Dual-energy computed tomography for detection of coronary artery disease

Abstract

Recent technological advances in computed tomography (CT) technology have fulfilled the prerequisites for the cardiac application of dual-energy CT (DECT) imaging. By exploiting the unique characteristics of materials when exposed to two different x-ray energies, DECT holds great promise for the diagnosis and management of coronary artery disease. It allows for the assessment of myocardial perfusion to discern the hemodynamic significance of coronary disease and possesses high accuracy for the detection and characterization of coronary plaques, while facilitating reductions in radiation dose. As such, DECT enabled cardiac CT to advance beyond the mere detection of coronary stenosis expanding its role in the evaluation and management of coronary atherosclerosis.

Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography

“…Dual-energy computed tomography (DECT) was first introduced in the late 1970s and allows for the differentiation of materials based on their X-ray attenuation at different tube voltages (34). The DECT technique allows the simultaneous acquisition of CT data using two different photon spectra (at 80/90/100 kV and 140/150 kV) of distinctly different mean energies within a single helical acquisition (34).…”

“…The DECT technique allows the simultaneous acquisition of CT data using two different photon spectra (at 80/90/100 kV and 140/150 kV) of distinctly different mean energies within a single helical acquisition (34). With this technique pure 80/90/100 kVand 140/150 kV-data sets as well as a weighted average image data set are derived.…”

“…A second approach consists of a single-source CT scanner with rapid kV switching (from 80 to 140 kV) to acquire the dualenergy samples almost simultaneously either in a single gantry rotation (GSI Cardiac; GE Healthcare), or in consecutive rotations (Acquilion One; Toshiba) (12,16,34). A third method involves a single X-ray source CT scanner operating at constant tube voltage with a sandwich detector technology in which the two detectors are superimposed and are composed of different materials (IQon Spectral CT, Philips Medical Systems) (12,16,34).…”

“…Dual-energy derived color-coded iodine maps superimposed on the virtual noncontrast CT data allow the visualization of myocardial iodine distribution during the first pass, arterial phase, which might be considered as a surrogate marker of myocardial perfusion ( Figure 4) (12,16,34).…”

Recent advances in cardiac computed tomography dose reduction strategies: a review of scientific evidence and technical developments

“…Dual energy CT has also been evaluated for myocardial perfusion. 90 Comparable radiation doses between single-and dual-energy CT have been reported although further research is necessary to compare doses with low tube potential single energy CT. 90 Ability to provide additional information from generation of perfusion data might help in decreasing the need of additional radiation-based investigations and reduction in overall radiation dose.…”