Myocardial signal density levels and beam-hardening artifact attenuation using dual-energy computed tomography


      The assessment of myocardial perfusion using single-energy (SE) imaging is influenced by beam-hardening artifacts (BHA). We sought to explore the ability of dual-energy (DE) imaging to attenuate the presence of BHA. Myocardial signal density (SD) was evaluated in 2240 myocardial segments (112 for each energy level) and in 320 American Heart Association segments among the SE group. Compared to DE reconstructions at the best energy level, SE acquisitions showed no significant differences overall regarding myocardial SD or signal-to-noise ratio. The segments most commonly affected by BHA showed significantly lower myocardial SD at the lowest energy levels, progressively normalizing at higher energy levels.


      SE (single energy), DE (dual energy), CTP (computed tomography perfusion), SD (signal density), BHA (beam-hardening artifacts), CCTA (coronary computed tomography angiography), CAD (coronary artery disease)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Rodriguez-Granillo GA
        • Ingino CA
        • Lylyk P
        Myocardial perfusion imaging and infarct characterization using multidetector cardiac computed tomography.
        World J Cardiol. 2010; 2: 198-204
        • Ko SM
        • Choi JW
        • Song MG
        • Shin JK
        • Chee HK
        • Chung HW
        • et al.
        Myocardial perfusion imaging using adenosine-induced stress dual-energy computed tomography of the heart: comparison with cardiac magnetic resonance imaging and conventional coronary angiography.
        Eur Radiol. 2011; 21: 26-35
        • Ko BS
        • Cameron JD
        • Leung M
        • Meredith IT
        • Leong DP
        • Antonis PR
        • et al.
        Combined CT coronary angiography and stress myocardial perfusion imaging for hemodynamically significant stenoses in patients with suspected coronary artery disease: a comparison with fractional flow reserve.
        JACC Cardiovasc imaging. 2012; 5: 1097-1111
        • Wang R
        • Yu W
        • Wang Y
        • He Y
        • Yang L
        • Bi T
        • et al.
        Incremental value of dual-energy CT to coronary CT angiography for the detection of significant coronary stenosis: comparison with quantitative coronary angiography and single photon emission computed tomography.
        Int J Cardiovasc Imaging. 2011; 27: 647-656
        • Carrascosa PM
        • Deviggiano A
        • Capunay C
        • Campisi R
        • de Munain ML
        • Vallejos J
        • et al.
        Incremental value of myocardial perfusion over coronary angiography by spectral computed tomography in patients with intermediate to high likelihood of coronary artery disease.
        Eur J Radiol. 2015; 84: 637-642
        • Meijboom WB
        • Van Mieghem CA
        • van Pelt N
        • Weustink A
        • Pugliese F
        • Mollet NR
        • et al.
        Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina.
        J Am Coll Cardiol. 2008; 52: 636-643
        • Meijboom WB
        • van Mieghem CA
        • Mollet NR
        • Pugliese F
        • Weustink AC
        • van Pelt N
        • et al.
        64-slice computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery disease.
        J Am Coll Cardiol. 2007; 50: 1469-1475
        • Gerber BL
        • Belge B
        • Legros GJ
        • Lim P
        • Poncelet A
        • Pasquet A
        • et al.
        Characterization of acute and chronic myocardial infarcts by multidetector computed tomography: comparison with contrast-enhanced magnetic resonance.
        Circulation. 2006; 113: 823-833
        • Weininger M
        • Schoepf UJ
        • Ramachandra A
        • Fink C
        • Rowe GW
        • Costello P
        • et al.
        Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: initial results.
        Eur J Radiol. 2012; 81: 3703-3710
        • Kang DK
        • Schoepf UJ
        • Bastarrika G
        • Nance JW
        • Abro JA
        • Ruzsics B
        Dual-energy computed tomography for integrative imaging of coronary artery disease: principles and clinical applications.
        Semin Ultrasound CT MR. 2010; 31: 276-291
        • Rodriguez-Granillo GA
        • Rosales MA
        • Degrossi E
        • Rodriguez AE
        Signal density of left ventricular myocardial segments and impact of beam hardening artifact: implications for myocardial perfusion assessment by multidetector CT coronary angiography.
        Int J Cardiovasc Imaging. 2010; 26: 345-354
        • Carrascosa PM
        • Cury RC
        • Deviggiano A
        • Capunay C
        • Campisi R
        • Lopez de Munain M
        • et al.
        Comparison of myocardial perfusion evaluation with single versus dual-energy CT and effect of beam-hardening artifacts.
        Acad Radiol. 2015; ([Epub ahead of print])
        • Cerqueira MD
        • Weissman NJ
        • Dilsizian V
        • Jacobs AK
        • Kaul S
        • Laskey WK
        • et al.
        Registration for Cardiac I. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association.
        Int J Cardiovasc Imaging. 2002; 18: 539-542
        • George RT
        • Silva C
        • Cordeiro MA
        • DiPaula A
        • Thompson DR
        • McCarthy WF
        • et al.
        Multidetector computed tomography myocardial perfusion imaging during adenosine stress.
        J Am Coll Cardiol. 2006; 48: 153-160
        • Gibbons RJ
        • Balady GJ
        • Bricker JT
        • Chaitman BR
        • Fletcher GF
        • Froelicher VF
        • et al.
        American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Committee to Update the Exercise Testing G. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines).
        J Am Coll Cardiol. 2002; 40: 1531-1540
        • Blankstein R
        • Shturman LD
        • Rogers IS
        • Rocha-Filho JA
        • Okada DR
        • Sarwar A
        • et al.
        Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography.
        J Am Coll Cardiol. 2009; 54: 1072-1084
        • Hoffmann U
        • Millea R
        • Enzweiler C
        • Ferencik M
        • Gulick S
        • Titus J
        • et al.
        Acute myocardial infarction: contrast-enhanced multi-detector row CT in a porcine model.
        Radiology. 2004; 231: 697-701
        • Kurata A
        • Kawaguchi N
        • Kido T
        • Inoue K
        • Suzuki J
        • Ogimoto A
        • et al.
        Qualitative and quantitative assessment of adenosine triphosphate stress whole-heart dynamic myocardial perfusion imaging using 256-slice computed tomography.
        PLoS One. 2013; 8: e83950
        • Rossi A
        • Merkus D
        • Klotz E
        • Mollet N
        • de Feyter PJ
        • Krestin GP
        Stress myocardial perfusion: imaging with multidetector CT.
        Radiology. 2014; 270: 25-46
        • Schwitter J
        • Wacker CM
        • van Rossum AC
        • Lombardi M
        • Al-Saadi N
        • Ahlstrom H
        • et al.
        MR-impact: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial.
        Eur Heart J. 2008; 29: 480-489
        • Scheske JA
        • O'Brien JM
        • Earls JP
        • Min JK
        • LaBounty TM
        • Cury RC
        • et al.
        Coronary artery imaging with single-source rapid kilovolt peak-switching dual-energy CT.
        Radiology. 2013; 268: 702-709
        • Carrascosa P
        • Capunay C
        • Rodriguez-Granillo GA
        • Deviggiano A
        • Vallejos J
        • Leipsic JA
        Substantial iodine volume load reduction in CT angiography with dual-energy imaging: insights from a pilot randomized study.
        Int J Cardiovasc Imaging. 2014; 30: 1613-1620