CTICasesMicrovascular Obstruction Post-Myocardial Infarction
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Imaging findings
Cine imaging demonstrated dyskinesis or akinesis and thinning of the anteroseptal wall of the left ventricle, extending through the mid-ventricle to the apex, suggestive of a prior myocardial infarction. Delayed enhancement imaging showed a large region of hypoenhancement (appearing very dark or 'black') within the infarct zone, representing microvascular obstruction where contrast did not perfuse due to impaired microcirculation. Some surrounding delayed enhancement (scar) was also observed. There was also some pericardial enhancement.
Key takeaways
Microvascular obstruction is a significant finding post-myocardial infarction, characterized on delayed enhancement MRI by a dark, hypoenhanced region within the infarct zone. This indicates severe impairment of microvascular perfusion despite epicardial artery recanalization, is associated with larger infarcts, and can have prognostic implications. Recognizing this distinct pattern is crucial for accurate assessment of myocardial viability.
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