Original ArticlesDual Energy CT With Nonlinear Image Blending Improves Visualization of Delayed Myocardial Contrast Enhancement in Acute Myocardial InfarctionKartje, Julia Katharina MD*†; Schmidt, Bernhard PhD‡; Bruners, Philipp PhD†§; Mahnken, Andreas H. MD, MBA, MME∥Author Information From the *Department of Internal Medicine, Medical Centre Aachen, Würselen; †Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen University, Aachen; ‡Siemens Healthcare, Forchheim; §Applied Medical Engineering, Helmholtz Institute of Biomedical Engineering, RWTH Aachen University, Aachen; and ∥Department of Radiology, University Hospital, Philipps-University Marburg, Marburg, Germany. Received for publication May 2, 2012; and accepted for publication, after revision, September 4, 2012. Conflicts of interest and sources of funding: Bernhard Schmidt is employee of Siemens Healthcare. Reprints: Andreas H. Mahnken, MD, MBA, MME, Department of Radiology, University Hospital, Philipps-University Marburg, Baldingerstrasse, D-35033 Marburg, Germany. E-mail: [email protected]. Investigative Radiology: January 2013 - Volume 48 - Issue 1 - p 41-45 doi: 10.1097/RLI.0b013e3182749b38 Buy Metrics Abstract Objectives The objective of this study was to evaluate the effect of, and optimal parameters for, nonlinear image blending compared with linear image blending in the late-phase dual energy computed tomography (DECT) for the visualization of delayed myocardial contrast enhancement in acute myocardial infarction (MI). Materials and Methods Acute reperfused MI was induced in 7 pigs by temporary occlusion of the left anterior descending or the left circumflex artery. Two hours after the reperfusion, a contrast-enhanced, late-phase DECT (80 kV/140 kV) scanning was performed. The DECT data were postprocessed with linear and nonlinear image blending techniques. Contrast and percentage signal differences between healthy and infarcted myocardium as well as the blood pool of the left ventricle were computed for the linear and nonlinear techniques and the low- and high-kilovolt images. Data were compared using repeated-measures analysis of variance and post hoc t tests. Results The nonlinear blending showed the highest signal differences for all contrasts and analyses. Repeated-measures ANOVA results confirmed that the differences were statistically significant for the different postprocessing techniques (P value ranging from <0.001–0.003). Paired-samples post hoc t tests proved the significance of these results (P value ranging from <0.001–0.037). The ideal settings for the nonlinear image blending can thus be deduced from the computed tomographic values of the regions of interest in the linearly blended images with the weighting factor 0.3. Conclusions Nonlinear image blending improves the visualization of acute MI in the late-phase DECT. It is superior to linearly blended images and source images obtained at 80 or 140 kV. © 2013 Lippincott Williams & Wilkins, Inc.