Static Myocardial Dual-Energy (DE) Perfusion and Delayed Enhancement in Detection of Chronic Myocardial Scar Tissue. Comparison with Late Gadolinium Ebhancement MRI

Purpose. To compare the performance of static myocardial
DECT perfusion imaging (CTA) with DECT delayed enhancement for  detection of ischemic myocardial scars using LGE MRI as a diagnostic standard.

Materials and Methods. 29 patients (m/f –16/13 mean age 57.6 ± 2.1) with chronic myocardial infarction were prospectively enrolled in the study. The CCTA protocol consisted of prospectively gated static myocardial DECT perfusion imaging (angiographic phase) and DECT delayed enhancement with 8 min delay after contrast media injection. Study was performed with 64-row single-source dual energy CT with fast kilovoltage switching. DECT images were visually assessed for first-pass arterial enhancement deficit and delayed enhancement using iodine distribution maps by 2 observers in comparison with LGE MRI. Sensitivity and specificity, the normalized iodine concentration ratio of normal myocardium and scar tissue were calculated both for both methods.

Results. For scar detection static myocardial DECT perfusion had  accuracy, sensitivity and specificity 95%, 90%, 95%, resp. vs.  delayed DECT – 96%, 88%, 99%, resp. There was no significant  difference between accuracy, sensitivity and specificity for DECT  perfusion and delayed DECT (p = 0.32). However diagnostic  confidence and normalized iodine concentration ratio of normal  myocardium and scar for static myocardial DECT perfusion were  significantly lower than for delayed DECT (p < 0.0001).

Conclusion. DECT CTA and DECT delayed enhancement have a  good accuracy for detection of post-infarction scars in comparison  with LGE MRI. The overall diagnostic performance of DECT delayed  enhancement was better then of static myocardial DECT perfusion  imaging. Thus, delayed sequences should not be omitted from CTA  standard protocol if the aim is myocardial scar detection.

1. Грамович В.В., Синицын В.Е. ГМП. Количественная оценка перфузии миокарда с помощью магнитно-резонансной томографии у больных хронической ишемической болезнью сердца. Кардиология. 2004; 8: 4–12. Gramovich V.V., Sinitsyn V.E.Quantitative myocardial perfusion assessment with magnetic resonance imaging in patients with coronary artery disease. Kardiology. 2004; 8: 4–12. (In Russian)

2. Архипова И.М., Мершина Е.А. СВЕ. Роль КТ коронарографии в диагностике ИБС на амбулаторном этапе. Поликлиника. 2013; 3–1: 18–21. Arkhipova I.M., Mershina E.A., Sinitsyn V.E. СT-angiography in CAD evaluation for outpatient. Poliklinika. 2013; 3–1: 18–21. (In Russian)

3. Arnoldi E., Lee Y.S., Ruzsics B., Weininger M., Spears J.R., Rowley C.P., Chiaramida S.A., Costello P., Reiser M.F., Schoepf U.J. CT detection of myocardial blood volume deficits: Dual- energy CT compared with single-energy CT spectra. J. Cardiovasc. Comput. Tomogr. 2011; 5 (6): 421–429. DOI:10.1016/j.jcct.2011.10.007.

4. Flohr T.G., McCollough C.H., Bruder H., Petersilka M., Gruber K., Süβ C., Grasruck M., Stierstorfer K., Krauss B., Raupach R., Primak A.N., Küttner A., Achenbach S., Becker C., Kopp A., Ohnesorge B.M. First performance evaluation of a dual-source CT (DSCT) system. Eur. Radiol. 2006; 16 (2): 256–268. DOI:10.1007/s00330-005-2919-2.

5. Johnson T.R.C., Krauß B., Sedlmair M., Grasruck M., Bruder H., Morhard D., Fink C., Weckbach S., Lenhard M., Schmidt B., Flohr T., Reiser M.F., Becker C.R. Material differentiation by dual energy CT: Initial experience. Eur. Radiol. 2007; 17 (6): 1510–1517. DOI:10.1007/s00330-006-0517-6.

6. Petersilka M., Bruder H., Krauss B., Stierstorfer K., Flohr T.G. Technical principles of dual source CT. Eur. J. Radiol. 2008; 68(3): 362–368. DOI:10.1016/j.ejrad.2008.08.013.

7. Koonce J.D., Vliegenthart R., Schoepf U.J. Accuracy of dual-energy computed tomography for the measurement of iodine concentration using cardiac CT protocols: validation in a phantom model. Eur. Radiol. 2014; 24: 512–518. DOI:10.1007/s00330-013-3040-6.

8. Kang D.K., Schoepf U.J., Bastarrika G., Nance J.W., Abro J.A., Ruzsics B. Dual-energy computed tomography for integrative imaging of coronary artery disease: principles and clinical applications. Semin. Ultrasound CT MR. 2010; 31(4): 276-291. DOI:10.1053/j.sult.2010.05.004.

9. Ruzsics B., Schwarz F., Schoepf U.J., Lee Y.S., Bastarrika G., Chiaramida S.A., Costello P., Zwerner, P.L. Comparison of dual-energy computed tomography of the heart with single photon emission computed tomography for assessment of coronary artery stenosis and of the myocardial blood supply. Am. J. Cardiol. 2009; 104 (3): 318–326. DOI:10.1016/j.amjcard.2009.03.051.

10. Wang R., Yu W., Wang Y., He Y., Yang L., Bi T., Jiao J., Wang Q., Chi L., Yu Y., Zhang Z. Incremental value of dual-energy CT to coronary CT angiography for the detection of significant coronary stenosis: comparison with quantitative coronary angiography and single photon emission computed tomography. Int. J. Cardiovasc. Imaging. 2011; 27 (5): 647–656. DOI:10.1007/s10554-011-9881-7.

11. Gerber B.L., Belge B., Legros G.J., Lim P., Poncelet A., Pasquet A., Gisellu G., Coche E., Vanoverschelde J.L. Characterization of acute and chronic myocardial infarcts by multidetector computed tomography: Comparison with contrast-enhanced magnetic resonance. Circulation. 2006; 113 (6): 823–833. DOI:10.1161/CIRCULATIONAHA.104.529511.

12. Nikolaou K., Knez A., Sagmeister S., Wintersperger B.J., Boekstegers P., Steinbeck G., Reiser M.F., Becker C.R. Assessment of myocardial infarctions using multidetectorrow computed tomography. J. Comput. Assist. Tomogr. 2004; 28 (2): 286–292. DOI:10.1097/00004728-200403000-00021.

13. Rubinshtein R., Miller T.D., Williamson E.E., Kirsch J., Gibbons R.J., Primak A.N., McCollough C.H., Araoz P.A. Detection of myocardial infarction by dual-source coronary computed tomography angiography using quantitated myocardial scintigraphy as the reference standard. Heart. 2009; 95 (17): 1419–1422. DOI:10.1136/hrt.2008.158618.

14. Hoffmann U., Millea R., Enzweiler C., Ferencik M., Gulick S., Titus J., Achenbach S., Kwait D., Sosnovik D., Brady T.J. Acute myocardial infarction: contrast-enhanced multi-detector row CT in a porcine model. Radiology. 2004; 231 (3): 697–701. DOI:10.1148/radiol.2313030132.

15. George R.T., Silva C., Cordeiro M.A.S., Silva C., Cordeiro M.A.S., DiPaula A., Thompson D.R., McCarthy W.F., Ichihara T., Lima J.A.C., Lardo A.C.M ultidetector Computed Tomography Myocardial Perfusion Imaging During Adenosine Stress. J. Am. Coll. Cardiol. 2006; 48 (1): 153–160. DOI:10.1016/j.jacc.2006.04.014.

16. Bettencourt N., Chiribiri A., Schuster A., Ferreira N., Sampaio F., Pires-Morais G., Santos L., Melica B., Rodrigues A., Braga P., Azevedo L., Teixeira M., Leite- Moreira A., Silva-Cardoso J., Nagel E., Gama V. Direct comparison of cardiac magnetic resonance and multidetector computed tomography stress-rest perfusion imaging for detection of coronary artery disease. J. Am. Coll. Cardiol. 2013; 61(10): 1099–1107. DOI:10.1016/j.jacc.2012.12.020.

17. Meinel F.G., De Cecco C.N., Schoepf U.J., Nance J.W., Silverman J.R., Flowers B.A., 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. 2013; 270 (3): 131183. DOI:10.1148/radiol.13131183.

18. Chen A., Liu A., Liu J., Tian S., Wang H., Liu Y. Application of dual-energy spectral CT imaging in differential diagnosis of bladder cancer and benign prostate hyperplasia. Medicine (Baltimore). 2016; 95 (52): e5705. DOI:10.1097/MD.0000000000005705.

19. Goetti R., Feuchtner G., Stolzmann P., Donati O.F., Wieser M., Plass A., Frauenfelder T., Leschka S., Alkadhi H. Delayed enhancement imaging of myocardial viability: Low-dose high- pitch CT versus MRI. Eur. Radiol. 2011; 21 (10): 2091–2099. doi:10.1007/s00330-011-2149-8.

20. Vliegenthart R., Henzler T., Moscariello A., Ruzsics B., Bastarrika G., Oudkerk M., Schoepf U.J. CT of coronary heart disease: Part 1, CT of myocardial infarction, ischemia, and viability. Am. J. Roentgenol. 2012; 198 (3): 531–547. DOI:10.2214/AJR.11.7082.