Advertisement

An approach to evaluate myocardial perfusion defect assessment for projection-based DECT: A phantom study

      Highlights

      • Multiple reconstructions can evaluate myocardial perfusion with projection-based dual-energy CT (DECT)
      • Myocardial phantoms were scanned with monochromatic (DECT-MCE) and material decomposition (DECT-MD) reconstructions
      • DECT-MCE 40 and 70 keV are more accurate than higher keV. DECT-MD pairs with iodine background are less accurate than others.
      • The most efficient diagnostic strategy is to use DECT-MCE at 40 or 70 keV, or DECT-MD without iodine background

      Abstract

      Introduction

      Dual-energy CT (DECT) can improve the accuracy of myocardial perfusion CT with projection-based monochromatic (DECT-MCE) and quantification of myocardial iodine in material decomposition (DECT-MD) reconstructions. However, evaluation of multiple reconstructions is laborious and the optimal reconstruction to detect myocardial perfusion defects is unknown.

      Methods

      Left ventricular (LV) phantoms with artificial perfusion defects were scanned using DECT and single energy cardiac computed tomography angiography (SECT). Reconstructions of DECT-MCE at 40, 70, 100 and 140 keV, DECT-MD pairs of water, iodine, iron and fat, and SECT were evaluated using a 17-segment myocardial model. The diagnostic performance of each reconstruction was calculated on a per-segment basis and compared across DECT reconstructions.

      Results

      Over 34 phantoms with artificial perfusion defects were found in 64/578 (11%) of segments, the sensitivity of DECT-MCE at 40, 70, 100, and 140 keV was 100% (95% confidence interval (CI): 93–100), 100% (95% CI: 93–100), 71% (95% CI: 56–83), and 25% (95% CI: 14–40), respectively, with a significant decline between 70 keV and 100 keV (p < 0.001). The specificity of DECT-MCE was 100% at all energies (95% CI: 99–100). As a group, the DECT-MD iodine background reconstructions had significantly lower sensitivity than the remaining modes (2.1% [95% CI, 0.05–11.1], vs. 100% [95% CI, 92.6–100], p < 0.001). Specificity of all material pair modes remained 100%.

      Conclusions

      Using LV phantom models, the approach with the best sensitivity and specificity to assess myocardial perfusion defects with DECT are reconstructions of DECT-MCE at 40 or 70 KeV and DECT-MD without iodine background.

      Keywords

      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:

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

      References

        • Shaw L.J.
        • Weintraub W.S.
        • Maron D.J.
        • Hartigan P.M.
        • Hachamovitch R.
        • Min J.K.
        • et al.
        Baseline stress myocardial perfusion imaging results and outcomes in patients with stable ischemic heart disease randomized to optimal medical therapy with or without percutaneous coronary intervention.
        Am Heart J. 2012; 164: 243-250
        • Fihn S.D.
        • Gardin J.M.
        • Abrams J.
        • Berra K.
        • Blankenship J.C.
        • Dallas A.P.
        • et al.
        2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
        J Am Coll Cardiol. 2012; 60: e44-e164
        • Miller J.M.
        • Rochitte C.E.
        • Dewey M.
        • Arbab-Zadeh A.
        • Niinuma H.
        • Gottlieb I.
        • et al.
        Diagnostic performance of coronary angiography by 64-row CT.
        N Engl J Med. 2008; 359: 2324-2336
        • Budoff M.J.
        • Dowe D.
        • Jollis J.G.
        • Gitter M.
        • Sutherland J.
        • Halamert E.
        • et al.
        Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial.
        J Am Coll Cardiol. 2008; 52: 1724-1732
        • Chen M.Y.
        • Rochitte C.E.
        • Arbab-Zadeh A.
        • Dewey M.
        • George R.T.
        • Miller J.M.
        • et al.
        Prognostic value of combined CT angiography and myocardial perfusion imaging versus invasive coronary angiography and nuclear stress perfusion imaging in the prediction of major adverse cardiovascular events: the CORE320 multicenter study.
        Radiology. 2017; 284 (161565): 55-65
        • George R.T.
        • Mehra V.C.
        • Chen M.Y.
        • Kitagawa K.
        • Arbab-Zadeh A.
        • Miller J.M.
        • et al.
        Myocardial CT perfusion imaging and SPECT for the diagnosis of coronary artery disease: a head-to-head comparison from the CORE320 multicenter diagnostic performance study.
        Radiology. 2014; 272: 407-416
        • Danad I.
        • B O.H.
        • Min J.K.
        Dual-energy computed tomography for detection of coronary artery disease.
        Expert Rev Cardiovasc Ther. 2015; 13: 1345-1356
        • Ruzsics B.
        • Lee H.
        • Zwerner P.L.
        • Gebregziabher M.
        • Costello P.
        • Schoepf U.J.
        Dual-energy CT of the heart for diagnosing coronary artery stenosis and myocardial ischemia-initial experience.
        Eur Radiol. 2008; 18: 2414-2424
        • Riederer S.J.
        • Mistretta C.A.
        Selective iodine imaging using K-edge energies in computerized x-ray tomography.
        Med Phys. 1977; 4: 474-481
        • Siontis K.C.
        • Gersh B.J.
        • Williamson E.E.
        • Foley T.A.
        • Askew J.W.
        • Anavekar N.S.
        Diagnostic performance of myocardial CT perfusion imaging with or without coronary CT angiography.
        JACC Cardiovasc Imaging. 2015; 9: 322-324
        • So A.
        • Hsieh J.
        • Narayanan S.
        • Thibault J.B.
        • Imai Y.
        • Dutta S.
        • et al.
        Dual-energy CT and its potential use for quantitative myocardial CT perfusion.
        J Cardiovasc Comput Tomogr. 2012; 6: 308-317
        • Nagao M.
        • Matsuoka H.
        • Kawakami H.
        • Higashino H.
        • Mochizuki T.
        • Murase K.
        • et al.
        Quantification of myocardial perfusion by contrast-enhanced 64-MDCT: characterization of ischemic myocardium.
        AJR Am J Roentgenol. 2008; 191: 19-25
        • Cerqueira M.D.
        • Weissman N.J.
        • Dilsizian V.
        • Jacobs A.K.
        • Kaul S.
        • Laskey W.K.
        • et al.
        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.
        Circulation. 2002; 105: 539-542
        • Tamm E.P.
        • Le O.
        • Liu X.
        • Layman R.R.
        • Cody D.D.
        • Bhosale P.R.
        “How to” incorporate dual-energy imaging into a high volume abdominal imaging practice.
        Abdom Radiol (New York). 2017; 42: 688-701
        • Marin D.
        • Boll D.T.
        • Mileto A.
        • Nelson R.C.
        State of the art: dual-energy CT of the abdomen.
        Radiology. 2014; 271: 327-342
        • Cohen J.
        A coefficient of agreement for nominal scales.
        Educ Psychol Meas. 1960; 20: 37-46
        • Ruzsics B.
        • Schwarz F.
        • Schoepf U.J.
        • Lee Y.S.
        • Bastarrika G.
        • Chiaramida S.A.
        • et al.
        Comparison of dual-energy computed tomography of the heart with single photon emission computed tomography for assessment of coronary artery stenosis and of the myocardial blood supply.
        Am J Cardiol. 2009; 104: 318-326
        • Ko S.M.
        • Song M.G.
        • Chee H.K.
        • Hwang H.K.
        • Feuchtner G.M.
        • Min J.K.
        Diagnostic performance of dual-energy CT stress myocardial perfusion imaging: direct comparison with cardiovascular MRI.
        AJR Am J Roentgenol. 2014; 203: W605-W613
        • Kim S.M.
        • Chang S.A.
        • Shin W.
        • Choe Y.H.
        Dual-energy CT perfusion during pharmacologic stress for the assessment of myocardial perfusion defects using a second-generation dual-source CT: a comparison with cardiac magnetic resonance imaging.
        J Comput Assist Tomogr. 2014; 38: 44-52
        • Carrascosa P.M.
        • Cury R.C.
        • 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; 22: 591-599
        • Danad I.
        • Cho I.
        • Elmore K.
        • Schulman-Marcus J.
        • B O.H.
        • Stuijfzand W.J.
        • et al.
        Comparative diagnostic accuracy of dual-energy CT myocardial perfusion imaging by monochromatic energy versus material decomposition methods.
        Clin Imaging. 2018; 50: 1-4
        • Rochitte C.E.
        • George R.T.
        • Chen M.Y.
        • Arbab-Zadeh A.
        • Dewey M.
        • Miller J.M.
        • et al.
        Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: the CORE320 study.
        Eur Heart J. 2014; 35: 1120-1130
        • Parker M.W.
        • Iskandar A.
        • Limone B.
        • Perugini A.
        • Kim H.
        • Jones C.
        • et al.
        Diagnostic accuracy of cardiac positron emission tomography versus single photon emission computed tomography for coronary artery disease: a bivariate meta-analysis.
        Circ Cardiovasc Imaging. 2012; 5: 700-707
        • Truong Q.A.
        • Knaapen P.
        • Pontone G.
        • Andreini D.
        • Leipsic J.
        • Carrascosa P.
        • et al.
        Rationale and design of the dual-energy computed tomography for ischemia determination compared to “gold standard” non-invasive and invasive techniques (DECIDE-Gold): a multicenter international efficacy diagnostic study of rest-stress dual-energy computed tomography angiography with perfusion.
        J Nucl Cardiol. 2015; 22: 1031-1040