Iodine Quantification Based on Rest / Stress Perfusion Dual Energy CT to Differentiate Ischemic, Infarcted and Normal Myocardium

Publication date: Available online 16 January 2019

Source: European Journal of Radiology

Author(s): Marly van Assen, Francesco Lavra, U. Joseph Schoepf, Brian E. Jacobs, Baxter T. Williams, Zachary M. Thompson, Akos Varga-Szemes, Balazs Ruzsics, Matthijs Oudkerk, Rozemarijn Vliegenthart, Carlo N. De Cecco

Abstract

Background

The aim of this study was to assess the potential of rest-stress DECT iodine quantification to discriminate between normal, ischemic, and infarcted myocardium.

Methods

Patients who underwent rest-stress DECT on a 2^nd generation dual-source system and cardiac magnetic resonance (CMR) were retrospectively included from a prospective study cohort. CMR was performed to identify ischemic and infarcted myocardium and categorize patients into ischemic, infarcted, and control groups. Controls were analyzed on a per-slice and per-segment basis. Regions of interest (ROIs) were placed in ischemic and infarcted areas based on CMR. Additionally, ROIs were placed in the septal area to assess normal and remote myocardium.

Results

We included 42 patients: 10 ischemic, 17 infarcted, and 15 controls. Iodine concentrations showed no significant between segments in controls. Iodine concentrations for normal myocardium increased significantly from rest to stress (median 3.7 mg/mL (interquartile range 3.5-3.9) vs. 4.5 mg/mL (4.3-4.9)) (p < 0.001). Iodine concentrations in diseased myocardium were significantly lower than in normal myocardium; 1.3 mg/mL (0.9-1.8) and 0.6 mg/mL (0.4-0.8) at rest and stress in ischemic myocardium, and 0.3 mg/mL (0.3-0.5) and 0.5 mg/mL (0.5-0.7) at rest and stress in infarcted myocardium (p < 0.005 and p < 0.001). At rest only, iodine concentrations were significantly lower in infarcted vs. ischemic myocardium (p < 0.001). The optimal threshold for differentiating diseased from normal myocardium was 2.5 mg/mL and 2.1 mg/mL for rest and stress (AUC 1.00). To discriminate ischemic from infarcted myocardium, the optimal threshold was 1.0 mg/ml (AUC 0.944) at rest.

Conclusion

DECT iodine concentration from rest-stress imaging can potentially differentiate between normal, ischemic, and infarcted myocardium.

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