Computed tomography for the detection of myocardial hypoperfusion in acute myocardial infarction and the associated CT-to-catheter time

Figures

• 

  Fig. 1. Time to ICA in dependence of number of segments with visual myocardial hypoperfusion on CT imaging. The y-axis shows the number of segments with hypoperfusion on CT imaging, while the x-axis depicts the time in minutes between the CT exam and the ICA. The red-dotted trendline within the diagram depicts that the higher the number of segments with visual hypoperfusion on imaging, the faster an ICA examination was initiated. In clinical context, this means that the more segments are seen to be affected, the more likely the patient was to develop either symptoms suggestive of AMI, distinctive ECG changes or biomarker dynamics that led to an ICA examination being performed earlier.

• 

  Fig. 2. Incidental finding of myocardial hypoperfusion on venous phase abdominal CT imaging for evaluation of postoperative hemorrhage after radical prostatecomty. In this image, reconstructed abdominal CT images in oblique (a) and axial (b) view are shown. Imaging was conducted due to suspicion of abdominal bleeding after previous radical prostatectomy. Myocardial hypoperfusion located at the basal and midventricular level of the septum and the inferior wall can be delineated (white arrows, images a and b).

• 

  Fig. 3. Exemplary case of proximal LAD occlusion with corresponding anterior perfusion defect. In image a, multiplanar reconstruction depicts regular contrasting of the left main coronary artery (a, white arrows). In the proximal LAD, a calcified plaque can be seen with only very faded contrast media in the downstream LAD. This plaque likely ruptured, subsequently causing LAD occlusion (a, red arrow). In images b and c, the corresponding anterior and apical perfusion defects of the left ventricular myocardium can be seen (b and c, red arrows). Ao Aorta, RV right ventricle, LV left ventricle.

• 

  Fig. 4. Myocardial Hypoperfusion in different reconstructions with imaging postprocessing. In images (a–c), myocardial hypoperfusion of the septal, inferior, and lateral wall at the midventricular level is depicted. While image (a) represents the conventional reconstruction, images (b) and (c) depict reconstructions derived from iodine density maps, where the affected segment can be delineated more clearly.

• 

  Fig. 5. Flowchart for incidental myocardial hypoperfusion on CT imaging.