title: Myocardial scar imaging by standard single-energy and dual-energy late enhancement CT: Comparison with pathology and electroanatomic map in an experimental chronic infarct porcine model.
abstract: BACKGROUND
  Myocardial scar is a substrate for ventricular tachycardia and sudden cardiac death. Late enhancement CT imaging can detect scar, but it remains unclear whether newer late enhancement dual-energy (LE-DECT) acquisition has benefit over standard single-energy late enhancement (LE-CT).
  
  
  OBJECTIVE
  We aim to compare late enhancement CT using newer LE-DECT acquisition and single-energy LE-CT acquisitions with pathology and electroanatomic map (EAM) in an experimental chronic myocardial infarction (MI) porcine study.
  
  
  METHODS
  In 8 pigs with chronic myocardial infarction (59 ± 5 kg), we performed dual-source CT, EAM, and pathology. For CT imaging, we performed 3 acquisitions at 10 minutes after contrast administration: LE-CT 80 kV, LE-CT 100 kV, and LE-DECT with 2 postprocessing software settings.
  
  
  RESULTS
  Of the sequences, LE-CT 100 kV provided the best contrast-to-noise ratio (all P ≤ .03) and correlation to pathology for scar (ρ = 0.88). LE-DECT overestimated scar (both P = .02), whereas LE-CT images did not (both P = .08). On a segment basis (n = 136), all CT sequences had high specificity (87%-93%) and modest sensitivity (50%-67%), with LE-CT 100 kV having the highest specificity of 93% for scar detection compared to pathology and agreement with EAM (κ = 0.69).
  
  
  CONCLUSIONS
  Standard single-energy LE-CT, particularly 100 kV, matched better to pathology and EAM than dual-energy LE-DECT for scar detection. Larger human trials as well as more technical studies that optimize varying different energies with newer hardware and software are warranted.
authors.affiliation: Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and the New York-Presbyterian Hospital, 413 E. 69th Street, Suite 108, New York, NY 10021, USA; Division of Cardiology, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, NY, USA. Electronic address: qat9001@med.cornell.edu.
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
authors.affiliation: Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Wai-Ee
authors.initials: WE
authors.lastname: Thai
authors.affiliation: Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Wai
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Cordaro
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Cheng
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Beaudoin
authors.affiliation: Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and the New York-Presbyterian Hospital, 413 E. 69th Street, Suite 108, New York, NY 10021, USA.
authors.forename: Guanglei
authors.initials: G
authors.lastname: Xiong
authors.affiliation: Division of Cardiology, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Jim W
authors.initials: JW
authors.lastname: Cheung
authors.affiliation: Al-Sabah Arrhythmia Institute, Mount Sinai St. Luke's-Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Altman
authors.affiliation: Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and the New York-Presbyterian Hospital, 413 E. 69th Street, Suite 108, New York, NY 10021, USA; Division of Cardiology, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Jagmeet P
authors.initials: JP
authors.lastname: Singh
authors.affiliation: Al-Sabah Arrhythmia Institute, Mount Sinai St. Luke's-Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Conor D
authors.initials: CD
authors.lastname: Barrett
authors.affiliation: Al-Sabah Arrhythmia Institute, Mount Sinai St. Luke's-Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Stephan
authors.initials: S
authors.lastname: Danik
mesh_terms: D000818:Animals; D018780:Body Surface Potential Mapping; D002921:Cicatrix / Q000175:diagnosis* / Q000209:etiology; D003287:Contrast Media / Q000008:administration & dosage; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D017682:Myocardial Stunning / Q000175:diagnosis* / Q000209:etiology; D011829:Radiation Dosage; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013552:Swine; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Computed tomography; Electrophysiology; Imaging; Myocardial infarction; Myocardial scar