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Synthetic Extracellular Volume Fraction Derived Using Virtual Unenhanced Attenuation of Blood on Contrast-Enhanced Cardiac Dual-Energy CT in Nonischemic Cardiomyopathy

Authors
 Na Young Kim  ;  Dong Jin Im  ;  Jong-Chan Youn  ;  Yoo Jin Hong  ;  Byoung Wook Choi  ;  Seok-Min Kang  ;  Hye-Jeong Lee 
Citation
 AMERICAN JOURNAL OF ROENTGENOLOGY, Vol.218(3) : 454-461, 2022-03 
Journal Title
AMERICAN JOURNAL OF ROENTGENOLOGY
ISSN
 0361-803X 
Issue Date
2022-03
MeSH
Adult ; Aged ; Cardiomyopathies / blood* ; Cardiomyopathies / diagnostic imaging* ; Cardiomyopathies / physiopathology ; Contrast Media* ; Female ; Heart / diagnostic imaging ; Humans ; Male ; Middle Aged ; Radiographic Image Enhancement / methods* ; Radiography, Dual-Energy Scanned Projection / methods* ; Retrospective Studies ; Tomography, X-Ray Computed / methods*
Keywords
cardiac CT ; cardiomyopathy ; dual energy ; myocardial fibrosis ; synthetic extracellular volume fraction
Abstract
BACKGROUND. Current methods for calculating the myocardial extracellular volume (ECV) fraction require blood sampling to determine the serum hematocrit. Synthetic hematocrit and thus synthetic ECV may be derived using unenhanced attenuation of blood. By use of virtual unenhanced (VUE) attenuation of blood, contrast-enhanced dual-energy CT (DECT) may allow synthetic ECV calculations without unenhanced acquisition. OBJECTIVE. The purpose of this study was to compare synthetic ECV calculated using synthetic hematocrit derived from VUE images and conventional ECV calculated using serum hematocrit, both of which were obtained by contrast-enhanced DECT, with ECV derived from MRI used as the reference standard. METHODS. This retrospective study included 51 patients (26 men and 25 women; mean age, 59.9 ± 15.6 [SD] years) with nonischemic cardiomyopathy who, as part of an earlier prospective investigation, underwent equilibrium phase contrast-enhanced cardiac DECT and cardiac MRI and had serum hematocrit measured within 6 hours of both tests. A separate retrospective sample of 198 patients who underwent contrast-enhanced thoracic DECT performed on the same day for suspected pulmonary embolism and serum hematocrit measurement was identified to derive a synthetic hematocrit formula using VUE attenuation of blood by linear regression analysis. In the primary sample, two radiologists independently used DECT iodine maps to obtain the conventional ECV using serum hematocrit and the synthetic ECV using synthetic hematocrit based on the independently derived formula. The concordance correlation coefficient (CCC) was computed between conventional ECV and synthetic ECV from DECT. Conventional ECV and synthetic ECV from DECT were compared with the ECV derived from MRI in Bland-Altman analyses. RESULTS. In the independent sample, the linear regression formula for synthetic hematocrit was as follows: synthetic hematocrit = 0.85 × (VUE attenuation of blood) - 5.40. In the primary sample, the conventional ECV and synthetic ECV from DECT showed excellent agreement (CCC, 0.95). Bland-Altman analysis showed a small bias of -0.44% (95% limits of agreement, -5.10% to 4.22%) between MRI-derived ECV and conventional ECV from DECT as well as a small bias of -0.78% (95% limits of agreement, -5.25% to 3.69%) between MRI-derived ECV and synthetic ECV from DECT. CONCLUSION. Synthetic ECV and conventional ECV derived from DECT show excel lent agreement and a comparable association with ECV derived from cardiac MRI. CLINICAL IMPACT. Synthetic hematocrit from VUE attenuation of blood may allow myocardial tissue characterization on DECT without the inconvenience of blood sampling.
Full Text
https://www.ajronline.org/doi/10.2214/AJR.21.26654
DOI
10.2214/AJR.21.26654
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
Kim, Na Young(김나영) ORCID logo https://orcid.org/0000-0003-1645-2434
Lee, Hye Jeong(이혜정) ORCID logo https://orcid.org/0000-0003-4349-9174
Im, Dong Jin(임동진) ORCID logo https://orcid.org/0000-0001-8139-5646
Choi, Byoung Wook(최병욱) ORCID logo https://orcid.org/0000-0002-8873-5444
Hong, Yoo Jin(홍유진) ORCID logo https://orcid.org/0000-0002-7276-0944
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/188830
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