Detection of Myocardial Infarction Using Delayed Enhancement Dual-Energy CT in Stable Patients.
AJR Am J Roentgenol. 2017 Nov;209(5):1023-1032. doi: 10.2214/AJR.17.18118. Epub 2017 Aug 31. Rodriguez-Granillo GA1, Campisi R1, Deviggiano A1, de Munain MNL1, Zan M1, Capunay C1, Carrascosa P1.
OBJECTIVE: The objective of our study was to explore whether delayed enhancement dual-energy CT (DECT) allows the detection of myocardial infarcts in stable patients.
SUBJECTS AND METHODS: Patients with known or suspected coronary artery disease clinically referred for myocardial perfusion imaging using SPECT were prospectively included. All patients (n = 34) also underwent stress, rest, and delayed enhancement DECT on a DECT scanner. At SPECT, segments with myocardial infarction (MI) were defined as those with a summed rest score of ≥ 2 in two or more consecutive segments, and a diagnosis of MI was supported by wall motion abnormalities, clinical history, and ECG findings.
RESULTS: Segments with MI were identified in 13 (38%), 15 (44%), and 14 (41%) patients using SPECT, perfusion CT, and delayed enhancement DECT, respectively. When combined SPECT and perfusion CT results were used as the reference standard, delayed enhancement DECT had a sensitivity, specificity, positive predictive value, and negative predictive value for the detection of MI of 91.7% (95% CI, 62-98%), 86.4% (95% CI, 65-97%), 78.6% (95% CI, 49-95%), and 95.0% (95% CI, 75-100%). At delayed enhancement DECT (40 keV), a signal attenuation higher than 161 HU had a sensitivity of 72% and a specificity of 79% for the detection of MI on a per-segment basis. The median signal attenuation of myocardial infarcts at 40 keV was 3.0 SDs (interquartile range, 1.3-4.0 SDs) above that of normal myocardium.
CONCLUSION: In this study, delayed enhancement DECT allowed the detection of myocardial infarcts in stable patients.