CTICasesMyocardial Microvascular Obstruction
Imaging findings
Cardiac MRI in a patient post-myocardial infarction demonstrates severe hypokinesis and T2 hyperintensity (edema) in the anterior wall and apex. First-pass perfusion shows a large, persistent subendocardial perfusion defect, and late gadolinium enhancement (LGE) shows a central non-enhancing zone ('no-reflow' zone) surrounded by hyperenhancing infarcted myocardium, extending from the apex to the mid-ventricle.
Key takeaways
Microvascular obstruction (MVO), or the 'no-reflow' phenomenon, occurs when the coronary microvasculature is damaged during acute myocardial infarction and reperfusion therapy, preventing capillary flow despite patent epicardial vessels. On cardiac MRI, MVO is characterized by a central hypointense (non-enhancing) core within the hyperenhancing infarcted wall on first-pass and late enhancement sequences, carrying a poor prognosis for functional recovery.
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