Delayed enhancement imaging of myocardial viability: low-dose high-pitch CT versus MRI

• DOI: 10.1007/s00330-011-2149-8
• Publication Date: 2011-05-14T13:52:12Z
• Authors: Robert Goetti; Gudrun Feuchtner; Paul Stolzmann; Olivio F. Donati; Monika Wieser; André Plass; Thomas Frauenfelder; Sebastian Leschka; Hatem Alkadhi
• Keywords: Aged, 80 and over; Male; 10042 Clinic for Diagnostic and Interventional Radiology; Myocardium; Reproducibility of Results; 610 Medicine & health; Coronary Artery Disease; Middle Aged; Reference Standards; Magnetic Resonance Imaging; 10020 Clinic for Cardiac Surgery; 3. Good health; Electrocardiography; 03 medical and health sciences; 0302 clinical medicine; Preoperative Period; 2741 Radiology, Nuclear Medicine and Imaging; Humans; Female; Coronary Artery Bypass; Tomography, X-Ray Computed; Algorithms; Aged

To evaluate the accuracy of high-pitch delayed enhancement (DE) CT for the assessment of myocardial viability with MRI as the reference standard.Twenty-four patients (mean age 66.9 ± 9.2 years) with coronary artery disease underwent DE imaging with 128-slice dual-source CT (prospective electrocardiography (ECG)-triggering) and MRI at 1.5 T. Two observers assessed DE transmurality per segment, and measured signal intensity (MRI) or attenuation (CT) in infarcted and healthy myocardium and noise in the left ventricular blood pool for calculating contrast-to-noise ratios (CNR).75/408 (18.4%) segments in 18/24 patients (75.0%) showed DE in MRI, of which 28 segments in 10/24 (41.7%) patients were non-viable (scar tissue transmurality >50%). Sensitivity, specificity and accuracy of CT for diagnosis of non-viability were 60.7%, 96.8% and 94.4% per segment, and 90.0%, 92.9% and 91.7% per patient. CNR was significantly higher in MR (7.4 ± 3.0 vs. 4.6 ± 1.5; p = 0.018), and image noise significantly lower (11.6 ± 5.7 vs.15.0 ± 4.5; p = 0.019). Radiation dose of DECT was 0.89 ± 0.07 mSv.CTDE imaging in the high-pitch mode enables myocardial viability assessment at a low radiation dose and good accuracy compared with MR, although associated with a lower CNR and higher noise.