Myocardial Extracellular Volume Fraction with Dual-Energy Equilibrium Contrast-enhanced Cardiac CT in Nonischemic Cardiomyopathy: A Prospective Comparison with Cardiac MR Imaging.
Purpose To evaluate the feasibility of equilibrium contrast material-enhanced dual-energy cardiac computed tomography (CT) to determine extracellular volume fraction (ECV) in nonischemic cardiomyopathy (CMP) compared with magnetic resonance (MR) imaging. Materials and Methods This study was approved by the institutional review board; informed consent was obtained. Seven healthy subjects and 23 patients (six with hypertrophic CMP, nine with dilated CMP, four with amyloidosis, and four with sarcoidosis) (mean age ± standard deviation, 57.33 years ± 14.82; 19 male participants [63.3%]) were prospectively enrolled. Twelve minutes after contrast material injection (1.8 mL/kg at 3 mL/sec), dual-energy cardiac CT was performed. ECV was measured by two observers independently. Hematocrit levels were compared between healthy subjects and patients with the Mann-Whitney U test. In per-subject analysis, interobserver agreement for CT was assessed with the intraclass correlation coefficient (ICC), and intertest agreement between MR imaging and CT was assessed with Bland-Altman analysis. In per-segment analysis, Student t tests in the linear mixed model were used to compare ECV on CT images between healthy subjects and patients. Results Hematocrit level was 43.44% ± 1.80 for healthy subjects and 41.23% ± 5.61 for patients with MR imaging (P = .16) and 43.50% ± 1.92 for healthy subjects and 41.35% ± 5.92 for patients with CT (P = .15). For observer 1 in per-subject analysis, ECV was 34.18% ± 8.98 for MR imaging and 34.48% ± 8.97 for CT. For observer 2, myocardial ECV was 34.42% ± 9.03 for MR imaging and 33.98% ± 9.05 for CT. Interobserver agreement for ECV at CT was excellent (ICC = 0.987). Bland-Altman analysis between MR imaging and CT showed a small bias (-0.06%), with 95% limits of agreement of -1.19 and 1.79. Compared with healthy subjects, patients with hypertrophic CMP, dilated CMP, amyloidosis, and sarcoidosis had significantly higher myocardial ECV at dual-energy equilibrium contrast-enhanced cardiac CT (all P < .01) in per-segment analysis. Conclusion Myocardial ECV with dual-energy equilibrium contrast-enhanced CT showed good agreement with MR imaging findings, suggesting the potential of myocardial tissue characterization with CT. (©) RSNA, 2016.
From the Department of Radiology, Research Institute of Radiological Science (H.J.L., D.J.I., S.C., Y.J.S., Y.J.H., Y.J.K., J.H., B.W.C.), and Division of Cardiology, Cardiovascular Hospital (J.C.Y.), Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
Hye-Jeong
HJ
Lee
From the Department of Radiology, Research Institute of Radiological Science (H.J.L., D.J.I., S.C., Y.J.S., Y.J.H., Y.J.K., J.H., B.W.C.), and Division of Cardiology, Cardiovascular Hospital (J.C.Y.), Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
Dong Jin
DJ
Im
From the Department of Radiology, Research Institute of Radiological Science (H.J.L., D.J.I., S.C., Y.J.S., Y.J.H., Y.J.K., J.H., B.W.C.), and Division of Cardiology, Cardiovascular Hospital (J.C.Y.), Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
Jong-Chan
JC
Youn
From the Department of Radiology, Research Institute of Radiological Science (H.J.L., D.J.I., S.C., Y.J.S., Y.J.H., Y.J.K., J.H., B.W.C.), and Division of Cardiology, Cardiovascular Hospital (J.C.Y.), Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
Suyon
S
Chang
From the Department of Radiology, Research Institute of Radiological Science (H.J.L., D.J.I., S.C., Y.J.S., Y.J.H., Y.J.K., J.H., B.W.C.), and Division of Cardiology, Cardiovascular Hospital (J.C.Y.), Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
Young Joo
YJ
Suh
From the Department of Radiology, Research Institute of Radiological Science (H.J.L., D.J.I., S.C., Y.J.S., Y.J.H., Y.J.K., J.H., B.W.C.), and Division of Cardiology, Cardiovascular Hospital (J.C.Y.), Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
Yoo Jin
YJ
Hong
From the Department of Radiology, Research Institute of Radiological Science (H.J.L., D.J.I., S.C., Y.J.S., Y.J.H., Y.J.K., J.H., B.W.C.), and Division of Cardiology, Cardiovascular Hospital (J.C.Y.), Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
Young Jin
YJ
Kim
From the Department of Radiology, Research Institute of Radiological Science (H.J.L., D.J.I., S.C., Y.J.S., Y.J.H., Y.J.K., J.H., B.W.C.), and Division of Cardiology, Cardiovascular Hospital (J.C.Y.), Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
Jin
J
Hur
From the Department of Radiology, Research Institute of Radiological Science (H.J.L., D.J.I., S.C., Y.J.S., Y.J.H., Y.J.K., J.H., B.W.C.), and Division of Cardiology, Cardiovascular Hospital (J.C.Y.), Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
Byoung Wook
BW
Choi
D009202:Cardiomyopathies / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods*; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods*; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media