title: Delayed enhancement imaging of myocardial viability: low-dose high-pitch CT versus MRI.
abstract: OBJECTIVE
  To evaluate the accuracy of high-pitch delayed enhancement (DE) CT for the assessment of myocardial viability with MRI as the reference standard.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
authors.forename: Robert
authors.initials: R
authors.lastname: Goetti
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.forename: Paul
authors.initials: P
authors.lastname: Stolzmann
authors.forename: Olivio F
authors.initials: OF
authors.lastname: Donati
authors.forename: Monika
authors.initials: M
authors.lastname: Wieser
authors.forename: André
authors.initials: A
authors.lastname: Plass
authors.forename: Thomas
authors.initials: T
authors.lastname: Frauenfelder
authors.forename: Sebastian
authors.initials: S
authors.lastname: Leschka
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001026:Coronary Artery Bypass / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D057234:Preoperative Period; D012015:Reference Standards; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*