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A distinção entre miocárdio atordoado e danificado tem sido uma preocupação relevante,
no cenário de um enfarte agudo do miocárdio (EAM). A avaliação da viabilidade
do miocárdio, pós-enfarte, é de importância vital, no contexto clínico,
principalmente numa fase inicial. Actualmente a Ressonância Magnética Cardíaca
é o exame de referência para a avaliação de viabilidade do miocárdio. No entanto, é
um exame com elevado custo e de difícil acesso. Estudos preliminares demonstraram
potencial na utilização de imagens por Tomografia Computorizada para avaliação
da área de enfarte, quer em estudos animais quer em humanos.
É
objectivo desta tese verificar a utilidade de um protocolo de avaliação de viabilidade
do miocárdio, com base em imagens de realce tardio (RT) por Tomografia
Computorizada, após um procedimento de intervenção coronária percutânea, no
contexto de enfarte agudo do miocárdio com elevação do segmento ST (STEMI).
Pretende-se igualmente contribuir para a análise da imagem médica do miocárdio,
proporcionando métodos de quantificação do RT e software de suporte à decisão
médica nesta modalidade de imagem substancialmente recente.
São avaliados vários processos para a quantificação do volume de RT, incluindo
um método inovador baseado na detecção automática do miocárdio normal. _E ainda
proposto um algoritmo para detecção automática do grau de transmuralidade, por
segmento do miocárdio, e comparado o seu grau de eficiência face ao diagnóstico
médico dos mesmos exames.
Apesar do reduzido número de exames utilizado para validação das técnicas
descritas nesta tese, os resultados são bastante promissores e podem constituir uma
mais-valia no auxilio à gestão do paciente com EAM.
Distinction between stunned or damaged myocardium is an important concern, in an acute myocardial infarction (AMI) scenario. It is of vital importance to evaluate the post infarction myocardial viability, particularly in the initial stage. Cardiac Magnetic Resonance is currently the gold standard for myocardial viability evaluation. However, there are limitations regarding exam cost and on time access. Preliminary studies have shown the potential for Computerized Tomography in the evaluation of infarction area in both animal and human studies. The purpose of this thesis is to study the usefulness of myocardial viability evaluation, based on CT Delayed Enhancement (DE) images, after percutaneous coronary angiography, in the context of ST-elevation acute myocardial infarction (STEMI). And also to impart an insight on myocardial imaging by providing DE quanti cation methods and clinic decision support systems on this farelly new imaging modality. Several DE quanti cation methods are presented, including an innovative method based on automatic remote myocardium detection. Additionally, an algorithm for automatic transmurality extension is also presented, and its e ciency tested regarding medical diagnosis. Despite the reduced number of exams used to validate the depicted methodology, the results presented in this thesis seem very promising and may provide an added value to the managing of the AMI pacient.
Distinction between stunned or damaged myocardium is an important concern, in an acute myocardial infarction (AMI) scenario. It is of vital importance to evaluate the post infarction myocardial viability, particularly in the initial stage. Cardiac Magnetic Resonance is currently the gold standard for myocardial viability evaluation. However, there are limitations regarding exam cost and on time access. Preliminary studies have shown the potential for Computerized Tomography in the evaluation of infarction area in both animal and human studies. The purpose of this thesis is to study the usefulness of myocardial viability evaluation, based on CT Delayed Enhancement (DE) images, after percutaneous coronary angiography, in the context of ST-elevation acute myocardial infarction (STEMI). And also to impart an insight on myocardial imaging by providing DE quanti cation methods and clinic decision support systems on this farelly new imaging modality. Several DE quanti cation methods are presented, including an innovative method based on automatic remote myocardium detection. Additionally, an algorithm for automatic transmurality extension is also presented, and its e ciency tested regarding medical diagnosis. Despite the reduced number of exams used to validate the depicted methodology, the results presented in this thesis seem very promising and may provide an added value to the managing of the AMI pacient.
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Instituto Politécnico do Porto. Instituto Superior de Engenharia do Porto