Tremamunno Giuseppe, Varga-Szemes Akos, Kravchenko Dmitrij, Laghi Andrea, Bamberg Fabian, Halfmann Moritz C, Suranyi Pál Spruill, Vecsey-Nagy Milán, Emrich Tilman, Hagar Muhammad Taha
Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy.
Eur Radiol. 2025 May 1. doi: 10.1007/s00330-025-11622-0.
To evaluate the diagnostic accuracy of iodine maps from photon-counting detector (PCD) CT in detecting myocardial late enhancement compared to late gadolinium enhancement (LGE)-MRI.
In this retrospective analysis of a prospective cohort, patients underwent cardiac MRI with LGE followed by late iodine enhancement (LIE)-CT using dual-source PCD-CT. LIE-CT was performed 5 min post-intravenous administration of 100 mL iopromide (370 mg I/mL) using an ECG-triggered sequential protocol with full spectral capabilities (120 kVp, 144 × 0.4 mm collimation). Iodine maps were reconstructed with a quantitative kernel (Qr40) and iterative reconstruction. Two radiologists independently rated image quality on a four-point scale (1: "poor" to 4: "excellent"). Diagnostic performance was assessed per-patient and per-segment using LGE-MRI as reference, and inter-reader agreement was analyzed using Cohen's kappa (κ).
The study included 27 patients (52% female; mean age 52.9 ± 17.2 years). Twelve (44%) had positive LGE, with 87/459 (19%) myocardial segments affected. Image quality was rated as good, with no significant differences between readers (median 3 [2-4] vs 3 [3-4]; p = 0.058). Per-patient sensitivities were 100% and 91.7%, specificities 73.3% and 80.0%, and accuracies 85.2%, respectively. Per-segment sensitivities, specificities, and accuracies were 74.7%, 94.9%, and 91.1% (reader 1) and 66.7%, 96.4%, and 90.7% (reader 2). Substantial inter-reader agreement was observed (κ = 0.70 per patient, 0.63 per segment).
Iodine maps from PCD-CT demonstrate high diagnostic accuracy for assessing myocardial late enhancement, with substantial inter-reader agreement. These findings suggest that PCD-CT may serve as a valuable alternative to LGE-MRI.
Question Can PCD CT iodine maps detect myocardial late enhancement with accuracy comparable to LGE-MRI? Findings PCD-CT iodine maps achieved high accuracy (85.2% per patient, > 90% per segment) with substantial inter-reader agreement. Clinical relevance PCD-CT iodine maps offer a valuable alternative to LGE-MRI for myocardial late enhancement assessment, especially for patients with contraindications to MRI.
与钆延迟增强（LGE）-MRI相比，评估光子计数探测器（PCD）CT碘图在检测心肌延迟增强方面的诊断准确性。
在这项对前瞻性队列的回顾性分析中，患者先接受了LGE心脏MRI检查，随后使用双源PCD-CT进行碘延迟增强（LIE）-CT检查。在静脉注射100 mL碘普罗胺（370 mg I/mL）后5分钟，采用具有全光谱功能（120 kVp，144×0.4 mm准直）的心电图触发序列协议进行LIE-CT检查。使用定量内核（Qr40）和迭代重建技术重建碘图。两名放射科医生独立地根据四点量表（1：“差”至4：“优”）对图像质量进行评分。以LGE-MRI作为参考，对每位患者和每个节段的诊断性能进行评估，并使用Cohen's kappa（κ）分析阅片者间的一致性。
该研究纳入了27例患者（52%为女性；平均年龄52.9±17.2岁）。12例（44%）患者LGE呈阳性，459个心肌节段中有87个（19%）受累。图像质量被评为良好，阅片者之间无显著差异（中位数3 [2-4] 对 3 [3-4]；p = 0.058）。每位患者的敏感性分别为100%和91.7%，特异性分别为73.3%和80.0%，准确性分别为85.2%。每个节段的敏感性、特异性和准确性分别为74.7%、94.9%和91.1%（阅片者1）以及66.7%、96.4%和90.7%（阅片者2）。观察到阅片者间具有高度一致性（每位患者κ = 0.70，每个节段κ = 0.63）。
PCD-CT碘图在评估心肌延迟增强方面显示出较高的诊断准确性，阅片者间具有高度一致性。这些发现表明PCD-CT可能是LGE-MRI的一种有价值的替代方法。
问题PCD CT碘图能否准确检测心肌延迟增强，其准确性与LGE-MRI相当？研究结果PCD-CT碘图具有较高的准确性（每位患者85.2%，每个节段>90%），阅片者间具有高度一致性。临床意义PCD-CT碘图为心肌延迟增强评估提供了一种有价值的替代LGE-MRI的方法，尤其适用于有MRI禁忌证的患者。
