Mergen Victor, Reiner Martin F, Klambauer Konstantin, Moser Lukas J, Guan Fu, Brunckhorst Corinna, Duru Firat, Klotz Ernst, Flohr Thomas, Ruschitzka Frank, Manka Robert, Eberhard Matthias, Alkadhi Hatem, Saguner Ardan M
Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Insights Imaging. 2025 Aug 29;16(1):187. doi: 10.1186/s13244-025-02069-4.
This study aimed to assess the feasibility of left ventricular myocardial characterization in patients with ventricular arrhythmias using late enhancement (LE) photon-counting detector computed tomography (PCD-CT) scans, in comparison with invasive endocardial electroanatomical mapping (EAM).
This single-center retrospective observational study included 20 patients (mean age 64 ± 8 years, 4 female) who underwent PCD-CT prior to 3D endocardial uni- and bipolar EAM and radiofrequency catheter ablation (RFCA) between May 2022 and February 2024. Sixteen patients (80%) had cardiac implantable electronic devices. Twelve (60%) had ischemic and 8 (40%) had non-ischemic cardiomyopathy. Pathologic myocardial segments were defined by low-voltage electrograms < 5 mV in unipolar and < 0.5 mV in bipolar maps. Cardiac scans included LE acquisitions 5 min after contrast injection in the ECG-triggered sequential mode. Myocardial extracellular volume was computed from cardiac LE scans and visualized as polar and atlas maps (the latter depicting wall thickness) to identify pathologic segments with fibrosis and/or scar. LE scans were compared with EAM.
In patients with ischemic cardiomyopathy, agreement of pathologic segments on CT was good with unipolar EAM (κ = 0.655 ± 0.249), and moderate with bipolar EAM (κ = 0.547 ± 0.267). In patients with non-ischemic cardiomyopathy, agreement of pathologic segments on CT was moderate compared with unipolar (κ = 0.455 ± 0.356) and fair with bipolar EAM (κ = 0.255 ± 0.260).
Preliminary evidence suggests that characterization of pathologic myocardial segments using LE PCD-CT scans is feasible and yields good agreement with endocardial EAM, particularly when compared with unipolar EAM and in patients with ischemic cardiomyopathy.
Characterization of pathologic left ventricular segments using myocardial extracellular volume and thickness representations from spectral late enhancement photon-counting detector CT scans indicates good agreement with unipolar endocardial electroanatomical mapping, particularly in patients with ischemic cardiomyopathy.
Cardiac late enhancement imaging with photon-counting detector CT may enable characterization of pathologic myocardial segments in ventricular arrhythmia. Myocardial extracellular volume and thickness representations yield good agreement with unipolar endocardial electroanatomical mapping, particularly in patients with ischemic cardiomyopathy. Left ventricular myocardial characterization is feasible with late enhancement photon-counting detector CT and may complement invasive radiofrequency catheter ablations.
本研究旨在评估采用延迟强化（LE）光子计数探测器计算机断层扫描（PCD-CT）对室性心律失常患者进行左心室心肌特征分析的可行性，并与有创心内膜电解剖标测（EAM）进行比较。
这项单中心回顾性观察研究纳入了20例患者（平均年龄64±8岁，4例女性），这些患者在2022年5月至2024年2月期间接受了PCD-CT检查，随后进行了三维心内膜单极和双极EAM以及射频导管消融（RFCA）。16例患者（80%）植入了心脏植入式电子设备。12例（60%）患有缺血性心肌病，8例（40%）患有非缺血性心肌病。病理性心肌节段通过单极电图<5mV和双极电图<0.5mV的低电压电图来定义。心脏扫描包括在心电图触发的序列模式下注射造影剂5分钟后进行的LE采集。从心脏LE扫描中计算心肌细胞外容积，并将其可视化为极坐标图和图谱（后者描绘壁厚），以识别有纤维化和/或瘢痕的病理性节段。将LE扫描与EAM进行比较。
在缺血性心肌病患者中，CT上病理性节段与单极EAM的一致性良好（κ=0.655±0.249），与双极EAM的一致性中等（κ=0.547±0.267）。在非缺血性心肌病患者中，CT上病理性节段与单极EAM的一致性中等（κ=0.455±0.356），与双极EAM的一致性一般（κ=0.255±0.260）。
初步证据表明，使用LE PCD-CT扫描对病理性心肌节段进行特征分析是可行的，并且与心内膜EAM具有良好的一致性，特别是与单极EAM相比，以及在缺血性心肌病患者中。
使用光谱延迟强化光子计数探测器CT扫描的心肌细胞外容积和厚度表示对病理性左心室节段进行特征分析，表明与单极心内膜电解剖标测具有良好的一致性，特别是在缺血性心肌病患者中。
光子计数探测器CT的心脏延迟强化成像可能有助于对室性心律失常的病理性心肌节段进行特征分析。心肌细胞外容积和厚度表示与单极心内膜电解剖标测具有良好的一致性，特别是在缺血性心肌病患者中。使用延迟强化光子计数探测器CT对左心室心肌进行特征分析是可行的，并且可以补充有创射频导管消融。
