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


      • 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



      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.


      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.


      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%.


      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.


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