The British journal of radiology · 2026
The Feasibility of Low Contrast Dose Dual-energy CT for Quantifying Myocardial Focal Scar via Extracellular Volume Fraction.
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Chen Feifei, Jia Taoyu, Luo Liyun, Qin Peixin, Zeng Linqi, Chen Borong, Jin Lizi, Tang Wenyi, Lu Ling, Hu Feng, Yang Zhengying, Zhou Xiaobing, Chen Jian, Pan Cunxue
Аннотация
OBJECTIVE: To explore the quantitative efficacy of low-contrast-agent-dose dual-energy CT (DECT) myocardial extracellular volume (ECV) for myocardial focal scar (MFS).
METHODS: 33 patients with confirmed old myocardial infarction (OMI) were prospectively enrolled. All underwent DECT late iodine enhancement (LIE), cardiac magnetic resonance(CMR) late gadolinium enhancement (LGE), native and enhanced T1 mapping. DECT-LIE-ECV and CMR-ECV were measured in 1-16 myocardial segments of the left ventricle. Additionally, with reference to the CMR-LGE images, DECT-LIE-ECV and CMR-ECV of the MFS and the remote myocardium at a same slice were measured. Quantitative performance was assessed via Spearman correlation, Bland-Altman analysis, ROC curves, and DeLong's tests.
RESULTS: A total of 438 myocardial segments from 28 patients were analyzed (including 101 MFS-positive, 337 MFS-negative). (2) MFS-positive segments showed higher ECV than MFS-negative (CMR: 41% vs. 29%; DECT: 33% vs. 25%). DECT-LIE-ECV correlated weakly with CMR-ECV (r = 0.21, p < 0.001) but had moderate agreement (mean bias: 0.8%). Diagnostic accuracy was lower for DECT (AUC: 0.711) than CMR (AUC: 0.892; p < 0.001). (3) Lesion-level: MFS regions had higher ECV than remote myocardium (CMR: 57% vs. 27%; DECT: 48% vs. 25%). DECT-LIE-ECV correlated strongly with CMR-ECV (r = 0.76, p < 0.001) and showed moderate agreement (mean bias: 0.8%). Both methods had near-perfect diagnostic accuracy (DECT AUC: 0.989; CMR AUC: 0.985; p = 0.720).
CONCLUSION: Low-contrast DECT-LIE-ECV accurately quantifies MFS when targeting scar regions directly, offering a promising supplementary tool for myocardial scar quantification, especially for patients with contraindications to CMR.
METHODS: 33 patients with confirmed old myocardial infarction (OMI) were prospectively enrolled. All underwent DECT late iodine enhancement (LIE), cardiac magnetic resonance(CMR) late gadolinium enhancement (LGE), native and enhanced T1 mapping. DECT-LIE-ECV and CMR-ECV were measured in 1-16 myocardial segments of the left ventricle. Additionally, with reference to the CMR-LGE images, DECT-LIE-ECV and CMR-ECV of the MFS and the remote myocardium at a same slice were measured. Quantitative performance was assessed via Spearman correlation, Bland-Altman analysis, ROC curves, and DeLong's tests.
RESULTS: A total of 438 myocardial segments from 28 patients were analyzed (including 101 MFS-positive, 337 MFS-negative). (2) MFS-positive segments showed higher ECV than MFS-negative (CMR: 41% vs. 29%; DECT: 33% vs. 25%). DECT-LIE-ECV correlated weakly with CMR-ECV (r = 0.21, p < 0.001) but had moderate agreement (mean bias: 0.8%). Diagnostic accuracy was lower for DECT (AUC: 0.711) than CMR (AUC: 0.892; p < 0.001). (3) Lesion-level: MFS regions had higher ECV than remote myocardium (CMR: 57% vs. 27%; DECT: 48% vs. 25%). DECT-LIE-ECV correlated strongly with CMR-ECV (r = 0.76, p < 0.001) and showed moderate agreement (mean bias: 0.8%). Both methods had near-perfect diagnostic accuracy (DECT AUC: 0.989; CMR AUC: 0.985; p = 0.720).
CONCLUSION: Low-contrast DECT-LIE-ECV accurately quantifies MFS when targeting scar regions directly, offering a promising supplementary tool for myocardial scar quantification, especially for patients with contraindications to CMR.