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Utility of Dual-Energy CT-based Monochromatic Imaging in the Assessment of Myocardial Delayed Enhancement in Patients with Cardiomyopathy

 Suyon Chang  ;  Kyunghwa Han  ;  Jong-Chan Youn  ;  Dong Jin Im  ;  Jin Young Kim  ;  Young Joo Suh  ;  Yoo Jin Hong  ;  Jin Hur  ;  Young Jin Kim  ;  Byoung Wook Choi  ;  Hye-Jeong Lee 
 Radiology, Vol.287(2) : 442-451, 2018 
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Adult ; Aged ; 80 and over Aged ; Cardiomyopathies/diagnostic imaging/*pathology ; Feasibility Studies ; Female ; Humans ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Myocardium/*pathology ; Observer Variation ; Predictive Value of Tests ; Prospective Studies ; Computer-Assisted *Radiographic Image Interpretation ; Dual-Energy Scanned Projection *Radiography ; Reproducibility of Results ; X-Ray Computed *Tomography ; Young Adult
Purpose To investigate the diagnostic utility of dual-energy computed tomography (CT)-based monochromatic imaging for myocardial delayed enhancement (MDE) assessment in patients with cardiomyopathy. Materials and Methods The institutional review board approved this prospective study, and informed consent was obtained from all participants who were enrolled in the study. Forty patients (27 men and 13 women; mean age, 56 years +/- 15 [standard deviation]; age range, 22-81 years) with cardiomyopathy underwent cardiac magnetic resonance (MR) imaging and dual-energy CT. Conventional (120-kV) and monochromatic (60-, 70-, and 80-keV) images were reconstructed from the dual-energy CT acquisition. Subjective quality score, contrast-to-noise ratio (CNR), and beam-hardening artifacts were compared pairwise with the Friedman test at post hoc analysis. With cardiac MR imaging as the reference standard, diagnostic performance of dual-energy CT in MDE detection and its predictive ability for pattern classification were compared pairwise by using logistic regression analysis with the generalized estimating equation in a per-segment analysis. The Bland-Altman method was used to find agreement between cardiac MR imaging and CT in MDE quantification. Results Among the monochromatic images, 70-keV CT images resulted in higher subjective quality (mean score, 3.38 +/- 0.54 vs 3.15 +/- 0.43; P = .0067), higher CNR (mean, 4.26 +/- 1.38 vs 3.93 +/- 1.33; P = .0047), and a lower value for beam-hardening artifacts (mean, 3.47 +/- 1.56 vs 4.15 +/- 1.67; P < .0001) when compared with conventional CT. When compared with conventional CT, 70-keV CT showed improved diagnostic performance for MDE detection (sensitivity, 94.6% vs 90.4% [P = .0032]; specificity, 96.0% vs 94.0% [P = .0031]; and accuracy, 95.6% vs 92.7% [P < .0001]) and improved predictive ability for pattern classification (subendocardial, 91.5% vs 84.3% [P = .0111]; epicardial, 94.3% vs 73.5% [P = .0001]; transmural, 93.0% vs 77.7% [P = .0018]; mesocardial, 85.4% vs 69.2% [P = .0047]; and patchy. 84.4% vs 78.4% [P = .1514]). For MDE quantification, 70-keV CT showed a small bias 0.1534% (95% limits of agreement: -4.7013, 5.0080). Conclusion Dual-energy CT-based 70-keV monochromatic images improve MDE assessment in patients with cardiomyopathy via improved image quality and CNR and reduced beam-hardening artifacts when compared with conventional CT images. ((c)) RSNA, 2017 Online supplemental material is available for this article.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
김영진(Kim, Young Jin) ORCID logo https://orcid.org/0000-0002-6235-6550
김진영(Kim, Jin Young)
서영주(Suh, Young Joo) ORCID logo https://orcid.org/0000-0002-2078-5832
윤종찬(Youn, Jong Chan)
이혜정(Lee, Hye Jeong) ORCID logo https://orcid.org/0000-0003-4349-9174
임동진(Im, Dong Jin) ORCID logo https://orcid.org/0000-0001-8139-5646
장수연(Chang, Su Yon)
최병욱(Choi, Byoung Wook) ORCID logo https://orcid.org/0000-0002-8873-5444
허진(Hur, Jin) ORCID logo https://orcid.org/0000-0002-8651-6571
홍유진(Hong, Yoo Jin) ORCID logo https://orcid.org/0000-0002-7276-0944
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