Myocardial extracellular volume fraction to differentiate healthy from cardiomyopathic myocardium using dual-source dual-energy CT

• Published in: Journal of cardiovascular computed tomography 2020-03, Vol.14 (2), p.162-167
• Main Authors: Abadia, Andres F., van Assen, Marly, Martin, Simon S., Vingiani, Vincenzo, Griffith, L. Parkwood, Giovagnoli, Dante A., Bauer, Maximilian J., Schoepf, U. Joseph
• Format: Article
• Language: English
• Subjects: Cardiomyopathy; Computed tomography; Extracellular volume fraction; Iodine; Spectral imaging
• ISSN: 1934-5925; 1876-861X
• DOI: 10.1016/j.jcct.2019.09.008

To evaluate the feasibility of dual-energy CT (DECT)-based iodine quantification to estimate myocardial extracellular volume (ECV) fraction in patients with and without cardiomyopathy (CM), as well as to assess its ability to distinguish healthy myocardial tissue from cardiomyopathic, with the goal of defining a threshold ECV value for disease detection. Ten subjects free of heart disease and 60 patients with CM (mean age 66.4 ± 9.4; 59 males and 11 females; 40 ischemic and 20 non-ischemic CM) underwent late iodine enhanced DECT imaging. Myocardial iodine maps were obtained using 3-material decomposition. ECV of the left ventricle was estimated from hematocrit levels and the iodine maps using the AHA 16-segment model. Receiver operating characteristic curve analysis was performed, with corresponding area under the curve, along with Youden's index assessment, to establish a threshold for CM detection. The median ECV for healthy myocardium, non-ischemic CM, and ischemic CM were 25.4% (22.9–27.3), 38.3% (33.7–43.0), and 36.9% (32.4–41.1), respectively. Healthy myocardium showed significantly lower ECV values compared to ischemic and non-ischemic CM (p