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Extra info for Computed Tomography and Magnetic Resonance of the Thorax
Myocardial contrast hyperenhancement of infarct regions, defined as increased signal intensity on delayed resting T1-weighted MR images acquired more than 5 minutes after intravenous administration of contrast, was first described more than 20 years ago. However, improvements in pulse sequence design have led to a nearly 500% increase in signal intensity between abnormal hyperenhanced regions of myocardium and normal myocardium (94). These regions of hyperenhancement show excellent anatomic agreement with the histologic extent of necrosis (95).
Additionally, in the setting of recent ischemia or chronic ischemia, regional myocardial function may become depressed, resulting in stunned (transient dysfunction) or hibernating (prolonged dysfunction) states without overt myocardial infarction. Because stunned or hibernating myocardium may normalize after revascularization of the involved regions, as opposed to regions with myocardial infarction, the distinction between these myocardial states is an important one (71–73). Currently, functional imaging can be performed using gated SPECT or PET, contrast stress echocardiography, and MR, and depending on the imaging protocol utilized, an assessment of perfusion and/or function can be made at rest and during stress conditions.
1-19 and 1-20). The left AV opening is inferior and to the left of the aortic orifice and a little smaller than the corresponding aperture on the right side. This aperture is surrounded by a dense fibrous ring, covered by the lining membrane of the heart and guarded by the bicuspid AV valve known as the mitral valve. The aortic opening is circular and located anterior and to the right of the mitral valve. Its orifice is guarded by the aortic semilunar valve. The LV walls are about three times as thick as those of the right ventricle, and on short axis section its shape presents an oval or nearly circular outline.