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Evaluation of monoenergetic late iodine enhancement dual-energy computed tomography for imaging of chronic myocardial infarction

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Abstract

Objectives

To evaluate image quality and diagnostic accuracy of selective monoenergetic reconstructions of late iodine enhancement (LIE) dual-energy computed tomography (DECT) for imaging of chronic myocardial infarction (CMI).

Methods

Twenty patients with a history of coronary bypass surgery underwent cardiac LIE-DECT and late gadolinium enhancement (LGE) magnetic resonance imaging (MRI). LIE-DECT images were reconstructed as selective monoenergetic spectral images with photon energies of 40, 60, 80, and 100 keV and the standard linear blending setting (M_0.6). Images were assessed for late enhancement, transmural extent, signal characteristics and subjective image quality.

Results

Seventy-nine myocardial segments (23 %) showed LGE. LIE-DECT detected 76 lesions. Images obtained at 80 keV and M_0.6 showed a high signal-to-noise ratio (15.9; 15.1), contrast-to-noise ratio (4.2; 4.0) and sensitivity (94.9 %; 92.4 %) while specificity was identical (99.6 %). Differences between these series were not statistically significant. Transmural extent of LIE was overestimated in both series (80 keV: 40 %; M_0.6: 35 %) in comparison to MRI. However, observers preferred 80 keV in 13/20 cases (65 %, κ = 0.634) over M_0.6 (4/20 cases) regarding subjective image quality.

Conclusions

Post-processing of LIE-DECT data with selective monoenergetic reconstructions at 80 keV significantly improves subjective image quality while objective image quality shows no significant difference compared to standard linear blending.

Key Points

• Late enhancement dual-energy CT allows for detection of chronic myocardial infarction.

• Monoenergetic reconstructions at 80 keV significantly improve subjective image quality.

• 80 keV and standard linear blending reconstructions show no significant differences.

• Extent of CMI detected with LIE-DECT is overestimated compared with MRI.

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Acknowledgements

The scientific guarantor of this publication is Dr. Julian L. Wichmann. The authors of this manuscript declare relationships with the following companies: Dr. Ralf W. Bauer and Dr. J. Matthias Kerl are on the speakers’ bureau of Siemens Healthcare, Computed Tomography division. However, all data was controlled by the authors (e.g. the corresponding author) without any potential conflict of interest. All other authors have nothing to disclose. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported.

In a recently published study by this workgroup (Wichmann JL, Bauer RW, Doss M et al (2013) 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. doi:10.1097/RLI.0b013e31829d91a8) the same patient group of 20 patients was analysed. However, both post-processing techniques are completely different from a technical point of view and analysis of all MRI and LIE-DECT data was performed in completely independent sessions by different observers which also explains the found differences regarding the detection of segments with late enhancement.

In addition, in this work we also evaluated the transmural extent of found lesions more thoroughly following the standardized classification known from cardiac LGE-MRI. This analytic asset was not evaluated in the previously published work.

Methodology: prospective, diagnostic or prognostic study, performed at one institution

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany

    Julian L. Wichmann, J. Matthias Kerl, Claudia Frellesen, Boris Bodelle, Thomas Lehnert, Thomas J. Vogl & Ralf W. Bauer

  2. Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania

    Ruta Arbaciauskaite

  3. Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt, Germany

    Nadejda Monsefi

Authors
  1. Julian L. Wichmann
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  2. Ruta Arbaciauskaite
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  3. J. Matthias Kerl
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  4. Claudia Frellesen
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  5. Boris Bodelle
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  6. Thomas Lehnert
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  7. Nadejda Monsefi
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  8. Thomas J. Vogl
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  9. Ralf W. Bauer
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Corresponding author

Correspondence to Julian L. Wichmann.

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Wichmann, J.L., Arbaciauskaite, R., Kerl, J.M. et al. Evaluation of monoenergetic late iodine enhancement dual-energy computed tomography for imaging of chronic myocardial infarction. Eur Radiol 24, 1211–1218 (2014). https://doi.org/10.1007/s00330-014-3126-9

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  • DOI: https://doi.org/10.1007/s00330-014-3126-9

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