Shrapnel in heart

Nov 15, 2006

The patient was injured by a mortar round that resulted in shrapnel becoming lodged in the heart. The 3D images were needed to determine exactly where the shrapnel lie to decide if intervention was needed.

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Representative images from diagnostic analysis of deep learning (DL)-based CT myocardial perfusion imaging (MPI). (A-D) Representative images in a 51-year-old woman with stable angina at presentation. (A) Curved planar reformation and (B) three-dimensional maximum intensity projection images show severe stenosis of the opening left anterior descending artery (arrow). (C) Fractional flow reserve (FFR) determined with invasive coronary angiography helps confirm that there was no hemodynamic significance of the opening left anterior descending artery lesion (arrow). (D) Dynamic CT MPI provided functional information to identify hemodynamically significant stenosis with reference to invasive FFR. Myocardial blood flow (MBF) derived from DL-based CT MPI revealed the absence of decreased myocardial perfusion of the left anterior descending artery territory (the areas outlined in black represent the myocardium subtended by the left anterior descending stenosis, and the color bar is a graphical scale that maps MBF ranges). (E-H) Representative images in a 62-year-old man with exertional chest pain at presentation. (E) Curved planar reformation and (F) three-dimensional maximum intensity projection images show moderate stenosis of the middle left anterior descending artery (arrow). (G) FFR determined at invasive coronary angiography helps confirm that the middle left anterior descending lesion was hemodynamically significant (arrow). (H) Dynamic CT MPI provided functional information to identify hemodynamically significant stenosis with reference to invasive FFR. DL-based CT MPI showed a reduction in MBF within the middle and basal anterior wall of the left anterior descending artery territory (the areas outlined in black represent the myocardium with decreased perfusion, and the color bar is a graphical scale that maps MBF ranges). MBFDL = MBF derived from the DL model.
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