CTICasesMyocardial Infarction with Microvascular Obstruction (MVO)
Imaging findings
Non-contrast chest CT in a young hypertensive patient shows a large, focal myocardial perfusion defect involving the left ventricular apex, anterior wall, and septum. Cardiac MRI confirms severe hypokinesis/akinesis of the affected territory and demonstrates late gadolinium enhancement (LGE) with a central, non-enhancing "parfait" dark core of microvascular obstruction (MVO).
Key takeaways
Microvascular obstruction (MVO), or the "no-reflow" phenomenon, is characterized by persistent hypoperfusion of the core infarcted myocardium despite recanalization of the epicardial coronary artery. On cardiac MRI, MVO is identified as a dark, non-enhancing zone within an area of hyperenhancing late gadolinium enhancement, which is a strong independent predictor of adverse left ventricular remodeling, complications, and poor clinical prognosis.
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