CT Imaging of Myocardial Viability: Experimental and Clinical Evidence

  • J. Matthias Kerl
Part of the Medical Radiology book series (MEDRAD)


The visualization of myocardial viability is one of the most relevant applications of cardiovascular imaging. There are several novel techniques to assess myocardial viability using CT. This chapter will give an overview of these techniques and detail the supporting experimental and clinical evidence.


Myocardial Perfusion Imaging Myocardial Blood Flow Arterial Phase Myocardial Viability Late Enhancement 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Abdel-Aty H, Zagrosek A, Schulz-Menger J, Taylor AJ, Messroghli D, Kumar A, Gross M, Dietz R, Friedrich MG (2004) Delayed enhancement and t2-weighted cardiovascular magnetic resonance imaging differentiate acute from chronic myocardial infarction. Circulation 109:2411–2416PubMedCrossRefGoogle Scholar
  2. Allard M, Doucet D, Kien P, Bonnemain B, Caille JM (1988) Experimental study of dota-gadolinium. Pharmacokinetics and pharmacologic properties. Investig Radiol 23(Suppl 1):S271–S274CrossRefGoogle Scholar
  3. Baks T, Cademartiri F, Moelker AD, Weustink AC, van Geuns RJ, Mollet NR, Krestin GP, Duncker DJ, de Feyter PJ (2006) Multislice computed tomography and magnetic resonance imaging for the assessment of reperfused acute myocardial infarction. J Am Coll Cardiol 48:144–152PubMedCrossRefGoogle Scholar
  4. Bamberg F, Becker A, Schwarz F, Marcus RP, Greif M, von Ziegler F, Blankstein R, Hoffmann U, Sommer WH, Hoffmann VS, Johnson TR, Becker HC, Wintersperger BJ, Reiser MF, Nikolaou K (2011) Detection of hemodynamically significant coronary artery stenosis: incremental diagnostic value of dynamic ct-based myocardial perfusion imaging. Radiology 260:689–698PubMedCrossRefGoogle Scholar
  5. Bastarrika G, Ramos-Duran L, Rosenblum MA, Kang DK, Rowe GW, Schoepf UJ (2010) Adenosine-stress dynamic myocardial ct perfusion imaging: initial clinical experience. Invest Radiol 45:306–313PubMedCrossRefGoogle Scholar
  6. Bauer RW, Kerl JM, Fischer N, Burkhard T, Larson MC, Ackermann H, Vogl TJ (2010) Dual-energy CT for the assessment of chronic myocardial infarction in patients with chronic coronary artery disease: comparison with 3-T MRI. AJR Am J Roentgenol 195:639–646PubMedCrossRefGoogle Scholar
  7. Becker CR, Knez A, Leber A, Treede H, Ohnesorge B, Schoepf UJ, Reiser MF (2002) Detection of coronary artery stenoses with multislice helical CT angiography. J Comput Assist Tomogr 26:750–755PubMedCrossRefGoogle Scholar
  8. Beek AM, Kuhl HP, Bondarenko O, Twisk JW, Hofman MB, van Dockum WG, Visser CA, van Rossum AC (2003) Delayed contrast-enhanced magnetic resonance imaging for the prediction of regional functional improvement after acute myocardial infarction. J Am Coll Cardiol 42:895–901PubMedCrossRefGoogle Scholar
  9. Brodoefel H, Klumpp B, Reimann A, Fenchel M, Heuschmid M, Miller S, Schroeder S, Claussen C, Scheule AM, Kopp AF (2007a) 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 62:235–246PubMedCrossRefGoogle Scholar
  10. Brodoefel H, Klumpp B, Reimann A, Ohmer M, Fenchel M, Schroeder S, Miller S, Claussen C, Kopp AF, Scheule AM (2007b) 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 17:475–483PubMedCrossRefGoogle Scholar
  11. Brunken R, Tillisch J, Schwaiger M, Child JS, Marshall R, Mandelkern M, Phelps ME, Schelbert HR (1986) Regional perfusion, glucose metabolism, and wall motion in patients with chronic electrocardiographic q wave infarctions: evidence for persistence of viable tissue in some infarct regions by positron emission tomography. Circulation 73:951–963PubMedCrossRefGoogle Scholar
  12. Buecker A, Katoh M, Krombach GA, Spuentrup E, Bruners P, Gunther RW, Niendorf T, Mahnken AH (2005) A feasibility study of contrast enhancement of acute myocardial infarction in multislice computed tomography: comparison with magnetic resonance imaging and gross morphology in pigs. Invest Radiol 40:700–704PubMedCrossRefGoogle Scholar
  13. Burt RW, Perkins OW, Oppenheim BE, Schauwecker DS, Stein L, Wellman HN, Witt RM (1995) Direct comparison of fluorine-18-fdg spect, fluorine-18-fdg pet and rest thallium-201 spect for detection of myocardial viability. J Nucl Med Off Publ Soc Nucl Med 36:176–179Google Scholar
  14. Cheng W, Zeng M, Arellano C, Mafori W, Goldin J, Krishnam M, Ruehm SG (2010) Detection of myocardial perfusion abnormalities: standard dual-source coronary computed tomography angiography versus rest/stress technetium-99 m single-photo emission CT. British J Radiol 83:652–660CrossRefGoogle Scholar
  15. Choi KM, Kim RJ, Gubernikoff G, Vargas JD, Parker M, Judd RM (2001) Transmural extent of acute myocardial infarction predicts long-term improvement in contractile function. Circulation 104:1101–1107PubMedCrossRefGoogle Scholar
  16. Cury RC, Nieman K, Shapiro MD, Butler J, Nomura CH, Ferencik M, Hoffmann U, Abbara S, Jassal DS, Yasuda T, Gold HK, Jang IK, Brady TJ (2008) Comprehensive assessment of myocardial perfusion defects, regional wall motion, and left ventricular function by using 64-section multidetector CT. Radiology 248:466–475PubMedCrossRefGoogle Scholar
  17. Deseive S, Bauer RW, Lehmann R, Kettner M, Kaiser C, Korkusuz H, Tandi C, Theisen A, Schachinger V, Schoepf UJ, Vogl TJ, Kerl JM (2011) Dual-energy computed tomography for the detection of late enhancement in reperfused chronic infarction: a comparison to magnetic resonance imaging and histopathology in a porcine model. Invest Radiol 46:450–456PubMedCrossRefGoogle Scholar
  18. Dewey M, Zimmermann E, Deissenrieder F, Laule M, Dubel HP, Schlattmann P, Knebel F, Rutsch W, Hamm B (2009) Noninvasive coronary angiography by 320-row computed tomography with lower radiation exposure and maintained diagnostic accuracy: comparison of results with cardiac catheterization in a head-to-head pilot investigation. Circulation 120:867–875PubMedCrossRefGoogle Scholar
  19. Flohr TG, McCollough CH, Bruder H, Petersilka M, Gruber K, Suss C, Grasruck M, Stierstorfer K, Krauss B, Raupach R, Primak AN, Kuttner A, Achenbach S, Becker C, Kopp A, Ohnesorge BM (2006) First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol 16:256–268PubMedCrossRefGoogle Scholar
  20. George RT, Silva C, Cordeiro MA, DiPaula A, Thompson DR, McCarthy WF, Ichihara T, Lima JA, Lardo AC (2006) Multidetector computed tomography myocardial perfusion imaging during adenosine stress. J Am Coll Cardiol 48:153–160PubMedCrossRefGoogle Scholar
  21. George RT, Arbab-Zadeh A, Miller JM, Kitagawa K, Chang HJ, Bluemke DA, Becker L, Yousuf O, Texter J, Lardo AC, Lima JA (2009) Adenosine stress 64- and 256-row detector computed tomography angiography and perfusion imaging: A pilot study evaluating the transmural extent of perfusion abnormalities to predict atherosclerosis causing myocardial ischemia. Circ Cardiovasc Imag 2:174–182CrossRefGoogle Scholar
  22. Gerber BL, Belge B, Legros GJ, Lim P, Poncelet A, Pasquet A, Gisellu G, Coche E, Vanoverschelde JL (2006) Characterization of acute and chronic myocardial infarcts by multidetector computed tomography: comparison with contrast-enhanced magnetic resonance. Circulation 113:823–833PubMedCrossRefGoogle Scholar
  23. 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 21:2091–2099PubMedCrossRefGoogle Scholar
  24. Herzog C, Zwerner PL, Doll JR, Nielsen CD, Nguyen SA, Savino G, Vogl TJ, Costello P, Schoepf UJ (2007) Significant coronary artery stenosis: comparison on per-patient and per-vessel or per-segment basis at 64-section CT angiography. Radiology 244:112–120PubMedCrossRefGoogle Scholar
  25. Ho KT, Chua KC, Klotz E, Panknin C (2010) Stress and rest dynamic myocardial perfusion imaging by evaluation of complete time-attenuation curves with dual-source CT. JACC Cardiovasc Imaging 3:811–820PubMedCrossRefGoogle Scholar
  26. Hoffmann U, Millea R, Enzweiler C, Ferencik M, Gulick S, Titus J, Achenbach S, Kwait D, Sosnovik D, Brady TJ (2004) Acute myocardial infarction: contrast-enhanced multi-detector row CT in a porcine model. Radiology 231:697–701PubMedCrossRefGoogle Scholar
  27. Hoffmann MH, Schmid FT, Jeltsch M, Wunderlich A, Duerk JL, Schmitz B, Aschoff AJ (2005) Multislice mr first-pass myocardial perfusion imaging: impact of the receiver coil array. J Magn Reson Imaging 21:310–316PubMedCrossRefGoogle Scholar
  28. Johnson TR, Krauss B, Sedlmair M, Grasruck M, Bruder H, Morhard D, Fink C, Weckbach S, Lenhard M, Schmidt B, Flohr T, Reiser MF, Becker CR (2007) Material differentiation by dual energy CT: initial experience. Eur Radiol 17:1510–1517PubMedCrossRefGoogle Scholar
  29. Kerl JM, Deseive S, Tandi C, Kaiser C, Kettner M, Korkusuz H, Lehmann R, Herzog C, Schoepf UJ, Vogl TJ, Bauer RW (2011a) Dual energy CT for the assessment of reperfused chronic infarction—a feasibility study in a porcine model. Acta Radiol 52:834–839PubMedCrossRefGoogle Scholar
  30. Kerl JM, Bauer RW, Maurer TB, Aschenbach R, Korkusuz H, Lehnert T, Deseive S, Ackermann H, Vogl TJ (2011b) Dose levels at coronary CT angiography–a comparison of dual energy-, dual source- and 16-slice CT. Eur Radiol 21:530–537PubMedCrossRefGoogle Scholar
  31. Kim RJ, Fieno DS, Parrish TB, Harris K, Chen EL, Simonetti O, Bundy J, Finn JP, Klocke FJ, Judd RM (1999) Relationship of mri delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation 100:1992–2002PubMedCrossRefGoogle Scholar
  32. Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM (2000) The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 343:1445–1453PubMedCrossRefGoogle Scholar
  33. Lardo AC, Cordeiro MA, Silva C, Amado LC, George RT, Saliaris AP, Schuleri KH, Fernandes VR, Zviman M, Nazarian S, Halperin HR, Wu KC, Hare JM, Lima JA (2006) Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction: characterization of myocyte death, microvascular obstruction, and chronic scar. Circulation 113:394–404PubMedCrossRefGoogle Scholar
  34. Lell M, Marwan M, Schepis T, Pflederer T, Anders K, Flohr T, Allmendinger T, Kalender W, Ertel D, Thierfelder C, Kuettner A, Ropers D, Daniel WG, Achenbach S (2009) Prospectively ecg-triggered high-pitch spiral acquisition for coronary ct angiography using dual source ct: technique and initial experience. Eur Radiol 19:2576–2583PubMedCrossRefGoogle Scholar
  35. Leschka S, Stolzmann P, Desbiolles L, Baumueller S, Goetti R, Schertler T, Scheffel H, Plass A, Falk V, Feuchtner G, Marincek B, Alkadhi H (2009) Diagnostic accuracy of high-pitch dual-source ct for the assessment of coronary stenoses: first experience. Eur Radiol 19:2896–2903PubMedCrossRefGoogle Scholar
  36. Lessick J, Dragu R, Mutlak D, Rispler S, Beyar R, Litmanovich D, Engel A, Agmon Y, Kapeliovich M, Hammerman H, Ghersin E (2007) Is functional improvement after myocardial infarction predicted with myocardial enhancement patterns at multidetector CT? Radiology 244:736–744PubMedCrossRefGoogle Scholar
  37. Mahnken AH, Koos R, Katoh M, Wildberger JE, Spuentrup E, Buecker A, Gunther RW, Kuhl 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 45:2042–2047PubMedCrossRefGoogle Scholar
  38. Mahnken AH, Bruners P, Katoh M, Wildberger JE, Gunther RW, Buecker A (2006) Dynamic multi-section ct imaging in acute myocardial infarction: preliminary animal experience. Eur Radiol 16:746–752PubMedCrossRefGoogle Scholar
  39. Mahnken AH, Bruners P, Kinzel S, Katoh M, Muhlenbruch G, Gunther RW, Wildberger JE (2007) Late-phase MSCT in the different stages of myocardial infarction: animal experiments. Eur Radiol 17:2310–2317PubMedCrossRefGoogle Scholar
  40. Mahrholdt H, Wagner A, Judd RM, Sechtem U (2002) Assessment of myocardial viability by cardiovascular magnetic resonance imaging. Eur Heart J 23:602–619PubMedCrossRefGoogle Scholar
  41. McFalls EO, Murad B, Haspel HC, Marx D, Sikora J, Ward HB (2003) Myocardial glucose uptake after dobutamine stress in chronic hibernating swine myocardium. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol 10:385–394CrossRefGoogle Scholar
  42. Mokdad AH, Marks JS, Stroup DF, Gerberding JL (2004) Actual causes of death in the united states, 2000. J Am Med Assoc 291:1238–1245CrossRefGoogle Scholar
  43. Nieman K, Shapiro MD, Ferencik M, Nomura CH, Abbara S, Hoffmann U, Gold HK, Jang IK, Brady TJ, Cury RC (2008) Reperfused myocardial infarction: contrast-enhanced 64-section CT in comparison to mr imaging. Radiology 247:49–56PubMedCrossRefGoogle Scholar
  44. Nikolaou K, Knez A, Sagmeister S, Wintersperger BJ, Boekstegers P, Steinbeck G, Reiser MF, Becker CR (2004) Assessment of myocardial infarctions using multidetector-row computed tomography. J Comput Assist Tomogr 28:286–292PubMedCrossRefGoogle Scholar
  45. Paul JF, Wartski M, Caussin C, Sigal-Cinqualbre A, Lancelin B, Angel C, Dambrin G (2005) Late defect on delayed contrast-enhanced multi-detector row CT scans in the prediction of spect infarct size after reperfused acute myocardial infarction: initial experience. Radiology 236:485–489PubMedCrossRefGoogle Scholar
  46. Reimann AJ, Kuettner A, Klumpp B, Heuschmid M, Schumacher F, Teufel M, Beck T, Burgstahler C, Schroder S, Claussen CD, Kopp AF (2008) Late enhancement using multidetector row computer tomography: a feasibility study with low dose 80 kv protocol. Eur J Radiol 66:127–133PubMedCrossRefGoogle Scholar
  47. Ruzsics B, Lee H, Zwerner PL, Gebregziabher M, Costello P, Schoepf UJ (2008) Dual-energy CT of the heart for diagnosing coronary artery stenosis and myocardial ischemia-initial experience. Eur Radiol 18:2414–2424PubMedCrossRefGoogle Scholar
  48. Ruzsics B, Schwarz F, Schoepf UJ, Lee YS, Bastarrika G, Chiaramida SA, Costello P, Zwerner PL (2009) Comparison of dual-energy computed tomography of the heart with single photon emission computed tomography for assessment of coronary artery stenosis and of the myocardial blood supply. Am J Cardiol 104:318–326PubMedCrossRefGoogle Scholar
  49. Sato A, Nozato T, Hikita H, Akiyama D, Nishina H, Hoshi T, Aihara H, Kakefuda Y, Watabe H, Hiroe M, Aonuma K (2012) Prognostic value of myocardial contrast delayed enhancement with 64-slice multidetector computed tomography after acute myocardial infarction. J Am Coll Cardiol 59:730–738PubMedCrossRefGoogle Scholar
  50. Schwarz F, Ruzsics B, Schoepf UJ, Bastarrika G, Chiaramida SA, Abro JA, Brothers RL, Vogt S, Schmidt B, Costello P, Zwerner PL (2008) Dual-energy ct of the heart–principles and protocols. Eur J Radiol 68:423–433PubMedCrossRefGoogle Scholar
  51. Selvanayagam JB, Kardos A, Francis JM, Wiesmann F, Petersen SE, Taggart DP, Neubauer S (2004) Value of delayed-enhancement cardiovascular magnetic resonance imaging in predicting myocardial viability after surgical revascularization. Circulation 110:1535–1541PubMedCrossRefGoogle Scholar
  52. Sicari R, Picano E, Landi P, Pingitore A, Bigi R, Coletta C, Heyman J, Casazza F, Previtali M, Mathias W Jr, Dodi C, Minardi G, Lowenstein J, Garyfallidis X, Cortigiani L, Morales MA, Raciti M (1997) Prognostic value of dobutamine-atropine stress echocardiography early after acute myocardial infarction. Echo dobutamine international cooperative (edic) study. J Am Coll Cardiol 29:254–260PubMedCrossRefGoogle Scholar
  53. Takeuchi M, Yoshitani H, Miyazaki C, Haruki N, Otani S, Sakamoto K, Yoshikawa J (2003) Color kinesis during contrast-enhanced dobutamine stress echocardiography: feasibility and applicability. Circ J Off J Jpn Circ Soc 67:49–53Google Scholar
  54. Writing Group M, Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C, Go A, Greenlund K, Haase N, Hailpern S, Ho PM, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott MM, Meigs J, Mozaffarian D, Mussolino M, Nichol G, Roger VL, Rosamond W, Sacco R, Sorlie P, Roger VL, Thom T, Wasserthiel-Smoller S, Wong ND, Wylie-Rosett J, American Heart Association Statistics C, Stroke Statistics S (2010) Heart disease and stroke statistics–2010 update: a report from the american heart association. Circulation 121:e46–e215Google Scholar
  55. Wu E, Judd RM, Vargas JD, Klocke FJ, Bonow RO, Kim RJ (2001) Visualisation of presence, location, and transmural extent of healed q-wave and non-q-wave myocardial infarction. Lancet 357:21–28PubMedCrossRefGoogle Scholar
  56. Yim NY, Kim YH, Choi S, Seon HJ, Kim YC, Jeong GW, Min BI, Lee SR, Jeong MH, Kim JK, Park JG, Kang HK (2009) Multidetector-row computed tomographic evaluation of myocardial perfusion in reperfused chronic myocardial infarction: value of color-coded perfusion map in a porcine model. Int J Cardiovasc Imag 25(Suppl 1):65–74Google Scholar
  57. Zatz LM (1976) The effect of the kvp level on emi values. selective imaging of various materials with different kvp settings. Radiology 119:683–688PubMedGoogle Scholar
  58. Zhang LJ, Peng J, Wu SY, Yeh BM, Zhou CS, Lu GM (2010) Dual source dual-energy computed tomography of acute myocardial infarction: correlation with histopathologic findings in a canine model. Invest Radiol 45:290–297PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Diagnostic and Interventional RadiologyGoethe-University Frankfurt am MainFrankfurt am MainGermany

Personalised recommendations