Abstract
Introduction: Myocardial strain is a new indicator of myocardial characteristics and function, mainly evaluated by transthoracic echocardiography (TTE) or magnetic resonance imaging (MRI) techniques that rely on dynamic two dimensional images. Hypothesis: We hypothesized that utilizing the full capability of four dimensional (4D) volumetric 320 slice CT image data with retrospective ECG gating we could provide additional information on myocardial morphology, characteristics and function on Novel 4D CT myocardial stain analysis (developed with PhyZioDynamics, Zio). Method: We retrospectively analyzed ten subjects with various rare and un- typical myocardial diseases diagnosed by 320 slice CT using retrospective ECG gating and dose modulation. Some diagnoses were confirmed using MRI, TTE or endomyocardial biopsy (EMB). 4D CT myocardial strain analysis confirmed their diagnosis (see fig). Areas with maximum strain are colored red and decreasing strain, yellow, green, blue, and finally no color (=no strain). Results: Case 1 had a large, idiopathic fat deposit in the left ventricle (LV) that could be observed using enhanced CT with a low CT attenuation area. On 4D CT strain analysis, the fat deposit showed no strain. Case 2 had cardiac amyloidosis confirmed by EMB and Case 3 had type 2 hypertrophic cardiomyopathy (HCM). MRI showed late gadolinium enhancements (LGE) in both cases. At corresponding sites, no strain was observed by 4D CT. Other cases analyzed were dilated cardiomyopathy with focal LGE on MRI, subendocardial myocardial infarction with enlarged LV myocardium, etc. Conclusion: This is the first report worldwide of a 4D CT myocardial strain analyzing technique that utilizes full volumetric data. Our new technique uses ordinary cardiac CT data acquired with retrospective ECG gating, to provide detailed additional information on myocardial characteristics and function in addition to LV ejection fraction volume data and information on coronary arteries.
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