Ashley Elizabeth Prosper BA, Presenter: Nothing to Disclose

Krishna M. Surti MD, Abstract Co-Author: Nothing to Disclose

Christopher Lee MD, Abstract Co-Author: Nothing to Disclose

Patrick M. Colletti MD, Abstract Co-Author: Research grant, Bayer AG

Jerold S. Shinbane MD, Abstract Co-Author: Nothing to Disclose

Alison Wilcox MD, Abstract Co-Author: Nothing to Disclose

Jabi E. Shriki MD, Abstract Co-Author: Nothing to Disclose

This study was conducted as a retrospective review of non-cardiac, conventional CT scans in patients with infarcts found on cardiac MR. This analysis was performed in order to evaluate how often findings related to myocardial infarction are observable at CT, and to determine if myocardial infarctions are an under-diagnosed entity on CT. An additional purpose of this abstract is to increase awareness of features of myocardial infarcts on conventional CT.

Following IRB approval, this study was conducted as a retrospective review of cardiac MR studies performed at our institution over a 4 year period, encompassing a total of 252 studies.  160 patients had areas of late gadolinium enhancement which were reported as infarcts.  These studies were re-reviewed by 2 experienced readers in order to confirm that the morphologies of areas of late enhancement were consistent with infarcts. Of these patients, 54 also underwent CT scans. CT scans were reviewed by 2 experienced cardiac readers in order to evaluate for potential CT evidence of a myocardial infarct. Findings used to suggest possible myocardial infarction on CT for the purposes of this analysis included lipoatrophy of the myocardium; the presence of myocardial thinning and decreased enhancement in a focal region, with or without aneurysm formation; myocardial wall calcifications without any other potential explanation; and the presence of an LV apical thrombus.

Of the 54 patients who had infarcts on cardiac MR who also had CT, findings suggestive of myocardial infarction were identified in 27 patients. These findings included lipoatrophy of the myocardium in 10 patients, thinning and decreased perfusion in 23 patients, myocardial calcifications in 2 patients, and apical thrombi in 3 patients. In 14/27 patients with findings suggestive of myocardial infarction on CT, the relevant findings were not mentioned in the radiology report.

CT may commonly show evidence of a myocardial infarction. In our population, findings suggestive of myocardial infarction were present in 27/54 patients. These findings may be under-recognized, supporting the contention that the heart may be a relative blind-spot for many radiologists. 

Myocardial infarcts may be clinically silent, but portend future cardiovascular events.  Identification of infarcts on CT, may provide an opportunity to improve recognition of atherosclerotic disease.

Prosper, A, Surti, K, Lee, C, Colletti, P, Shinbane, J, Wilcox, A, Shriki, J, Frequency of Myocardial Infarcts Observed at Conventional CT: An Often Overlooked Entity.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9006379.html