Prospective Electrocardiogram-Gated Delayed Enhanced Multidetector Computed Tomography Accurately Quantifies Infarct Size and Reduces Radiation Exposure

Hyuk Jae Chang, Richard T. George, Karl H. Schuleri, Kristine Evers, Kakuya Kitagawa, João A.C. Lima, Albert C. Lardo

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27 Citations (Scopus)


Objectives: This study sought to determine whether low-dose, prospective electrocardiogram (ECG)-gated delayed contrast-enhanced multidetector computed tomography (DCE-MDCT) can accurately delineate the extent of myocardial infarction (MI) compared with retrospective ECG-gated DCE-MDCT. Background: For defining the location and extent of MI, DCE-MDCT compares well with delayed enhanced cardiac magnetic resonance. However, the addition of a delayed scan requires additional radiation exposure to patients. MDCT protocols using prospective ECG gating can substantially reduce effective radiation dose exposure, but these protocols have not yet been applied to infarct imaging. Methods: Ten porcine models of acute MI were imaged 10 days after MI using prospective and retrospective ECG-gated DCE-MDCT (64-slice) 10 min after a 90-ml contrast bolus. The MDCT images were analyzed using a semiautomated computed tomography density (CTD) threshold technique. Infarct size, signal-to-noise (SNR) ratios, contrast-to-noise (CNR) ratios, and image quality metrics were compared between the 2 ECG-gating techniques. Results: Infarct volume measurements obtained by both methods were strongly correlated (R = 0.93, p < 0.001) and in good agreement (mean difference: -0.46 ml ± 4.00%). Compared with retrospective ECG gating, estimated radiation dosages were markedly reduced with prospective ECG gating (930.1 ± 62.2 mGy×cm vs. 42.4 ± 2.3 mGy×cm, p < 0.001). The SNR and CNR of infarcted myocardium were somewhat lower for prospective gated images (22.0 ± 11.0 vs. 16.3 ± 7.8 and 8.8 ± 5.3 vs. 7.0 ± 3.9, respectively; p < 0.001). However, all examinations using prospective gating protocol achieved sufficient diagnostic image quality for the assessment of MI. Conclusions: Prospective ECG-gated DCE-MDCT accurately assesses infarct size compared with retrospective ECG-gated DCE-MDCT imaging. Although infarct SNR and CNR were significantly higher for the retrospective gated protocol, prospective ECG-gated DCE-MDCT provides high-resolution imaging of MI, while substantially lowering the radiation dose.

Original languageEnglish
Pages (from-to)412-420
Number of pages9
JournalJACC: Cardiovascular Imaging
Issue number4
Publication statusPublished - 2009 Apr

Bibliographical note

Funding Information:
This study was supported, in part, by research grants from Toshiba Medical Systems Co., Ltd., Tokyo, Japan. Dr. George was supported by the Donald W. Reynolds Cardiovascular Research Center at Johns Hopkins University. The terms of this arrangement are managed by Johns Hopkins University in accordance with its conflict of interest policies. Drs. Chang and George contributed equally to this paper.

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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