title: Clinical experiences of delayed contrast enhancement with cardiac computed tomography: case series.
abstract: BACKGROUND
  Myocardial delayed enhancement (MDE) by gadolinium-enhanced cardiac MRI is well established for myocardial scar assessment in ischemic and non-ischemic heart disease. The role of MDE by cardiac CT (CT-MDE) is not yet defined.
  
  
  RESULTS
  We reviewed all clinical cases of CT-MDE at a tertiary referral center to present the cases as a case series. All clinical cardiac CT exams which utilized CT-MDE imaging between January 1, 2005 and October 1, 2010 were collected as a series and their findings were also compared with available myocardial imaging to assess for myocardial abnormalities, including echocardiography (wall motion, morphology), cardiac MRI (delayed enhancement, morphology), SPECT MPI (perfusion defects). 5,860 clinical cardiac CT exams were performed during the study period. CT-MDE was obtained in 18 patients and was reported to be present in 9 patients. The indications for CT-MDE included ischemic and non-ischemic heart diseases. In segments positive for CT-MDE, there was excellent agreement of CT with other modalities: echocardiography (n=8) demonstrated abnormal morphology and wall motion (k=1.0 and k=0.82 respectively); prior MRI (n=2) demonstrated abnormal delayed enhancement (MR-MDE) (k=1.0); SPECT MPI (n=1) demonstrated fixed perfusion defects (k=1.0). In the subset of patients without CT-MDE, no abnormal segments were identified by echocardiography (n=8), MRI (n=1) and nuclear MPI (n=0).
  
  
  CONCLUSIONS
  CT-MDE was performed in rare clinical situations. The indications included both ischemic and non-ischemic heart disease and there was an excellent agreement between CT-MDE and abnormal myocardium by echocardiography, cardiac MRI, and nuclear MPI.
authors.affiliation: Department of Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA. manavsidhu83@gmail.com
authors.forename: Manavjot S
authors.initials: MS
authors.lastname: Sidhu
authors.forename: Brian B
authors.initials: BB
authors.lastname: Ghoshhajra
authors.forename: Shanmugam
authors.initials: S
authors.lastname: Uthamalingam
authors.forename: Niamh
authors.initials: N
authors.lastname: Kilcullen
authors.forename: Leif-Christopher
authors.initials: LC
authors.lastname: Engel
authors.forename: Hector M
authors.initials: HM
authors.lastname: Medina
authors.forename: Vikram
authors.initials: V
authors.lastname: Venkatesh
authors.forename: Yongkasem
authors.initials: Y
authors.lastname: Vorasettakarnkij
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Ricardo C
authors.initials: RC
authors.lastname: Cury
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Brady
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D004562:Electrocardiography; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media