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Abu-Omar A, Murray N, Ali IT, Khosa F, Barrett S, Sheikh A, Nicolaou S, Tamburrini S, Iacobellis F, Sica G, Granata V, Saba L, Masala S, Scaglione M. Utility of Dual-Energy Computed Tomography in Clinical Conundra. Diagnostics (Basel) 2024; 14:775. [PMID: 38611688 PMCID: PMC11012177 DOI: 10.3390/diagnostics14070775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Advancing medical technology revolutionizes our ability to diagnose various disease processes. Conventional Single-Energy Computed Tomography (SECT) has multiple inherent limitations for providing definite diagnoses in certain clinical contexts. Dual-Energy Computed Tomography (DECT) has been in use since 2006 and has constantly evolved providing various applications to assist radiologists in reaching certain diagnoses SECT is rather unable to identify. DECT may also complement the role of SECT by supporting radiologists to confidently make diagnoses in certain clinically challenging scenarios. In this review article, we briefly describe the principles of X-ray attenuation. We detail principles for DECT and describe multiple systems associated with this technology. We describe various DECT techniques and algorithms including virtual monoenergetic imaging (VMI), virtual non-contrast (VNC) imaging, Iodine quantification techniques including Iodine overlay map (IOM), and two- and three-material decomposition algorithms that can be utilized to demonstrate a multitude of pathologies. Lastly, we provide our readers commentary on examples pertaining to the practical implementation of DECT's diverse techniques in the Gastrointestinal, Genitourinary, Biliary, Musculoskeletal, and Neuroradiology systems.
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Affiliation(s)
- Ahmad Abu-Omar
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Nicolas Murray
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Ismail T. Ali
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Faisal Khosa
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Sarah Barrett
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Adnan Sheikh
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Savvas Nicolaou
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131 Naples, Italy;
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS Di Napoli, 80131 Naples, Italy
| | - Luca Saba
- Medical Oncology Department, AOU Cagliari, Policlinico Di Monserrato (CA), 09042 Monserrato, Italy
| | - Salvatore Masala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale S. Pietro, 07100 Sassari, Italy; (S.M.)
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale S. Pietro, 07100 Sassari, Italy; (S.M.)
- Department of Radiology, Pineta Grande Hospital, 81030 Castel Volturno, Italy
- Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK
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Cetin T, Kantarci M, Irgul B, Aydin S, Aydin F, Koseturk T, Levent A. Quadruple-Rule-Out Computed Tomography Angiography (QRO-CT): A Novel Dual-Energy Computed Tomography Technique for the Diagnostic Work-Up of Acute Chest Pain. Diagnostics (Basel) 2023; 13:2799. [PMID: 37685337 PMCID: PMC10486597 DOI: 10.3390/diagnostics13172799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/19/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Computerized tomography (CT) has been increasingly utilized in the differential diagnosis of acute chest pain. Combining the triple rule out CT angiography (TRO-CT) approach with dual-energy CT (DECT) can enhance the diagnostic capability by identifying myocardial perfusion deficiencies. This combination can yield a quadruple-rule-out computed tomography angiography (QRO-CT) technique. The aim of this study is to determine the efficacy of the QRO-CT. METHODS Intraluminal diseases and abnormalities in the main coronary arteries and branches were investigated. The myocardial dark spots on the color-coded iodine map were identified as perfusion deficiencies. Pulmonary arteries and aorta were also evaluated. RESULTS The study population consisted of 211 patients. The sensitivity, specificity, and positive and negative predictive values of QRO-CT for pulmonary embolism were 93.5%, 100%, 100%, and 95.3%, respectively. For obstructive coronary artery disease, the values were 96.1%, 93.4%, 89.2%, and 97.7%, respectively. For myocarditis, the values were 69.2%, 100%, 100%, and 93.6%, respectively. CONCLUSIONS the QRO-CT method may successfully evaluate myocardial perfusion deficits, hence expanding the differential diagnosis capabilities of the standard TRO-CT method for myocarditis. It can provide useful information on myocardial perfusion, which may influence the choice to perform invasive catheterization in cases of coronary artery obstruction.
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Affiliation(s)
- Turkhun Cetin
- Department of Radiology, Erzincan Binali Yidirim University, Erzincan 24100, Turkey; (T.C.); (S.A.); (A.L.)
| | - Mecit Kantarci
- Department of Radiology, Ataturk University, Erzurum 25100, Turkey; (M.K.); (F.A.)
| | - Baris Irgul
- Department of Radiology, Erzincan Binali Yidirim University, Erzincan 24100, Turkey; (T.C.); (S.A.); (A.L.)
| | - Sonay Aydin
- Department of Radiology, Erzincan Binali Yidirim University, Erzincan 24100, Turkey; (T.C.); (S.A.); (A.L.)
| | - Fahri Aydin
- Department of Radiology, Ataturk University, Erzurum 25100, Turkey; (M.K.); (F.A.)
| | - Taner Koseturk
- Department of Anatomy, Erzincan Binali Yidirim University, Erzincan 24100, Turkey;
| | - Akin Levent
- Department of Radiology, Erzincan Binali Yidirim University, Erzincan 24100, Turkey; (T.C.); (S.A.); (A.L.)
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Dell’Aversana S, Ascione R, De Giorgi M, De Lucia DR, Cuocolo R, Boccalatte M, Sibilio G, Napolitano G, Muscogiuri G, Sironi S, Di Costanzo G, Cavaglià E, Imbriaco M, Ponsiglione A. Dual-Energy CT of the Heart: A Review. J Imaging 2022; 8:jimaging8090236. [PMID: 36135402 PMCID: PMC9503750 DOI: 10.3390/jimaging8090236] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022] Open
Abstract
Dual-energy computed tomography (DECT) represents an emerging imaging technique which consists of the acquisition of two separate datasets utilizing two different X-ray spectra energies. Several cardiac DECT applications have been assessed, such as virtual monoenergetic images, virtual non-contrast reconstructions, and iodine myocardial perfusion maps, which are demonstrated to improve diagnostic accuracy and image quality while reducing both radiation and contrast media administration. This review will summarize the technical basis of DECT and review the principal cardiac applications currently adopted in clinical practice, exploring possible future applications.
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Affiliation(s)
- Serena Dell’Aversana
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
- Correspondence:
| | - Raffaele Ascione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Marco De Giorgi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Davide Raffaele De Lucia
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Marco Boccalatte
- Coronary Care Unit, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Gerolamo Sibilio
- Coronary Care Unit, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | | | - Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy
| | - Sandro Sironi
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy
| | - Giuseppe Di Costanzo
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Enrico Cavaglià
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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Baehr A, Umansky KB, Bassat E, Jurisch V, Klett K, Bozoglu T, Hornaschewitz N, Solyanik O, Kain D, Ferraro B, Cohen-Rabi R, Krane M, Cyran C, Soehnlein O, Laugwitz KL, Hinkel R, Kupatt C, Tzahor E. Agrin Promotes Coordinated Therapeutic Processes Leading to Improved Cardiac Repair in Pigs. Circulation 2020; 142:868-881. [PMID: 32508131 DOI: 10.1161/circulationaha.119.045116] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ischemic heart diseases are leading causes of death and reduced life quality worldwide. Although revascularization strategies significantly reduce mortality after acute myocardial infarction (MI), a large number of patients with MI develop chronic heart failure over time. We previously reported that a fragment of the extracellular matrix protein agrin promotes cardiac regeneration after MI in adult mice. METHODS To test the therapeutic potential of agrin in a preclinical porcine model, we performed ischemia-reperfusion injuries using balloon occlusion for 60 minutes followed by a 3-, 7-, or 28-day reperfusion period. RESULTS We demonstrated that local (antegrade) delivery of recombinant human agrin to the infarcted pig heart can target the affected regions in an efficient and clinically relevant manner. A single dose of recombinant human agrin improved heart function, infarct size, fibrosis, and adverse remodeling parameters 28 days after MI. Short-term MI experiments along with complementary murine studies revealed myocardial protection, improved angiogenesis, inflammatory suppression, and cell cycle reentry as agrin's mechanisms of action. CONCLUSIONS A single dose of agrin is capable of reducing ischemia-reperfusion injury and improving heart function, demonstrating that agrin could serve as a therapy for patients with acute MI and potentially heart failure.
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Affiliation(s)
- Andrea Baehr
- I Medizinische Klinik & Poliklinik, University Clinic Rechts der Isar, Technical University Munich, Germany (A.B., V.J., K.K., T.B., N.H., K.L.L., R.H., C.K.).,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany (A.B., V.J., K.K., T.B., N.H., B.F., O.S., K.L.L., R.H., C.K.)
| | - Kfir Baruch Umansky
- The Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel (K.B.U., E.B., D.K., R.C.-R., E.T.)
| | - Elad Bassat
- The Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel (K.B.U., E.B., D.K., R.C.-R., E.T.)
| | - Victoria Jurisch
- I Medizinische Klinik & Poliklinik, University Clinic Rechts der Isar, Technical University Munich, Germany (A.B., V.J., K.K., T.B., N.H., K.L.L., R.H., C.K.).,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany (A.B., V.J., K.K., T.B., N.H., B.F., O.S., K.L.L., R.H., C.K.)
| | - Katharina Klett
- I Medizinische Klinik & Poliklinik, University Clinic Rechts der Isar, Technical University Munich, Germany (A.B., V.J., K.K., T.B., N.H., K.L.L., R.H., C.K.).,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany (A.B., V.J., K.K., T.B., N.H., B.F., O.S., K.L.L., R.H., C.K.)
| | - Tarik Bozoglu
- I Medizinische Klinik & Poliklinik, University Clinic Rechts der Isar, Technical University Munich, Germany (A.B., V.J., K.K., T.B., N.H., K.L.L., R.H., C.K.).,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany (A.B., V.J., K.K., T.B., N.H., B.F., O.S., K.L.L., R.H., C.K.)
| | - Nadja Hornaschewitz
- I Medizinische Klinik & Poliklinik, University Clinic Rechts der Isar, Technical University Munich, Germany (A.B., V.J., K.K., T.B., N.H., K.L.L., R.H., C.K.).,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany (A.B., V.J., K.K., T.B., N.H., B.F., O.S., K.L.L., R.H., C.K.)
| | - Olga Solyanik
- Department of Radiology, Klinikum Großhadern (O.S., C.C.), LMU Munich, Germany
| | - David Kain
- The Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel (K.B.U., E.B., D.K., R.C.-R., E.T.)
| | - Bartolo Ferraro
- Institute for Cardiovascular Prevention (B.F., O.S.), LMU Munich, Germany
| | - Renee Cohen-Rabi
- The Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel (K.B.U., E.B., D.K., R.C.-R., E.T.)
| | - Markus Krane
- Department of Surgery, German Heart Center Munich, Germany (M.K.)
| | - Clemens Cyran
- Department of Radiology, Klinikum Großhadern (O.S., C.C.), LMU Munich, Germany
| | - Oliver Soehnlein
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany (A.B., V.J., K.K., T.B., N.H., B.F., O.S., K.L.L., R.H., C.K.).,Institute for Cardiovascular Prevention (B.F., O.S.), LMU Munich, Germany
| | - Karl Ludwig Laugwitz
- I Medizinische Klinik & Poliklinik, University Clinic Rechts der Isar, Technical University Munich, Germany (A.B., V.J., K.K., T.B., N.H., K.L.L., R.H., C.K.).,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany (A.B., V.J., K.K., T.B., N.H., B.F., O.S., K.L.L., R.H., C.K.)
| | - Rabea Hinkel
- I Medizinische Klinik & Poliklinik, University Clinic Rechts der Isar, Technical University Munich, Germany (A.B., V.J., K.K., T.B., N.H., K.L.L., R.H., C.K.).,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany (A.B., V.J., K.K., T.B., N.H., B.F., O.S., K.L.L., R.H., C.K.).,Department of Laboratory Animal Science, Deutsches Primatenzentrum GmbH, Leibniz-Institut für Primatenforschung, Göttingen, Germany (R.H.)
| | - Christian Kupatt
- I Medizinische Klinik & Poliklinik, University Clinic Rechts der Isar, Technical University Munich, Germany (A.B., V.J., K.K., T.B., N.H., K.L.L., R.H., C.K.).,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany (A.B., V.J., K.K., T.B., N.H., B.F., O.S., K.L.L., R.H., C.K.)
| | - Eldad Tzahor
- The Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel (K.B.U., E.B., D.K., R.C.-R., E.T.)
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Ko SM, Kim TH, Chun EJ, Kim JY, Hwang SH. Assessment of Left Ventricular Myocardial Diseases with Cardiac Computed Tomography. Korean J Radiol 2019; 20:333-351. [PMID: 30799565 PMCID: PMC6389818 DOI: 10.3348/kjr.2018.0280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/03/2018] [Indexed: 01/09/2023] Open
Abstract
Rapid advances in cardiac computed tomography (CT) have enabled the characterization of left ventricular (LV) myocardial diseases based on LV anatomical morphology, function, density, and enhancement pattern. Global LV function and regional wall motion can be evaluated using multi-phasic cine CT images. CT myocardial perfusion imaging facilitates the identification of hemodynamically significant coronary artery disease. CT delayed-enhancement imaging is used to detect myocardial scar in myocardial infarction and to measure the extracellular volume fraction in non-ischemic cardiomyopathy. Multi-energy cardiac CT allows the mapping of iodine distribution in the myocardium. This review summarizes the current techniques of cardiac CT for LV myocardial assessment, highlights the key findings in various myocardial diseases, and presents future applications to complement echocardiography and cardiovascular magnetic resonance.
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Affiliation(s)
- Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
| | - Tae Hoon Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Young Kim
- Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
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Mukai-Yatagai N, Ohta Y, Amisaki R, Sasaki N, Akasaka T, Watanabe T, Kishimoto J, Kato M, Ogawa T, Yamamoto K. Myocardial delayed enhancement on dual-energy computed tomography: The prevalence and related factors in patients with suspicion of coronary artery disease. J Cardiol 2019; 75:302-308. [PMID: 31500962 DOI: 10.1016/j.jjcc.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/17/2019] [Accepted: 08/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND We aimed to assess the prevalence of myocardial delayed enhancement (MDE) in patients with suspected obstructive coronary artery disease (CAD), and to investigate factors related to the presence or absence of MDE. METHODS We retrospectively evaluated 191 consecutive patients who underwent coronary computed tomography angiography (CCTA) with MDE imaging for clinical suspicion of CAD from December 2014 to December 2016. The presence of MDE on iodine-density images using dual-energy CT was assessed by two independent readers. Multivariable logistic regression analyses were used to determine factors associated with the presence of MDE. RESULTS MDE was detected in 58 (30%) patients. Male gender, hypertension, prior heart failure (HF) hospitalization, and CCTA-detected CAD were independent factors related to the presence of MDE. When CCTA-detected CAD was excluded to narrow down the analysis to factors obtainable before CCTA, interventricular septum thickness (IVST) ≥12 mm was added as another independent factor. The combination of the following four factors: female gender, no history of hypertension, no history of prior HF hospitalization, and IVST < 12 mm demonstrated high specificity (98.3%) and positive predictive value (96.2%) for predicting the absence of MDE. CONCLUSIONS Male gender, hypertension, prior HF hospitalization, and CAD were independently associated with the presence of MDE in patients with suspected CAD. The combination of female gender, no history of hypertension, no history of prior HF hospitalization, and IVST < 12 mm is likely to be a helpful predictor in discriminating patients without MDE before CCTA.
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Affiliation(s)
- Natsuko Mukai-Yatagai
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan.
| | - Yasutoshi Ohta
- Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ryosuke Amisaki
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Naoko Sasaki
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Toshihiko Akasaka
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Tomomi Watanabe
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Junichi Kishimoto
- Department of Clinical Radiology, Tottori University Hospital, Yonago, Japan
| | - Masahiko Kato
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Toshihide Ogawa
- Division of Radiology, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
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Ohta Y, Kitao S, Yunaga H, Watanabe T, Mukai—Yatagai N, Kishimoto J, Yamamoto K, Ogawa T. Quantitative evaluation of non-ischemic dilated cardiomyopathy by late iodine enhancement using rapid kV switching dual-energy computed tomography: A feasibility study. J Cardiovasc Comput Tomogr 2019; 13:148-156. [DOI: 10.1016/j.jcct.2018.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/03/2018] [Accepted: 10/26/2018] [Indexed: 10/28/2022]
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Ohta Y, Kitao S, Yunaga H, Fujii S, Mukai N, Yamamoto K, Ogawa T. Myocardial Delayed Enhancement CT for the Evaluation of Heart Failure: Comparison to MRI. Radiology 2018; 288:682-691. [PMID: 29989514 DOI: 10.1148/radiol.2018172523] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To assess the diagnostic performance of dual-energy CT with myocardial delayed enhancement (MDE) in the detection and classification of myocardial scar in patients with heart failure, with late gadolinium enhancement (LGE) MRI as the standard of reference. Materials and Methods MDE CT and LGE MRI were performed in 44 patients with heart failure (30 men; mean patient age, 66 years ± 14) between 2013 and 2016, and images were retrospectively analyzed. The presence and patterns of MDE on iodine-density and virtual monochromatic (VM) images were assessed by two independent readers. Contrast-to-noise ratio (CNR) and percentage signal intensity increase relative to normal myocardium were measured. Diagnostic performance and area under the receiver operating characteristic curve for MDE CT and kappa values for reader agreement were determined. Results Thirty-five of the 44 patients (80%) demonstrated a focal area of LGE, with a nonischemic pattern in 22 of the 44 patients (50%) and an ischemic pattern in 13 (30%). Iodine-density images demonstrated the highest CNR and percentage signal intensity increase on CT images (P < .05), resulting in the highest diagnostic performance in the detection of any MDE CT abnormality (92% sensitivity [195 of 213 segments] and 98% specificity [481 of 491 segments]). The areas under the receiver operating characteristic curve for iodine-density images and 40-keV VM images in the detection of MDE were 0.97 and 0.95, respectively (P < .001). Kappa values for reader agreement were 0.82 for iodine-density images and 0.72 for 40-keV VM images. Conclusion Myocardial delayed enhancement CT enables accurate detection and localization of scar in patients with heart failure when compared with late gadolinium enhancement MRI, the reference standard.
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Affiliation(s)
- Yasutoshi Ohta
- From the Division of Radiology, Department of Pathophysiological and Therapeutic Science (Y.O., S.K., H.Y., S.F., T.O.), and Division of Molecular Medicine and Therapeutics, Department of Multidisciplinary Internal Medicine (N.M., K.Y.), Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Shinichiro Kitao
- From the Division of Radiology, Department of Pathophysiological and Therapeutic Science (Y.O., S.K., H.Y., S.F., T.O.), and Division of Molecular Medicine and Therapeutics, Department of Multidisciplinary Internal Medicine (N.M., K.Y.), Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Hiroto Yunaga
- From the Division of Radiology, Department of Pathophysiological and Therapeutic Science (Y.O., S.K., H.Y., S.F., T.O.), and Division of Molecular Medicine and Therapeutics, Department of Multidisciplinary Internal Medicine (N.M., K.Y.), Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Shinya Fujii
- From the Division of Radiology, Department of Pathophysiological and Therapeutic Science (Y.O., S.K., H.Y., S.F., T.O.), and Division of Molecular Medicine and Therapeutics, Department of Multidisciplinary Internal Medicine (N.M., K.Y.), Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Natsuko Mukai
- From the Division of Radiology, Department of Pathophysiological and Therapeutic Science (Y.O., S.K., H.Y., S.F., T.O.), and Division of Molecular Medicine and Therapeutics, Department of Multidisciplinary Internal Medicine (N.M., K.Y.), Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Kazuhiro Yamamoto
- From the Division of Radiology, Department of Pathophysiological and Therapeutic Science (Y.O., S.K., H.Y., S.F., T.O.), and Division of Molecular Medicine and Therapeutics, Department of Multidisciplinary Internal Medicine (N.M., K.Y.), Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Toshihide Ogawa
- From the Division of Radiology, Department of Pathophysiological and Therapeutic Science (Y.O., S.K., H.Y., S.F., T.O.), and Division of Molecular Medicine and Therapeutics, Department of Multidisciplinary Internal Medicine (N.M., K.Y.), Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
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Albrecht MH, De Cecco CN, Schoepf UJ, Spandorfer A, Eid M, De Santis D, Varga-Szemes A, van Assen M, von Knebel-Doeberitz PL, Tesche C, Puntmann VO, Nagel E, Vogl TJ, Nance JW. Dual-energy CT of the heart current and future status. Eur J Radiol 2018; 105:110-118. [PMID: 30017266 DOI: 10.1016/j.ejrad.2018.05.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 05/17/2018] [Accepted: 05/29/2018] [Indexed: 11/19/2022]
Abstract
Several applications utilizing dual-energy cardiac CT (DECT) have recently transitioned from the realm of research into clinical workflows. DECT acquisition techniques and subsequent post-processing can provide improved qualitative analysis, allow quantitative imaging, and have the potential to decrease requisite radiation and contrast material doses. Additionally, several experimental DECT techniques are pending further investigation and may improve the diagnostic accuracy of cardiac CT and/or provide evaluation of emerging imaging biomarkers in the future. This review article will summarize the major applications utilizing DECT in diagnosis of cardiovascular disease, including both the clinically used and investigational techniques examined to date.
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Affiliation(s)
- Moritz H Albrecht
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States; University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt, Germany.
| | - Carlo N De Cecco
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States.
| | - U Joseph Schoepf
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States.
| | - Adam Spandorfer
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States.
| | - Marwen Eid
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States.
| | - Domenico De Santis
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States; University of Rome "Sapienza", Department of Radiological Sciences, Oncological and Pathological Sciences, Latina, Italy.
| | - Akos Varga-Szemes
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States.
| | - Marly van Assen
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States; University Medical Center Groningen, Center for Medical Imaging, Department of Radiology, Groningen, The Netherlands.
| | - Philipp L von Knebel-Doeberitz
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States.
| | - Christian Tesche
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States; Heart Center Munich-Bogenhausen, Department of Cardiology and Intensive Care Medicine, Munich, Germany.
| | - Valentina O Puntmann
- University Hospital Frankfurt, Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Frankfurt, Germany.
| | - Eike Nagel
- University Hospital Frankfurt, Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Frankfurt, Germany.
| | - Thomas J Vogl
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt, Germany.
| | - John W Nance
- Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, United States.
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Sun K, Han R, Zhao R, Bai S, Wang J, Hu J, Lu B. Evaluation of dual energy computed tomography iodine mapping within the myocardial blood pool for detection of acute myocardial infarction: correlation with histopathological findings in a porcine model. Br J Radiol 2018; 91:20170569. [PMID: 29688745 DOI: 10.1259/bjr.20170569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We assessed the diagnostic value of "one-step" dual energy CT (DECT) in combination with coronary CT angiography and iodine mapping within the myocardial blood pool in detecting acute myocardial infarction (AMI). METHODS Five minipigs were subjected to transcatheter embolization of coronary artery with a gelatin sponge to induce AMI. Arterial-phase myocardial DECT imaging was carried out 1 h before and 24 h after embolism of the coronary. Color-coded iodine maps were used to evaluate myocardial blood pool deficits in the 17-segment model. Myocardial DECT imaging 24 h after MI induction was used for final comparison with post-mortem histology. RESULTS We found a sensitivity of 95.55% and a specificity of 95%, respectively, for AMI detection by DECT-based iodine mapping within the myocardial blood pool. The dose-length product values were 219.4 ± 60.9 mGy.cm (172-321 mGy.cm) and the effective radiation dose was 5.7 ± 1.5 mSv (4.4-8.3 mSv). CONCLUSION This experimental study demonstrated that DECT-based iodine mapping shows a high value for the detection of myocardial perfusion defects in the first-pass myocardial perfusion. Hybrid heart images obtained by coronary CT angiography and DECT-based iodine mapping may yield valuable data and help clinicians accurately identify cases requiring further treatment after AMI. Advances in knowledge: This study demonstrated that DECT-based iodine mapping is a promising new technique for the detection of myocardial perfusion defects in the first-pass myocardial perfusion.
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Affiliation(s)
- Kai Sun
- 1 Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China.,2 Department of Radiology, Baotou Central Hospital, Inner Mongolia , Baotou , China
| | - Ruijuan Han
- 3 Translational Medicine Research Center, Baotou Central Hospital, Inner Mongolia , Baotou , China
| | - Ruiping Zhao
- 3 Translational Medicine Research Center, Baotou Central Hospital, Inner Mongolia , Baotou , China
| | - Shuancheng Bai
- 2 Department of Radiology, Baotou Central Hospital, Inner Mongolia , Baotou , China
| | - Junyan Wang
- 2 Department of Radiology, Baotou Central Hospital, Inner Mongolia , Baotou , China
| | - Jiang Hu
- 3 Translational Medicine Research Center, Baotou Central Hospital, Inner Mongolia , Baotou , China
| | - Bin Lu
- 1 Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
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Kalisz K, Halliburton S, Abbara S, Leipsic JA, Albrecht MH, Schoepf UJ, Rajiah P. Update on Cardiovascular Applications of Multienergy CT. Radiographics 2017; 37:1955-1974. [DOI: 10.1148/rg.2017170100] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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12
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Kishimoto J, Ohta Y, Kitao S, Watanabe T, Ogawa T. Image quality improvements using adaptive statistical iterative reconstruction for evaluating chronic myocardial infarction using iodine density images with spectral CT. Int J Cardiovasc Imaging 2017; 34:633-639. [DOI: 10.1007/s10554-017-1258-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/10/2017] [Indexed: 11/28/2022]
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Abstract
Cardiac computed tomography (CT) is increasingly used in the evaluation of cardiomyopathies, particularly in patients who are not able to undergo other non-invasive imaging tests such as magnetic resonance imaging (MRI) due to the presence of MRI-incompatible pacemakers/defibrillators or other contraindications or due to extensive artifacts from indwelling metallic devices. Advances in scanner technology enable acquisition of CT images with high spatial resolution, good temporal resolution, wide field of view and multi-planar reconstruction capabilities. CT is useful in cardiomyopathies in several ways, particularly in the evaluation of coronary arteries, characterization of cardiomyopathy phenotype, quantification of cardiac volumes and function, treatment-planning, and post-treatment evaluation. In this article, we review the imaging techniques and specific applications of CT in the evaluation of cardiomyopathies.
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Affiliation(s)
- Kevin Kalisz
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Prabhakar Rajiah
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, Texas, USA
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14
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Tanabe Y, Kido T, Kurata A, Kouchi T, Fukuyama N, Yokoi T, Uetani T, Yamashita N, Miyagawa M, Mochizuki T. Late iodine enhancement computed tomography with image subtraction for assessment of myocardial infarction. Eur Radiol 2017; 28:1285-1292. [DOI: 10.1007/s00330-017-5048-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/02/2017] [Accepted: 08/22/2017] [Indexed: 01/22/2023]
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15
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Cardiac Dual-Energy CT Applications and Clinical Impact. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0237-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Ha SJ, Jang Y, Lee BK, Cho IJ, Shim CY, Hong GR, Chung N, Chang HJ. Assessment of myocardial viability based on dual-energy computed tomography in patients with chronic myocardial infarction: comparison with magnetic resonance imaging. Clin Imaging 2017; 46:8-13. [PMID: 28672224 DOI: 10.1016/j.clinimag.2017.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/12/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of dual-energy computed tomography (DECT) for the assessment of myocardial viability compared with magnetic resonance imaging (MRI) in patients with chronic myocardial infarction (CMI). METHODS AND MATERIAL Twenty-six patients were prospectively enrolled, who underwent DECT and MRI at delayed phase. The infarct volumes for DECT and MRI were measured. RESULTS In per-segment and per-vessel analysis, DECT showed excellent diagnostic performance compared with MRI (diagnostic accuracy: 86.2%, 81.2% respectively). In volume analysis, DECT correlated well with MRI (r=0.966, p<0.0001). CONCLUSIONS DECT has excellent diagnostic performance for detecting CMI.
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Affiliation(s)
- Sang Jin Ha
- Division of Cardiology, Departmet of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Yeonggul Jang
- Brain Korea 21 Project for Medical Science Yonsei University, Republic of Korea; Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Kwon Lee
- Department of Internal Medicine, Yonsei University Gangnam Severance Hospital, Seoul, Republic of Korea
| | - In-Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Republic of Korea
| | - Chi Young Shim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Republic of Korea
| | - Geu-Ru Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Republic of Korea
| | - Namsik Chung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Republic of Korea
| | - Hyuk-Jae Chang
- Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Republic of Korea.
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17
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Impact of knowledge-based iterative model reconstruction on myocardial late iodine enhancement in computed tomography and comparison with cardiac magnetic resonance. Int J Cardiovasc Imaging 2017; 33:1609-1618. [DOI: 10.1007/s10554-017-1137-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/08/2017] [Indexed: 01/08/2023]
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18
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Rodriguez-Granillo GA. Delayed enhancement cardiac computed tomography for the assessment of myocardial infarction: from bench to bedside. Cardiovasc Diagn Ther 2017; 7:159-170. [PMID: 28540211 DOI: 10.21037/cdt.2017.03.16] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A large number of studies support the increasingly relevant prognostic value of the presence and extent of delayed enhancement (DE), a surrogate marker of fibrosis, in diverse etiologies. Gadolinium and iodinated based contrast agents share similar kinetics, thus leading to comparable myocardial characterization with cardiac magnetic resonance (CMR) and cardiac computed tomography (CT) at both first-pass perfusion and DE imaging. We review the available evidence of DE imaging for the assessment of myocardial infarction (MI) using cardiac CT (CTDE), from animal to clinical studies, and from 16-slice CT to dual-energy CT systems (DECT). Although both CMR and gadolinium agents have been originally deemed innocuous, a number of concerns (though inconclusive and very rare) have been recently issued regarding safety issues, including DNA double-strand breaks related to CMR, and gadolinium-associated nephrogenic systemic fibrosis and deposition in the skin and certain brain structures. These concerns have to be considered in the context of non-negligible rates of claustrophobia, increasing rates of patients with implantable cardiac devices, and a number of logistic drawbacks compared with CTDE, such as higher costs, longer scanning times, and difficulties to scan patients with impaired breath-holding capabilities. Overall, these issues might encourage the role of CTDE as an alternative for DE-CMR in selected populations.
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Dual-contrast agent photon-counting computed tomography of the heart: initial experience. Int J Cardiovasc Imaging 2017; 33:1253-1261. [DOI: 10.1007/s10554-017-1104-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 02/25/2017] [Indexed: 11/25/2022]
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20
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Sandfort V, Palanisamy S, Symons R, Pourmorteza A, Ahlman MA, Rice K, Thomas T, Davies-Venn C, Krauss B, Kwan A, Pandey A, Zimmerman SL, Bluemke DA. Optimized energy of spectral CT for infarct imaging: Experimental validation with human validation. J Cardiovasc Comput Tomogr 2017; 11:171-178. [PMID: 28229910 DOI: 10.1016/j.jcct.2017.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/03/2017] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Late contrast enhancement visualizes myocardial infarction, but the contrast to noise ratio (CNR) is low using conventional CT. The aim of this study was to determine if spectral CT can improve imaging of myocardial infarction. MATERIALS AND METHODS A canine model of myocardial infarction was produced in 8 animals (90-min occlusion, reperfusion). Later, imaging was performed after contrast injection using CT at 90 kVp/150 kVpSn. The following reconstructions were evaluated: Single energy 90 kVp, mixed, iodine map, multiple monoenergetic conventional and monoenergetic noise optimized reconstructions. Regions of interest were measured in infarct and remote regions to calculate contrast to noise ratio (CNR) and Bhattacharya distance (a metric of the differentiation between regions). Blinded assessment of image quality was performed. The same reconstruction methods were applied to CT scans of four patients with known infarcts. RESULTS For animal studies, the highest CNR for infarct vs. myocardium was achieved in the lowest keV (40 keV) VMo images (CNR 4.42, IQR 3.64-5.53), which was superior to 90 kVp, mixed and iodine map (p = 0.008, p = 0.002, p < 0.001, respectively). Compared to 90 kVp and iodine map, the 40 keV VMo reconstructions showed significantly higher histogram separation (p = 0.042 and p < 0.0001, respectively). The VMo reconstructions showed the highest rate of excellent quality scores. A similar pattern was seen in human studies, with CNRs for infarct maximized at the lowest keV optimized reconstruction (CNR 4.44, IQR 2.86-5.94). CONCLUSIONS Dual energy in conjunction with noise-optimized monoenergetic post-processing improves CNR of myocardial infarct delineation by approximately 20-25%.
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Affiliation(s)
- Veit Sandfort
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Srikanth Palanisamy
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Rolf Symons
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Amir Pourmorteza
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Mark A Ahlman
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Kelly Rice
- ORS Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, USA
| | - Tom Thomas
- ORS Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, USA
| | - Cynthia Davies-Venn
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | | | - Alan Kwan
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | - David A Bluemke
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA.
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21
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White Paper of the Society of Computed Body Tomography and Magnetic Resonance on Dual-Energy CT, Part 3. J Comput Assist Tomogr 2017; 41:1-7. [DOI: 10.1097/rct.0000000000000538] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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22
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Rijnierse MT, Allaart CP, Knaapen P. Principles and techniques of imaging in identifying the substrate of ventricular arrhythmia. J Nucl Cardiol 2016; 23:218-34. [PMID: 26667814 PMCID: PMC4785206 DOI: 10.1007/s12350-015-0344-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 11/10/2015] [Indexed: 01/26/2023]
Abstract
Life-threatening ventricular arrhythmias (VA) are a major cause of death in patients with cardiomyopathy. To date, impaired left ventricular ejection fraction remains the primary criterion for implantable cardioverter-defibrillator therapy to prevent sudden cardiac death. In recent years, however, advanced imaging techniques such as nuclear imaging, cardiac magnetic resonance imaging, and computed tomography have allowed for a more detailed evaluation of the underlying substrate of VA. These imaging modalities have emerged as a promising approach to assess the risk of sudden cardiac death. In addition, non-invasive identification of the critical sites of arrhythmias may guide ablation therapy. Typical anatomical substrates that can be evaluated by multiple advanced imaging techniques include perfusion abnormalities, scar and its border zone, and sympathetic denervation. Understanding the principles and techniques of different imaging modalities is essential to gain more insight in their role in identifying the arrhythmic substrate. The current review describes the principles of currently available imaging techniques to identify the substrate of VA.
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Affiliation(s)
- Mischa T Rijnierse
- Department of Cardiology and Institute for Cardiovascular Research (IcaR-VU), VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology and Institute for Cardiovascular Research (IcaR-VU), VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology and Institute for Cardiovascular Research (IcaR-VU), VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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Saeed M, Bajwa HZ, Do L, Hetts SW, Wilson MW. Multi-detector CT and MRI of microembolized myocardial infarct: monitoring of left ventricular function, perfusion, and myocardial viability in a swine model. Acta Radiol 2016; 57:215-24. [PMID: 25735621 DOI: 10.1177/0284185115574737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 01/31/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patients with acute myocardial infarct (MI) show additional damage after coronary interventions. PURPOSE To longitudinally quantify structural and functional changes in the left ventricle (LV) subjected to microembolized MI using multidisciplinary computed tomography (MDCT) and independent reference methods. MATERIAL AND METHODS Swine (n = 20) served as controls (group I) or were subjected to a combination of coronary occlusion, microembolization, and reperfusion and imaged at 3 days (group II) or 3 days and 5 weeks (group III). LV volumes, perfusion, and MI mass were quantified on cine, perfusion, and delayed contrast enhancement (DE) MDCT. MRI, cardiac injury biomarkers, histochemical and histopathologic stains were used as independent references. RESULTS MDCT showed a reduction in ejection fraction and increased end systolic volume (31 ± 2% and 82 ± 3 mL, respectively) of group III compared with I (48 ± 2% and 57 ± 1 mL, respectively). It also demonstrated perfusion deficits in microembolized MI and peri-infarcts. DE-MDCT delineated microvascular obstruction (MVO) zones embedded in acute microembolized MI and microinfarct specks resulting from persistent MVO by deposited microemboli in microvessels of peri-infarct zone. Bland-Altman test showed close agreements between the extents of microembolized MI measured on DE-MDCT, DE-MRI, and histochemical TTC staining, but not between these modalities and microscopy. MI resorption was evident between 3 days and 5 weeks (13.4 ± 0.5 g and 9.8 ± 0.5 g, P < 0.017) and histologic examination revealed incomplete healing. Injury biomarkers were increased after intervention. CONCLUSION MDCT can longitudinally quantify regional perfusion deficits, LV dysfunction, and resorption of microembolized MI. MDCT or MRI can be used alternatively after coronary interventions in cases of contraindications for one modality or the other.
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Affiliation(s)
- Maythem Saeed
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, California, USA
| | - Hisham Z Bajwa
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, California, USA
| | - Loi Do
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, California, USA
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, California, USA
| | - Mark W Wilson
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, California, USA
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Diagnostic accuracy of late iodine enhancement on cardiac computed tomography with a denoise filter for the evaluation of myocardial infarction. Int J Cardiovasc Imaging 2015. [DOI: 10.1007/s10554-015-0716-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Jang Y, Cho I, Hartaigh BWÓ, Park SI, Hong Y, Shin S, Ha S, Jeon B, Jung H, Shim H, Min JK, Chang HJ, Jang Y, Chung N. Viability assessment after conventional coronary angiography using a novel cardiovascular interventional therapeutic CT system: Comparison with gross morphology in a subacute infarct swine model. J Cardiovasc Comput Tomogr 2015; 9:321-328. [PMID: 26088379 DOI: 10.1016/j.jcct.2015.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 03/30/2015] [Accepted: 04/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Given the lack of promptness and inevitable use of additional contrast agents, the myocardial viability imaging procedures have not been used widely for determining the need to performing revascularization. OBJECTIVE This study is aimed to evaluate the feasibility of myocardial viability assessment, consecutively with diagnostic invasive coronary angiography (ICA) without use of additional contrast agent, using a novel hybrid system comprising ICA and multislice CT (MSCT). METHODS In all, 14 Yucatan miniature swine models (female; age, 3 months; weight, 28-30 kg) were subjected to ICA followed by balloon occlusion (90 minutes) and reperfusion of the left anterior descending coronary artery. Two weeks after induction of myocardial infarction, delayed hyperenhancement (DHE) images were obtained, using a novel combined machine comprising ICA and 320-channel MSCT scanner (Aquilion ONE, Toshiba), after 2, 5, 7, 10, 15, and 20 minutes after conventional ICA. The heart was sliced in 10-mm consecutive sections in the short-axis plane and was embedded in a solution of 1% triphenyltetrazolium chloride (TTC). Infarct size was determined as TTC-negative areas as a percentage of total left ventricular area. On MSCT images, infarct size per slice was calculated by dividing the DHE area by the total slice area (%) and compared with histochemical analyses. RESULTS Serial MSCT scans revealed a peak CT attenuation of the infarct area (222.5 ± 36.5 Hounsfield units) with a maximum mean difference in CT attenuation between the infarct areas and normal myocardium of at 2 minutes after contrast injection (106.4; P for difference = 0.002). Furthermore, the percentage difference of infarct size by MSCT vs histopathologic specimen was significantly lower at 2 (8.5% ± 1.8%) and 5 minutes (9.5% ± 1.9%) than those after 7 minutes. Direct comparisons of slice-matched DHE area by MSCT demonstrated excellent correlation with TTC-derived infarct size (r = 0.952; P < .001). Bland-Altman plots of the differences between DHE by MSCT and TTC-derived infarct measurements plotted against their means showed good agreement between the 2 methods. CONCLUSION The feasibility of myocardial viability assessment by DHE using MSCT after conventional ICA was proven in experimental models, and the optimal viability images were obtained after 2 to 5 minutes after the final intracoronary injection of contrast agent for conventional ICA.
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Affiliation(s)
- Yeonggul Jang
- Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, Korea
| | - Iksung Cho
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Korea
| | - Bríain W Ó Hartaigh
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.,Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, Adler Geriatric Center, New Haven, CT, USA
| | - Se-Il Park
- Cardiovascular Product Evaluation Center, Yonsei University College of Medicine, Seoul, Korea
| | - Youngtaek Hong
- Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, Korea
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Korea
| | - Seongmin Ha
- Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, Korea
| | - Byunghwan Jeon
- Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, Korea
| | - Hoyup Jung
- Department of Computer Science and Engineering, Hankuk University of Foreign Studies, Kyonggi, 449-791, Korea
| | - Hackjoon Shim
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Korea
| | - Namsik Chung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Truong QA, Thai WE, Wai B, Cordaro K, Cheng T, Beaudoin J, Xiong G, Cheung JW, Altman R, Min JK, Singh JP, Barrett CD, Danik S. Myocardial scar imaging by standard single-energy and dual-energy late enhancement CT: Comparison with pathology and electroanatomic map in an experimental chronic infarct porcine model. J Cardiovasc Comput Tomogr 2015; 9:313-20. [PMID: 25977115 DOI: 10.1016/j.jcct.2015.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 02/27/2015] [Accepted: 03/16/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Myocardial scar is a substrate for ventricular tachycardia and sudden cardiac death. Late enhancement CT imaging can detect scar, but it remains unclear whether newer late enhancement dual-energy (LE-DECT) acquisition has benefit over standard single-energy late enhancement (LE-CT). OBJECTIVE We aim to compare late enhancement CT using newer LE-DECT acquisition and single-energy LE-CT acquisitions with pathology and electroanatomic map (EAM) in an experimental chronic myocardial infarction (MI) porcine study. METHODS In 8 pigs with chronic myocardial infarction (59 ± 5 kg), we performed dual-source CT, EAM, and pathology. For CT imaging, we performed 3 acquisitions at 10 minutes after contrast administration: LE-CT 80 kV, LE-CT 100 kV, and LE-DECT with 2 postprocessing software settings. RESULTS Of the sequences, LE-CT 100 kV provided the best contrast-to-noise ratio (all P ≤ .03) and correlation to pathology for scar (ρ = 0.88). LE-DECT overestimated scar (both P = .02), whereas LE-CT images did not (both P = .08). On a segment basis (n = 136), all CT sequences had high specificity (87%-93%) and modest sensitivity (50%-67%), with LE-CT 100 kV having the highest specificity of 93% for scar detection compared to pathology and agreement with EAM (κ = 0.69). CONCLUSIONS Standard single-energy LE-CT, particularly 100 kV, matched better to pathology and EAM than dual-energy LE-DECT for scar detection. Larger human trials as well as more technical studies that optimize varying different energies with newer hardware and software are warranted.
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Affiliation(s)
- Quynh A Truong
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and the New York-Presbyterian Hospital, 413 E. 69th Street, Suite 108, New York, NY 10021, USA; Division of Cardiology, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, NY, USA.
| | - Wai-Ee Thai
- Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Bryan Wai
- Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin Cordaro
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Teresa Cheng
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Beaudoin
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Guanglei Xiong
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and the New York-Presbyterian Hospital, 413 E. 69th Street, Suite 108, New York, NY 10021, USA
| | - Jim W Cheung
- Division of Cardiology, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, NY, USA
| | - Robert Altman
- Al-Sabah Arrhythmia Institute, Mount Sinai St. Luke's-Roosevelt Hospital Center, New York, NY, USA
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and the New York-Presbyterian Hospital, 413 E. 69th Street, Suite 108, New York, NY 10021, USA; Division of Cardiology, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, NY, USA
| | - Jagmeet P Singh
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Conor D Barrett
- Al-Sabah Arrhythmia Institute, Mount Sinai St. Luke's-Roosevelt Hospital Center, New York, NY, USA
| | - Stephan Danik
- Al-Sabah Arrhythmia Institute, Mount Sinai St. Luke's-Roosevelt Hospital Center, New York, NY, USA
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Late Gadolinium Enhancement Imaging in Assessment of Myocardial Viability. Radiol Clin North Am 2015; 53:397-411. [DOI: 10.1016/j.rcl.2014.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Rajiah P, Halliburton SS. Dual Energy Imaging in Cardiovascular CT: Current Status and Impact on Radiation, Contrast and Accuracy. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9289-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Diagnostic accuracy of late iodine-enhancement dual-energy computed tomography for the detection of chronic myocardial infarction compared with late gadolinium-enhancement 3-T magnetic resonance imaging. Invest Radiol 2014; 48:851-6. [PMID: 23907104 DOI: 10.1097/rli.0b013e31829d91a8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The purpose of the study was to compare the performance of late iodine-enhancement (LIE) dual-energy computed tomography (DECT) linear blending and selective myocardial iodine mapping for the detection of chronic myocardial infarction (CMI) with late gadolinium-enhancement (LGE) 3-T magnetic resonance imaging. MATERIALS AND METHODS This study was approved by the institutional review board, and the patients gave informed consent. A total of 20 patients with a history of CMI underwent cardiac LIE-DECT and LGE-MRI. Images of the LIE-DECT were reconstructed as 100 kilovolt (peak) (kV[p]), 140 kV(p), and weighted-average (WA; linear blending) images from low- and high-kilovoltage peak data using 3 different weighting factors (0.8, 0.6, 0.3). Additional color-coded myocardial iodine distribution maps were calculated. The images were reviewed for the presence of late enhancement, transmural extent, signal characteristics, infarct volume, and subjective image quality. RESULTS Segmental analysis of LIE-DECT data from 100 kV(p), WA of 0.8, and WA of 0.6 showed identical results for the identification of CMI (89% sensitivity, 98% specificity, 96% accuracy) and correctly identified all segments with transmural scarring detected through LGE-MRI. Weighted average of 0.6 received the best subjective image quality rating (15/20 votes) and average measured infarct size correlated best with LGE-MRI (5.7% difference). In comparison with LGE-MRI, iodine distribution maps were susceptible to false-positive and false-negative findings (52% sensitivity, 88% specificity, 81% accuracy), overestimating quantity of transmural scars by 78% while underestimating infarct volume by 55%. CONCLUSIONS Late iodine enhancement cardiac dual-energy computed tomography correlates well with LGE-MRI for detecting CMI, whereas iodine distribution analysis provides inferior accuracy. Linear blending further improves image quality and enables more precise estimation of scar volume.
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Wichmann JL, Hu X, Kerl JM, Schulz B, Bodelle B, Frellesen C, Lehnert T, Vogl TJ, Bauer RW. Non-linear blending of dual-energy CT data improves depiction of late iodine enhancement in chronic myocardial infarction. Int J Cardiovasc Imaging 2014; 30:1145-50. [DOI: 10.1007/s10554-014-0440-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 04/29/2014] [Indexed: 12/23/2022]
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Wichmann JL, Arbaciauskaite R, Kerl JM, Frellesen C, Bodelle B, Lehnert T, Monsefi N, Vogl TJ, Bauer RW. Evaluation of monoenergetic late iodine enhancement dual-energy computed tomography for imaging of chronic myocardial infarction. Eur Radiol 2014; 24:1211-8. [DOI: 10.1007/s00330-014-3126-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/06/2014] [Accepted: 02/12/2014] [Indexed: 11/30/2022]
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Meinel FG, De Cecco CN, Schoepf UJ, Nance JW, Silverman JR, Flowers BA, Henzler T. First–Arterial-Pass Dual-Energy CT for Assessment of Myocardial Blood Supply: Do We Need Rest, Stress, and Delayed Acquisition? Comparison with SPECT. Radiology 2014; 270:708-16. [DOI: 10.1148/radiol.13131183] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Novel MRI and CT Approaches for the Characterization of Myocardial Infarct. CURRENT RADIOLOGY REPORTS 2013. [DOI: 10.1007/s40134-013-0027-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cho SG, Kim JH, Cho JY, Kim HS, Bom HS. Myocardial Blood Flow and Flow Reserve in Proximal and Mid-to-Distal Lesions of Left Anterior Descending Artery Measured By N-13 Ammonia PET/CT. Nucl Med Mol Imaging 2013; 47:158-65. [PMID: 24900102 DOI: 10.1007/s13139-013-0208-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/24/2013] [Accepted: 04/29/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of this study is to compare the myocardial blood flow (MBF) and flow reserve (MFR) between proximal and mid-to-distal lesions of the left anterior descending artery (pLAD and mdLAD, respectively) using N-13 ammonia positron emission tomography/computed tomography (PET/CT). METHODS Subjects were 11 patients (six men and five women, mean age 64.5 years) with known coronary artery disease (CAD) involving LAD studied by N-13 ammonia PET/CT. They were divided into two groups by the location of stenotic lesions, i.e. pLAD versus mdLAD. Global and regional MBF and MFR were measured and compared. Characteristics of perfusion defects including the number of involved segments, basal area involvement, location, size, and shape were also compared between the two groups. RESULTS The regional MFR in mid-anterior segment was significantly lower in pLAD group (1.80 ± 0.35 vs 2.76 ± 1.13 for pLAD and mdLAD groups, respectively, p = 0.034), while global MFR was not different (2.10 ± 1.10 vs 2.34 ± 0.84). Both stress and rest MBF in LAD territories were not different in both groups. The size of the perfusion defects were significantly larger in pLAD group (44.0 ± 11.5 % vs 21.1 ± 15.8 %, p = 0.041). Other characteristics such as location, basal area involvement, and shape were not significantly different between two groups. CONCLUSIONS The proximal lesion makes lower MFR in the mid-anterior segment and larger perfusion defect in the LAD territory but comparable MBF compared with mdLAD lesion.
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Affiliation(s)
- Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Jae Young Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Hyeon Sik Kim
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam Korea 519-763
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam Korea 519-763
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Peng J, Zhang LJ, Schoepf UJ, Gibbs KP, Ji HS, Yang GF, Zhu H, Lu GM. Acute myocardial infarct detection with dual energy CT: correlation with single photon emission computed tomography myocardial scintigraphy in a canine model. Acta Radiol 2013; 54:259-66. [PMID: 23543148 DOI: 10.1258/ar.2012.120104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dual-energy CT (DECT) has been used to detect myocardial infarct. However, few comparable studies with histopathological findings as gold standard have been published. PURPOSE To investigate the accuracy of DECT iodine maps for detecting acute myocardial infarction compared with single photon emission computed tomography (SPECT) in a canine model using histopathological findings as the reference standard. MATERIAL AND METHODS A model of myocardial ischemia was created by ligating the left anterior descending (LAD) coronary artery after thoracotomy in six dogs, while another three dogs undergoing thoracotomy without LAD ligature served as a control group. Contrast-enhanced DECT scans of the heart were performed, followed by resting 99mTc-MIBI SPECT myocardial perfusion imaging in all nine dogs before and 3 h after the procedure. Triphenyltetrazolium chloride (TTC) staining was performed and analyzed. In the short axis of the left ventricle, the wall surface was divided into 17 segments, which were assessed for infarcted myocardium on conventional CT from average-weighted data, DECT myocardial iodine maps, conventional CT plus DECT, SPECT, and histopathology. Inter-observer and inter-modality agreement for conventional CT, DECT myocardial iodine maps, and SPECT were calculated. CT value of infracted and non-infracted areas was measured. RESULTS With the histopathological results as the reference standard, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 75.0% (30/40), 92.0% (104/113), 76.9% (30/39), 91.2% (104/114), 87.6% (134/153) for conventional CT, 85.0% (34/40), 84.1% (95/113), 65.4% (34/52), 94.1% (95/101), 84.3% (129/153) for DECT myocardial iodine maps; 87.5% (35/40), 92.9% (105/113), 81.4% (35/43), 95.5% (105/110), 91.5% (140/153) for conventional CT plus DECT; 82.5% (33/40), 90.3% (102/113), 75.0% (33/44), and 93.6% (102/109), 88.2% (135/153) for SPECT, respectively. Excellent inter-observer agreement (Kappa value >0.8) and good inter-modality agreement (Kappa value >0.6) for each modality were found. CT values of infarcted myocardium (26 ± 22 HU, 36 ± 33 HU, 34 ± 16 HU) were lower than those of non-infarcted myocardium (115 ± 16 HU, 121 ± 28 HU, 123 ± 11 HU) on images of 140 kVp, 80 kVp, and average-weighted 120 kVp images (all P < 0.05). CONCLUSION With histopathology as the reference standard, DECT myocardial iodine maps can detect acute myocardial infarction with diagnostic accuracy comparable to resting SPECT myocardial perfusion imaging in a canine model. DECT plus conventional CT had a potential to improve the detection of acute myocardial infarction.
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Affiliation(s)
- Jin Peng
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
- Department of Medical Imaging, Chenggong Hospital, Xiamen University, Xiamen, Fujian, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Kevin P Gibbs
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Heng Shan Ji
- Department of Nuclear Medicine, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - Gui Fen Yang
- Department of Nuclear Medicine, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - Hong Zhu
- Department of Nuclear Medicine, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
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Dual Energy CT of the Heart: Current Status and Future Applications. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9197-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
OBJECTIVE Interest in dual-energy CT (DECT) for evaluating the myocardial blood supply, as an addition to coronary artery assessment, is increasing. Although it is still in the early clinical phase, assessment of myocardial ischemia and infarction by DECT constitutes a promising step toward comprehensive evaluation of coronary artery disease with a single noninvasive modality. CONCLUSION Compared with dynamic CT approaches, DECT has advantages regarding radiation dose and clinical applicability. In this review, the literature on DECT of the heart is discussed.
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Abstract
OBJECTIVE Various applications for dual-energy CT (DECT) have been investigated and have shown substantial clinical benefits. However, only limited data are available regarding the radiation dose associated with DECT imaging. The purpose of this article is to review the available literature regarding the radiation dose associated with DECT imaging applications in comparison with conventional single-energy CT techniques. CONCLUSION The rediscovery of DECT and the increasing availability of this technique on clinical CT systems have opened new dimensions for CT. The advanced spectral differentiation of materials within the human body as well as the selective visualization or subtraction of iodinated contrast material or xenon provides both advanced visualization of disease-specific molecular substrates as well as additional functional information within a single scan.
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Dual Energy CT With Nonlinear Image Blending Improves Visualization of Delayed Myocardial Contrast Enhancement in Acute Myocardial Infarction. Invest Radiol 2013. [DOI: 10.1097/rli.0b013e3182749b38] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Metal artifact reduction by dual-energy computed tomography using energetic extrapolation: a systematically optimized protocol. Invest Radiol 2012; 47:406-14. [PMID: 22659595 DOI: 10.1097/rli.0b013e31824c86a3] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Energetic extrapolation is a promising strategy to reduce metal artifacts in dual-source computed tomography (DSCT). We performed this study to systematically optimize image acquisition parameters for this approach in a hip phantom and assess its value in a clinical study. MATERIALS AND METHODS Titanium and steel hip prostheses were placed in a standard hip phantom and a water tank and scanned on a DSCT scanner. Tube spectra, tube current ratio, collimation, pitch, and rotation time were optimized in a stepwise process. Artifacts were quantified by measuring the standard deviation of the computed tomography density in a doughnut-shaped region of interest placed around the prosthesis. A total of 22 adult individuals with metallic implants referred for computed tomography for a musculoskeletal indication were scanned using the optimized protocol. Degree of artifacts and diagnostic image quality were rated visually (0-10) and maximum streak intensity was measured. RESULTS Sn140/100 kVp proved superior to Sn140/80 kVp. There was a benefit for increasing tube current ratio from 1:1 to 3:1, but not beyond, in favor of the Sn140 kVp spectrum. Artifacts were less severe for a collimation of 32 × 0.6 mm as compared with 40 × 0.6 mm. A pitch of 0.5 at a rotation time of 0.5 seconds per rotation was preferable to other combinations with comparable scanning times. In the clinical study, increasing the extrapolated photon energy from 64 to 120 keV decreased the severity of artifacts from 8.0 to 2.0 (P < 0.001) and decreased streak intensity from 871 to 153 HU (P < 0.001). The median diagnostic image quality rating improved from 2.5 to 8.0 (P < 0.001). The median energy level visually perceived as optimal for diagnostic evaluation was 113 keV (range, 100-130 keV). CONCLUSIONS Sn140/100 kVp with a tube current ratio of 3:1, a collimation of 32 × 0.6 mm, and extrapolated energies of 105 to 120 keV are optimal parameters for a dedicated DSCT protocol that effectively reduces metal artifacts by energetic extrapolation. The protocol effectively reduces metal artifacts in all types of metal implants. The optimized reconstructions yielded relevant additional findings.
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Spectral CT imaging of myocardial infarction: preliminary animal experience. Eur Radiol 2012; 23:133-8. [PMID: 22814826 DOI: 10.1007/s00330-012-2560-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 06/04/2012] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To evaluate the capability of spectral CT imaging to detect the different stages and angiogenesis of myocardial infarction (MI). METHODS MI was surgically induced in 40 rabbits that were evenly divided into four stages of MI: 6 h (6H), 3 days (3D), 7 days (7D) and 14 days (14D). Spectral CT was performed at 10 s, 1 min and 3 min after intravenous contrast medium administration. CD31 immunohistochemistry was used for the microvessel density (MVD) measurement. Iodine concentrations in the myocardium were measured and normalised to the aorta as nIC. The relationships between infarcted myocardial nIC and MVD were analysed. RESULTS The nIC of infarct myocardium decreased at 10 s and increased in late-phase CT images. There were significant differences between the 6H and other groups (P ( 6H-3D ) = 0.01, P ( 6H-7D ) = 0.01, P ( 6H-14D ) = 0.00). There was a significant difference in the MVD of infarct myocardium between the two groups except in the 7D and 14D groups (P = 0.08). In the 10-s phase, the nIC of infarct myocardium was negatively correlated with MVD (r = -0.54, P = 0.00), whereas in the late phases, there was a positive correlation between them (r = 0.57, P = 0.00 in the 1-min phase, r = 0.48, P = 0.00 in the 3-min phase). CONCLUSION Spectral CT imaging of the myocardium can be used to evaluate the different stages and angiogenesis of MI.
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