title: Dual-energy CT of the heart--principles and protocols.
abstract: The introduction of coronary CT angiography (cCTA) has reinvigorated the debate whether management of patients with suspected coronary artery disease (CAD) should be primarily based on physiological versus anatomical testing. Anatomical testing (i.e., cCTA or invasive catheterization) enables direct visualization and grading of coronary artery stenoses but has shortcomings for gauging the hemodynamic significance of lesions for myocardial perfusion. Conversely, rest/stress myocardial perfusion imaging (MPI) has been extensively validated for assessing the clinical significance of CAD by demonstrating fixed or reversible perfusion defects but has only limited anatomical information. There is early evidence that contrast medium enhanced dual-energy cCTA (DECT) has potential for the comprehensive analysis of coronary artery morphology as well as changes in myocardial perfusion. DECT exploits the fact that tissues in the human body and iodine-based contrast media have unique absorption characteristics when penetrated with different X-ray energy levels, which enables mapping the iodine (and thus blood) distribution within the myocardium. The purpose of this communication is to describe the practical application of this emerging technology for the comprehensive diagnosis of coronary artery disease in the context of the currently used tomographic imaging modalities (cCTA, nuclear MPI, MR MPI).
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29401, USA.
authors.forename: Florian
authors.initials: F
authors.lastname: Schwarz
authors.forename: Balazs
authors.initials: B
authors.lastname: Ruzsics
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.forename: Gorka
authors.initials: G
authors.lastname: Bastarrika
authors.forename: Salvatore A
authors.initials: SA
authors.lastname: Chiaramida
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Abro
authors.forename: Robin L
authors.initials: RL
authors.lastname: Brothers
authors.forename: Sebastian
authors.initials: S
authors.lastname: Vogt
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schmidt
authors.forename: Philip
authors.initials: P
authors.lastname: Costello
authors.forename: Peter L
authors.initials: PL
authors.lastname: Zwerner
mesh_terms: D002114:Calcinosis / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D006801:Humans; D011856:Radiographic Image Enhancement / Q000379:methods*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*