Computed tomography assessment of myocardial perfusion, viability, and function.

In addition to coronary artery assessment, contrast-enhanced multidetector spiral computed tomography (CE-MDCT) can provide valuable information about myocardial perfusion. Using CE-MDCT, myocardial perfusion defects are often observed in the early phase of the contrast bolus (early defect (ED)), with residual defects (RDs) and late enhancement (LE) observed in the late phase in myocardial infarction (MI). However, the clinical significance of EDs, RDs, and LE has not yet been fully described. This work reviews myocardial viability and function by CE-MDCT based on our prior data by including contrast-enhanced single-slice (detector) CT (CE-SSCT) and CE-MDCT. Recently, equivalent results were obtained, as seen in CE-SSCT with images by CE-MDCT. In this review, images that were acquired by MDCT will be presented. In this work, the following items will be the focus: myocardial enhancement patterns (EDs, LE, and RDs), early perfusion defects and their relationship to wall thickness (WT) and wall motion, early CT perfusion defects vs. Tl-201 single photon emission CT (SPECT), the protocol for performing dual-phase contrast CT, classification of enhancement patterns, enhancement patterns on dual-phase CE-MDCT vs. left ventricular functional recovery and WT, changes in enhancement patterns in conjunction with healing stage, enhancement patterns on dual-phase CE-MDCT vs. 201Tl/99mTc-pyrophosphate (dual-isotope SPECT), the clinical meaning of each enhancement pattern, pitfalls of enhancement patterns and other diseases, and study limitations and the future of MDCT. Copyright 2004 Wiley-Liss, Inc.