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Diagnostic Accuracy of Late Iodine–Enhancement Dual-Energy Computed Tomography for the Detection of Chronic Myocardial Infarction Compared With Late Gadolinium–Enhancement 3-T Magnetic Resonance Imaging

Wichmann, Julian L. MD; Bauer, Ralf W. MD; Doss, Mirko MD; Stock, Wenzel MED; Lehnert, Thomas MD; Bodelle, Boris MD; Frellesen, Claudia MD; Vogl, Thomas J. MD; Kerl, J. Matthias MD

doi: 10.1097/RLI.0b013e31829d91a8
Original Articles

Objectives: The purpose of the study was to compare the performance of late iodine–enhancement (LIE) dual-energy computed tomography (DECT) linear blending and selective myocardial iodine mapping for the detection of chronic myocardial infarction (CMI) with late gadolinium–enhancement (LGE) 3-T magnetic resonance imaging.

Materials and Methods: This study was approved by the institutional review board, and the patients gave informed consent. A total of 20 patients with a history of CMI underwent cardiac LIE-DECT and LGE-MRI. Images of the LIE-DECT were reconstructed as 100 kilovolt (peak) (kV[p]), 140 kV(p), and weighted-average (WA; linear blending) images from low– and high–kilovoltage peak data using 3 different weighting factors (0.8, 0.6, 0.3). Additional color-coded myocardial iodine distribution maps were calculated. The images were reviewed for the presence of late enhancement, transmural extent, signal characteristics, infarct volume, and subjective image quality.

Results: Segmental analysis of LIE-DECT data from 100 kV(p), WA of 0.8, and WA of 0.6 showed identical results for the identification of CMI (89% sensitivity, 98% specificity, 96% accuracy) and correctly identified all segments with transmural scarring detected through LGE-MRI. Weighted average of 0.6 received the best subjective image quality rating (15/20 votes) and average measured infarct size correlated best with LGE-MRI (5.7% difference). In comparison with LGE-MRI, iodine distribution maps were susceptible to false-positive and false-negative findings (52% sensitivity, 88% specificity, 81% accuracy), overestimating quantity of transmural scars by 78% while underestimating infarct volume by 55%.

Conclusions: Late iodine enhancement cardiac dual-energy computed tomography correlates well with LGE-MRI for detecting CMI, whereas iodine distribution analysis provides inferior accuracy. Linear blending further improves image quality and enables more precise estimation of scar volume.

From the Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany.

Received for publication November 5, 2012; and accepted for publication, after revision, May 22, 2013.

Conflicts of interest and sources of funding: Drs Bauer and Kerl are on the speakers’ bureau of Siemens Healthcare, Computed Tomography Division.

The authors report no conflicts of interest.

Reprints: Julian L. Wichmann, MD, Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. E-mail: docwichmann@gmail.com.

© 2013 by Lippincott Williams & Wilkins