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

Quynh A. Truong, Wai Ee Thai, Bryan Wai, Kevin Cordaro, Teresa Cheng, Jonathan Beaudoin, Guanglei Xiong, Jim W. Cheung, Robert Altman, James K. Min, Jagmeet P. Singh, Conor D. Barrett, Stephan Danik

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

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.

Original languageEnglish
Pages (from-to)313-320
Number of pages8
JournalJournal of Cardiovascular Computed Tomography
Volume9
Issue number4
DOIs
StatePublished - 1 Jul 2015
Externally publishedYes

Keywords

  • Computed tomography
  • Electrophysiology
  • Imaging
  • Myocardial infarction
  • Myocardial scar

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