Detection of extracellular myocardial matrix with Dual Energy computed tomography: systematic review and meta-analysis

Background. The amount of extracellular myocardial matrix is a non-invasive tool for quantitative assessment of myocardial fibrosis. MRI with late gadolinium-enhancement is considered to be the “Gold standard” of non-invasive practice.  Dual Energy computed tomography is a new non-invasive approach for detection of myocardial fibrosis and its prognostic value remains unclear. The purpose of this study was to summarize all available data and to study prognostic value of DECT for the detection of fibrotic changes in myocardium.

Methods. We searched MEDLINE, EMBASE, Cochrane, SCOPUS and Web of Science for cohort studies up to October 2021 that reported myocardial extracellular volume fraction quantification using contrast enhanced dual energy CT or/and MRI with delayed enhancement.

Results. Eleven studies met eligibility criteria. A systematic analysis demonstrated the difference in extracellular volume fraction in patients with fibrotic and inflammation changes of the myocardium, as well as good comparability between DECT and MRI. The value of extracellular volume fraction in myocardium with fibrotic or inflammatory changes was higher than in healthy tissue, which makes it possible to use the ECV as a non-invasive marker of myocardial fibrosis.

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