FIGURE 8.

An example of multiparametric imaging (A, conventional image; B, MonoE 55 keV; C, iodine map; D, Z-effective) of myocardial perfusion anomalies of the left ventricle as assessed on a short axis apical plane of a cardiac angiography using an SPCCT system (Philips Healthcare). Conventional images (A) showed a few small hypodense spots (black arrowheads) of the anterior segment, possibly adipose metaplasia. These lesions were also visible on spectral images (arrowheads in B, C, D) and also showed an adjacent area of hypoperfusion (white arrows) with transmural extension but more pronounced in the subendocardial layer. The combination of adipose remodeling and hypoperfusion raised the suspicion of myocardial infarction. A second area of hypoperfusion of the inferior wall, also more obvious in the subendocardial layer, could be spotted with some difficulties on conventional images (arrowhead in A) but very easily on the spectral images (arrowhead in B, C, D). In addition, the perforating branches of the diagonal coronary artery (arrow in A, B, C) providing supplementary vascularization to the infarcted area can be easily seen.