Myocardial iodine concentration measurement using dual-energy computed tomography for the diagnosis of cardiac amyloidosis: a pilot study
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To measure myocardium iodine concentration (MIC) in patients with cardiac amyloidosis (CA) using dual-energy computed tomography (DECT).
Twenty-two patients with CA, 13 with non-amyloid hypertrophic cardiomyopathies (CH) and 10 control patients were explored with pre-contrast, arterial and 5-minute DECT acquisition (Iomeprol; 1.5 mL/kg). Inter-ventricular septum (IVS) thickness, blood pool iodine concentration (BPIC), MIC (mg/mL), iodine ratio and extra-cellular volume (ECV) were calculated.
IVS thickness was significantly (p < 0.001) higher in CA (17 ± 4 mm) and CH (15 ± 3 mm) patients than in control patients (10 ± 1 mm). CA patients exhibited significantly (p < 0.001) higher 5-minute MIC [2.6 (2.3–3.1) mg/mL], 5-minute iodine ratio (0.88 ± 0.12) and ECV (0.56 ± 0.07) than CH [1.7 (1.4–2.2) mg/mL, 0.57 ± 0.07 and 0.36 ± 0.05, respectively] and control patients [1.9 (1.7–2.4) mg/mL, 0.58 ± 0.07 and 0.35 ± 0.04, respectively). CH and control patients exhibited similar values (p = 0.9). The area under the curve of 5-minute iodine ratio for the differential diagnosis of CA from CH patients was 0.99 (0.73–1.0; p = 0.001). With a threshold of 0.65, the sensitivity and specificity of 5-minute iodine ratio were 100% and 92%, respectively.
Five-minute MIC and iodine ratio were increased in CA patients and exhibited best diagnosis performance to diagnose CA in comparison to other parameters.
• Dual-energy computed tomography can be used to detect cardiac amyloidosis
• Five-minute myocardial iodine concentration and iodine ratio increase in cardiac amyloidosis
• Among iodine parameters, 5-minute iodine ratio has the best diagnosis performance
KeywordsAmyloidosis/diagnosis Amyloidosis/complication Dual-energy computed tomography Cardiac imaging techniques Iodine map
Blood pool iodine concentration
Dual-energy computed tomography
Gemstone spectral imaging
Myocardium iodine concentration
Compliance with ethical standards
The scientific guarantor of this publication is Jean-François Deux.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
The authors state that this work has not received any funding.
Statistics and biometry
One of the authors has significant statistical expertise.
Institutional review board approval was obtained.
Written informed consent was obtained from all subjects (patients) in this study.
• performed at one institution
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