Utility of dual-energy CT-based monochromatic imaging in the assessment of myocardial delayed enhancement in patients with cardiomyopathy

Suyon Chang, Kyunghwa Han, Jong Chan Youn, Dong Jin Im, Jin Young Kim, Young Joo Suh, Yoo Jin Hong, Jin Hur, Young Jin Kim, Byoung Wook Choi, Hye Jeong Lee

Research output: Contribution to journalArticlepeer-review

36 Citations (Scopus)


Purpose: To investigate the diagnostic utility of dual-energy computed tomography (CT)-based monochromatic imaging for myocardial delayed enhancement (MDE) assessment in patients with cardiomyopathy. Materials and Methods: The institutional review board approved this prospective study, and informed consent was obtained from all participants who were enrolled in the study. Forty patients (27 men and 13 women; mean age, 56 years ± 15 [standard deviation]; age range, 22-81 years) with cardiomyopathy underwent cardiac magnetic resonance (MR) imaging and dual-energy CT. Conventional (120-kV) and monochromatic (60-, 70-, and 80-keV) images were reconstructed from the dual-energy CT acquisition. Subjective quality score, contrast-to-noise ratio (CNR), and beam-hardening artifacts were compared pairwise with the Friedman test at post hoc analysis. With cardiac MR imaging as the reference standard, diagnostic performance of dual-energy CT in MDE detection and its predictive ability for pattern classification were compared pairwise by using logistic regression analysis with the generalized estimating equation in a per-segment analysis. The Bland-Altman method was used to find agreement between cardiac MR imaging and CT in MDE quantification. Results: Among the monochromatic images, 70-keV CT images resulted in higher subjective quality (mean score, 3.38 ± 0.54 vs 3.15 ± 0.43; P =.0067), higher CNR (mean, 4.26 ± 1.38 vs 3.93 ± 1.33; P =.0047), and a lower value for beam-hardening artifacts (mean, 3.47 ± 1.56 vs 4.15 ± 1.67; P <.0001) when compared with conventional CT. When compared with conventional CT, 70-keV CT showed improved diagnostic performance for MDE detection (sensitivity, 94.6% vs 90.4% [P =.0032]; specificity, 96.0% vs 94.0% [P =.0031]; and accuracy, 95.6% vs 92.7% [P <.0001]) and improved predictive ability for pattern classification (subendocardial, 91.5% vs 84.3% [P =.0111]; epicardial, 94.3% vs 73.5% [P =.0001]; transmural, 93.0% vs 77.7% [P =.0018]; mesocardial, 85.4% vs 69.2% [P =.0047]; and patchy. 84.4% vs 78.4% [P =.1514]). For MDE quantification, 70-keV CT showed a small bias 0.1534% (95% limits of agreement: 24.7013, 5.0080). Conclusion: Dual-energy CT-based 70-keV monochromatic images improve MDE assessment in patients with cardiomyopathy via improved image quality and CNR and reduced beam-hardening artifacts when compared with conventional CT images.

Original languageEnglish
Pages (from-to)442-451
Number of pages10
Issue number2
Publication statusPublished - 2018 May

Bibliographical note

Funding Information:
Supported by Bracco (1-2014-0047).

Publisher Copyright:
© RSNA, 2018.

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging


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