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Quantitative myocardial perfusion with stress dual-energy CT: iodine concentration differences between normal and ischemic or necrotic myocardium. Initial experience

  • Cardiac
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Abstract

Objectives

To determine whether the quantification of iodine with stress dual-energy computed tomography (DECT-S) allows for the discrimination between a normal and an ischemic or necrotic myocardium using magnetic resonance (MR) as a reference.

Methods

This retrospective study was approved by the institutional review board, with waiver of informed consent. Thirty-six cardiac MR and DECT-S images from patients with suspected coronary artery disease were evaluated. Perfusion defects were visually determined, and myocardial iodine concentration was calculated by two observers using DECT colour-coded iodine maps. Iodine concentration differences were calculated using parametric tests. Receiver operating characteristic (ROC) curve analysis was conducted to estimate the optimal iodine concentration threshold for discriminating pathologic myocardium.

Results

In total, 576 cardiac segments were evaluated. There were differences in mean iodine concentration (p < 0.001) between normal (2.56 ± 0.66 mg/mL), ischemic (1.98 ± 0.36 mg/dL) and infarcted segments (1.35 ± 0.57 mg/mL). A myocardium iodine concentration of 2.1 mg/mL represented the optimal threshold to discriminate between normal and pathologic myocardium (sensitivity 75 %, specificity 73.6 %, area under the curve 0.806). Excellent agreement was found in measured myocardium iodine concentration (intraclass correlation coefficient 0.814).

Conclusion

Cardiac DECT-S with iodine quantification may be useful to differentiate healthy and ischemic or necrotic myocardium.

Key Points

• DECT-S allows for determination of myocardial iodine concentration as a quantitative perfusion parameter.

• A high interobserver correlation exists in measuring myocardial iodine concentration with DECT-S.

• Myocardial iodine concentration may be useful in the assessment of patients with CAD.

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Abbreviations

CAD:

Coronary artery disease

DECT-S:

Dual-energy CT stress

MDCTA:

Multi-detector computed tomography angiography

MRI:

Magnetic resonance imaging

ROI:

Region of interest

TGE:

Turbo gradient echo

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Acknowledgments

The scientific guarantor of this publication is Roque Oca Pernas. 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. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Some study subjects have been previously reported by Delgado, Vázquez, Oca, Vilar, Sanmartín (Myocardial ischemia evaluation with dual-source computed tomography: comparison with magnetic resonance imaging. Rev Esp Cardiol 66(11):864–870, 2013). Methodology: retrospective, diagnostic or prognostic study/observational, performed at one institution.

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Authors and Affiliations

  1. Radiology Department, Povisa Hospital, Salamanca, 36211, Vigo, Pontevedra, Spain

    Carlos Delgado Sánchez-Gracián, Roque Oca Pernas, Carmen Trinidad López, Eloísa Santos Armentia, María Vázquez Caamaño & Gonzalo Tardáguila de la Fuente

  2. Vigo University and Povisa Hospital, Vigo, Pontevedra, Spain

    Antonio Vaamonde Liste

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  1. Carlos Delgado Sánchez-Gracián
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Correspondence to Roque Oca Pernas.

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Delgado Sánchez-Gracián, C., Oca Pernas, R., Trinidad López, C. et al. Quantitative myocardial perfusion with stress dual-energy CT: iodine concentration differences between normal and ischemic or necrotic myocardium. Initial experience. Eur Radiol 26, 3199–3207 (2016). https://doi.org/10.1007/s00330-015-4128-y

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  • DOI: https://doi.org/10.1007/s00330-015-4128-y

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