular volume fraction estimation in patients with old myocardial infarction

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Delayed enhancement cardiac CT is a potential tool for myocardial viability assessment and is essential for extracellular volume fraction (ECV) estimation with CT. The objective of this study is to determine the optimal delay time for acquisition of delayed CT scans. Thirty-five patients with enhancement pattern typical of previous myocardial infarction on delayed CT and 17 control subjects comprised the study population. Delayed scans were acquired at 3, 5 and 7 min after contrast material injection. Image quality and estimated ECV were compared among the three time points. Delayed CT at 5 min showed the highest signal-to-noise ratio of 15.2 ± 1.0 [p < 0.0001; vs. 3 min (13.6 ± 1.0), p = 0.0015; vs. 7 min (14.9 ± 1.0)]. Contrast-to-noise ratio of infarcted and remote myocardium was highest at 7 min (6.4 ± 2.5), but was not significantly different from 5 min (6.1 ± 2.2, p = 0.08). The ECV values were constant over the three time points, although, in segments containing infarcted myocardium, trend of lower values was noted at 3 min compared to 5 and 7 min. ECV values at 5 min was 27.1% ± 2.1% in control subjects, 27.2% ± 3.0% in remote segments of patients with infarction, and 39.6% ± 5.3% in segments containing infarcted myocardium. Myocardial scars are equally best visualized with delay time of 5 and 7 min post contrast administration. No significant difference was observed in ECV of healthy myocardium or focal scars among delay time of 3, 5, and 7 min. Delay time of 5 min after contrast injection may be recommended for CT delayed enhancement imaging.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Aikawa T, Oyama-Manabe N, Naya M, Ohira H, Sugimoto A, Tsujino I, Obara M, Manabe O, Kudo K, Tsutsui H, Tamaki N (2017) Delayed contrast-enhanced computed tomography in patients with known or suspected cardiac sarcoidosis: a feasibility study. Eur Radiol 27:4054–4063

    Article  PubMed  Google Scholar 

  2. Tanabe Y, Kido T, Kurata A, Kouchi T, Fukuyama N, Yokoi T, Uetani T, Yamashita N, Miyagawa M, Mochizuki T (2018) Late iodine enhancement computed tomography with image subtraction for assessment of myocardial infarction. Eur Radiol 28:1285–1292

    Article  PubMed  Google Scholar 

  3. Kurobe Y, Kitagawa K, Ito T, Kurita Y, Shiraishi Y, Nakamori S, Nakajima H, Nagata M, Ishida M, Dohi K (2014) Myocardial delayed enhancement with dual-source CT: advantages of targeted spatial frequency filtration and image averaging over half-scan reconstruction. J Cardiovasc Comput Tomogr 8:289–298

    Article  PubMed  Google Scholar 

  4. Omori T, Kurita T, Dohi K, Takasaki A, Nakata T, Nakamori S, Fujimoto N, Kitagawa K, Hoshino K, Tanigawa T, Sakuma H, Ito M (2018) Prognostic impact of unrecognized myocardial scar in the non-culprit territories by cardiac magnetic resonance imaging in patients with acute myocardial infarction. Eur Heart J Cardiovasc Imaging 19:108–116

    Article  PubMed  Google Scholar 

  5. Becker MAJ, Cornel JH, van de Ven PM, van Rossum AC, Allaart CP, Germans T (2018) The prognostic value of late gadolinium-enhanced cardiac magnetic resonance imaging in nonischemic dilated cardiomyopathy: a review and meta-analysis. JACC Cardiovasc Imaging 11:1274–1284

    Article  PubMed  Google Scholar 

  6. Hulten E, Agarwal V, Cahill M, Cole G, Vita T, Parrish S, Bittencourt MS, Murthy VL, Kwong R, Di Carli MF (2016) Presence of late gadolinium enhancement by cardiac magnetic resonance among patients with suspected cardiac sarcoidosis is associated with adverse cardiovascular prognosis clinical perspective: a systematic review and meta-analysis. Circ Cardiovasc Imaging 9:e005001

    PubMed  PubMed Central  Google Scholar 

  7. Zhuang B, Sirajuddin A, Wang S, Arai A, Zhao S, Lu M (2018) Prognostic value of T1 mapping and extracellular volume fraction in cardiovascular disease: a systematic review and meta-analysis. Heart Fail Rev 23:723–731

    Article  PubMed  Google Scholar 

  8. Mendoza DD, Joshi SB, Weissman G, Taylor AJ, Weigold WG (2010) Viability imaging by cardiac computed tomography. J Cardiovasc Comput Tomogr 4:83–91

    Article  PubMed  Google Scholar 

  9. Jacquier A, Boussel L, Amabile N, Bartoli JM, Douek P, Moulin G, Paganelli F, Saeed M, Revel D, Croisille P (2008) Multidetector computed tomography in reperfused acute myocardial infarction: assessment of infarct size and no-reflow in comparison with cardiac magnetic resonance imaging. Investig Radiol 43:773–781

    Article  Google Scholar 

  10. Boussel L, Ribagnac M, Bonnefoy E, Staat P, Elicker BM, Revel D, Douek P (2008) Assessment of acute myocardial infarction using MDCT after percutaneous coronary intervention: comparison with MRI. Am J Roentgenol 191:441–447

    Article  Google Scholar 

  11. Choe YH, Choo KS, Jeon E-S, Gwon H-C, Choi J-H, Park J-E (2008) Comparison of MDCT and MRI in the detection and sizing of acute and chronic myocardial infarcts. Eur J Radiol 66:292–299

    Article  PubMed  Google Scholar 

  12. George RT, Arbab-Zadeh A, Miller JM, Vavere AL, Bengel FM, Lardo AC, Lima JA (2012) Computed tomography myocardial perfusion imaging with 320-row detector computed tomography accurately detects myocardial ischemia in patients with obstructive coronary artery disease. Circ Cardiovasc Imaging 5:333–340

    Article  PubMed  Google Scholar 

  13. Gerber BL, Belge B, Legros GJ, Lim P, Poncelet A, Pasquet A, Gisellu G, Coche E, Vanoverschelde J-LJ (2006) Characterization of acute and chronic myocardial infarcts by multidetector computed tomography comparison with contrast-enhanced magnetic resonance. Circulation 113:823–833

    Article  PubMed  Google Scholar 

  14. Kurita Y, Kitagawa K, Kurobe Y, Nakamori S, Nakajima H, Dohi K, Ito M, Sakuma H (2016) Estimation of myocardial extracellular volume fraction with cardiac CT in subjects without clinical coronary artery disease: a feasibility study. J Cardiovasc Comput Tomogr 10:237–241

    Article  PubMed  Google Scholar 

  15. Lardo AC, Cordeiro MA, Silva C, Amado LC, George RT, Saliaris AP, Schuleri KH, Fernandes VR, Zviman M, Nazarian S (2006) Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction characterization of myocyte death, microvascular obstruction, and chronic scar. Circulation 113:394–404

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lessick J, Dragu R, Mutlak D, Rispler S, Beyar R, Litmanovich D, Engel A, Agmon Y, Kapeliovich M, Hammerman H (2007) Is functional improvement after myocardial infarction predicted with myocardial enhancement patterns at multidetector CT? 1. Radiology 244:736–744

    Article  PubMed  Google Scholar 

  17. Mahnken AH, Koos R, Katoh M, Wildberger JE, Spuentrup E, Buecker A, Günther RW, Kühl HP (2005) Assessment of myocardial viability in reperfused acute myocardial infarction using 16-slice computed tomography in comparison to magnetic resonance imaging. J Am Coll Cardiol 45:2042–2047

    Article  PubMed  Google Scholar 

  18. Nieman K, Shapiro MD, Ferencik M, Nomura CH, Abbara S, Hoffmann U, Gold HK, Jang I-K, Brady TJ, Cury RC (2008) Reperfused myocardial infarction: contrast-enhanced 64-section CT in comparison to MR imaging 1. Radiology 247:49–56

    Article  PubMed  Google Scholar 

  19. Brodoefel H, Klumpp B, Reimann A, Ohmer M, Fenchel M, Schroeder S, Miller S, Claussen C, Kopp A, Scheule A (2007) Late myocardial enhancement assessed by 64-MSCT in reperfused porcine myocardial infarction: diagnostic accuracy of low-dose CT protocols in comparison with magnetic resonance imaging. Eur Radiol 17:475–483

    Article  CAS  PubMed  Google Scholar 

  20. Brodoefel H, Reimann A, Klumpp B, Fenchel M, Ohmer M, Miller S, Schroeder S, Claussen C, Scheule A, Kopp AF (2007) Assessment of myocardial viability in a reperfused porcine model: evaluation of different MSCT contrast protocols in acute and subacute infarct stages in comparison with MRI. J Comput Assisted Tomogr 31:290–298

    Article  Google Scholar 

  21. Nacif MS, Kawel N, Lee JJ, Chen X, Yao J, Zavodni A, Sibley CT, Lima JA, Liu S, Bluemke DA (2012) Interstitial myocardial fibrosis assessed as extracellular volume fraction with low-radiation-dose cardiac CT. Radiology 264:876–883

    Article  PubMed  PubMed Central  Google Scholar 

  22. Halliburton SS, Abbara S, Chen MY, Gentry R, Mahesh M, Raff GL, Shaw LJ, Hausleiter J (2011) SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. J Cardiovasc Comput Tomogr 5:198–224

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kurita Y, Kitagawa K, Kurobe Y, Nakamori S, Nakajima H, Dohi K, Ito M, Sakuma H (2016) Data on correlation between CT-derived and MRI-derived myocardial extracellular volume. Data Brief 7:1045–1047

    Article  PubMed  PubMed Central  Google Scholar 

  24. Treibel TA, Bandula S, Fontana M, White SK, Gilbertson JA, Herrey AS, Gillmore JD, Punwani S, Hawkins PN, Taylor SA (2015) Extracellular volume quantification by dynamic equilibrium cardiac computed tomography in cardiac amyloidosis. J Cardiovasc Comput Tomogr 9:585–592

    Article  PubMed  PubMed Central  Google Scholar 

  25. Bandula S, White SK, Flett AS, Lawrence D, Pugliese F, Ashworth MT, Punwani S, Taylor SA, Moon JC (2013) Measurement of myocardial extracellular volume fraction by using equilibrium contrast-enhanced CT: validation against histologic findings. Radiology 269:396–403

    Article  PubMed  Google Scholar 

  26. Goetti R, Feuchtner G, Stolzmann P, Donati OF, Wieser M, Plass A, Frauenfelder T, Leschka S, Alkadhi H (2011) Delayed enhancement imaging of myocardial viability: low-dose high-pitch CT versus MRI. Eur Radiol 21:2091

    Article  PubMed  Google Scholar 

  27. Brodoefel H, Klumpp B, Reimann A, Fenchel M, Heuschmid M, Miller S, Schroeder S, Claussen C, Scheule A, Kopp A (2007) Sixty-four-MSCT in the characterization of porcine acute and subacute myocardial infarction: determination of transmurality in comparison to magnetic resonance imaging and histopathology. Eur J Radiol 62:235–246

    Article  CAS  PubMed  Google Scholar 

  28. Jablonowski R, Wilson MW, Do L, Hetts SW, Saeed M (2014) Multidetector CT measurement of myocardial extracellular volume in acute patchy and contiguous infarction: validation with microscopic measurement. Radiology 274:370–378

    Article  PubMed  Google Scholar 

  29. Puntmann VO, Voigt T, Chen Z, Mayr M, Karim R, Rhode K, Pastor A, Carr-White G, Razavi R, Schaeffter T (2013) Native T1 mapping in differentiation of normal myocardium from diffuse disease in hypertrophic and dilated cardiomyopathy. JACC: Cardiovasc Imaging 6:475–484

    Google Scholar 

  30. Mahmod M, Piechnik SK, Levelt E, Ferreira VM, Francis JM, Lewis A, Pal N, Dass S, Ashrafian H, Neubauer S (2014) Adenosine stress native T1 mapping in severe aortic stenosis: evidence for a role of the intravascular compartment on myocardial T1 values. J Cardiovasc Magn Reson 16:92

    Article  PubMed  PubMed Central  Google Scholar 

  31. Sado DM, Flett AS, Banypersad SM, White SK, Maestrini V, Quarta G, Lachmann RH, Murphy E, Mehta A, Hughes DA (2012) Cardiovascular magnetic resonance measurement of myocardial extracellular volume in health and disease. Heart 98:1436–1441

    Article  PubMed  Google Scholar 

  32. Jerosch-Herold M, Sheridan DC, Kushner JD, Nauman D, Burgess D, Dutton D, Alharethi R, Li D, Hershberger RE (2008) Cardiac magnetic resonance imaging of myocardial contrast uptake and blood flow in patients affected with idiopathic or familial dilated cardiomyopathy. Am J Physiol Heart Circ Physiol 295:H1234–H1242

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Klein C, Nekolla SG, Balbach T, Schnackenburg B, Nagel E, Fleck E, Schwaiger M (2004) The influence of myocardial blood flow and volume of distribution on late Gd-DTPA kinetics in ischemic heart failure. J Magn Reson Imaging 20:588–594

    Article  PubMed  Google Scholar 

  34. Ugander M, Oki AJ, Hsu L-Y, Kellman P, Greiser A, Aletras AH, Sibley CT, Chen MY, Bandettini WP, Arai AE (2012) Extracellular volume imaging by magnetic resonance imaging provides insights into overt and sub-clinical myocardial pathology. Eur Heart J 33:1268–1278

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Kitagawa K, Goto Y, Nakamura S, Takafuji M, Hamdy A, Ishida M, Sakuma H (2018) Dynamic CT perfusion imaging: state of the art. Cardiovasc Imaging Asia 2:38–48

    Article  Google Scholar 

  36. Goto Y, Kitagawa K, Uno M, Nakamori S, Ito T, Nagasawa N, Dohi K, Sakuma H (2017) Diagnostic accuracy of endocardial-to-epicardial myocardial blood flow ratio for the detection of significant coronary artery disease with dynamic myocardial perfusion dual-source computed tomography. Circ J 81:1477–1483

    Article  PubMed  Google Scholar 

  37. Blankstein R, Shturman LD, Rogers IS, Rocha-Filho JA, Okada DR, Sarwar A, Soni AV, Bezerra H, Ghoshhajra BB, Petranovic M, Loureiro R, Feuchtner G, Gewirtz H, Hoffmann U, Mamuya WS, Brady TJ, Cury RC (2009) Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography. J Am Coll Cardiol 54:1072–1084

    Article  PubMed  Google Scholar 

  38. Reimann AJ, Kuettner A, Klumpp B, Heuschmid M, Schumacher F, Teufel M, Beck T, Burgstahler C, Schröder S, Claussen CD (2008) Late enhancement using multidetector row computer tomography: a feasibility study with low dose 80 kV protocol. Eur J Radiol 66:127–133

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Ahmed Hamdy, Kakuya Kitagawa, Yoshitaka Goto, Akimasa Yamada, Satoshi Nakamura, Masafumi Takafuji, Naoki Nagasawa & Hajime Sakuma

Authors
  1. Ahmed Hamdy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kakuya Kitagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshitaka Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akimasa Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Satoshi Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masafumi Takafuji
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Naoki Nagasawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hajime Sakuma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kakuya Kitagawa.

Ethics declarations

Conflict of interest

One of the authors (H.S.) received a research grant from DAIICHI SANKYO COMPANY, LIMITED, Fuji Pharma Co., Ltd., FUJIFILM RI Pharma Co., Ltd., Eisai Co., Ltd. All the other authors have nothing to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 18 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hamdy, A., Kitagawa, K., Goto, Y. et al. Comparison of the different imaging time points in delayed phase cardiac CT for myocardial scar assessment and extracellular volume fraction estimation in patients with old myocardial infarction. Int J Cardiovasc Imaging 35, 917–926 (2019). https://doi.org/10.1007/s10554-018-1513-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-018-1513-z

Keywords

Search

Navigation