title: Dual-contrast agent photon-counting computed tomography of the heart: initial experience.
abstract: To determine the feasibility of dual-contrast agent imaging of the heart using photon-counting detector (PCD) computed tomography (CT) to simultaneously assess both first-pass and late enhancement of the myocardium. An occlusion-reperfusion canine model of myocardial infarction was used. Gadolinium-based contrast was injected 10 min prior to PCD CT. Iodinated contrast was infused immediately prior to PCD CT, thus capturing late gadolinium enhancement as well as first-pass iodine enhancement. Gadolinium and iodine maps were calculated using a linear material decomposition technique and compared to single-energy (conventional) images. PCD images were compared to in vivo and ex vivo magnetic resonance imaging (MRI) and histology. For infarct versus remote myocardium, contrast-to-noise ratio (CNR) was maximal on late enhancement gadolinium maps (CNR 9.0 ± 0.8, 6.6 ± 0.7, and 0.4 ± 0.4, p < 0.001 for gadolinium maps, single-energy images, and iodine maps, respectively). For infarct versus blood pool, CNR was maximum for iodine maps (CNR 11.8 ± 1.3, 3.8 ± 1.0, and 1.3 ± 0.4, p < 0.001 for iodine maps, gadolinium maps, and single-energy images, respectively). Combined first-pass iodine and late gadolinium maps allowed quantitative separation of blood pool, scar, and remote myocardium. MRI and histology analysis confirmed accurate PCD CT delineation of scar. Simultaneous multi-contrast agent cardiac imaging is feasible with photon-counting detector CT. These initial proof-of-concept results may provide incentives to develop new k-edge contrast agents, to investigate possible interactions between multiple simultaneously administered contrast agents, and to ultimately bring them to clinical practice.
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Drive, Bldg 10, Bethesda, MD, USA.
authors.forename: Rolf
authors.initials: R
authors.lastname: Symons
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Drive, Bldg 10, Bethesda, MD, USA.
authors.forename: Tyler E
authors.initials: TE
authors.lastname: Cork
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Drive, Bldg 10, Bethesda, MD, USA.
authors.forename: Manu N
authors.initials: MN
authors.lastname: Lakshmanan
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Drive, Bldg 10, Bethesda, MD, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Evers
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Drive, Bldg 10, Bethesda, MD, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Davies-Venn
authors.affiliation: Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Rice
authors.affiliation: Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Marvin L
authors.initials: ML
authors.lastname: Thomas
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Drive, Bldg 10, Bethesda, MD, USA.
authors.forename: Chia-Ying
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Siemens Healthcare GmbH, Forchheim, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Kappler
authors.affiliation: Siemens Healthcare GmbH, Forchheim, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Ulzheimer
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Drive, Bldg 10, Bethesda, MD, USA.
authors.forename: Veit
authors.initials: V
authors.lastname: Sandfort
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Drive, Bldg 10, Bethesda, MD, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Drive, Bldg 10, Bethesda, MD, USA. amir.pourmorteza@nih.gov.
authors.forename: Amir
authors.identifier: http://orcid.org/0000-0001-7149-5424
authors.initials: A
authors.lastname: Pourmorteza
mesh_terms: D000818:Animals; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage*; D004195:Disease Models, Animal; D004285:Dogs; D005240:Feasibility Studies; D006321:Heart / Q000000981:diagnostic imaging*; D007090:Image Interpretation, Computer-Assisted; D007479:Iopamidol / Q000008:administration & dosage*; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008536:Meglumine / Q000008:administration & dosage*; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000473:pathology; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging* / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D009942:Organometallic Compounds / Q000008:administration & dosage*; D017785:Photons; D011189:Potassium Chloride / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D000075082:Proof of Concept Study; D015203:Reproducibility of Results; D059629:Signal-To-Noise Ratio; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D011189:Potassium Chloride; D008536:Meglumine; D007479:Iopamidol; C072417:gadoterate meglumine
keywords: Cardiac imaging techniques; Computed tomography; Contrast media; Myocardial infarction; Photon-counting CT; Spectral CT