Truong Quynh A, Thai Wai-Ee, Wai Bryan, Cordaro Kevin, Cheng Teresa, Beaudoin Jonathan, Xiong Guanglei, Cheung Jim W, Altman Robert, Min James K, Singh Jagmeet P, Barrett Conor D, Danik Stephan
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.
Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
J Cardiovasc Comput Tomogr. 2015 Jul-Aug;9(4):313-20. doi: 10.1016/j.jcct.2015.03.003. Epub 2015 Mar 24.
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).
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.
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.
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).
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.
心肌瘢痕是室性心动过速和心源性猝死的基础。延迟强化CT成像可检测瘢痕，但新型延迟强化双能量（LE-DECT）采集相对于标准单能量延迟强化（LE-CT）是否具有优势仍不清楚。
我们旨在通过一项实验性慢性心肌梗死（MI）猪研究，比较使用新型LE-DECT采集的延迟强化CT和单能量LE-CT采集与病理学及电解剖图（EAM）的差异。
对8只患有慢性心肌梗死（体重59±5千克）的猪进行双源CT、EAM和病理学检查。对于CT成像，在注射造影剂后10分钟进行3次采集：80 kV的LE-CT、100 kV的LE-CT以及使用2种后处理软件设置的LE-DECT。
在所有序列中，100 kV的LE-CT提供了最佳的对比噪声比（所有P≤0.03）以及与瘢痕病理学的最佳相关性（ρ = 0.88）。LE-DECT高估了瘢痕（两者P = 0.02），而LE-CT图像则没有（两者P = 0.08）。在节段基础上（n = 136），所有CT序列均具有较高的特异性（87%-93%）和中等的敏感性（50%-67%），与病理学相比，100 kV的LE-CT对瘢痕检测的特异性最高，为93%，并且与EAM的一致性最好（κ = 0.69）。
在瘢痕检测方面，标准单能量LE-CT，尤其是100 kV，比双能量LE-DECT与病理学和EAM的匹配度更好。有必要进行更大规模的人体试验以及更多利用更新硬件和软件优化不同能量的技术研究。
