Interstitial Myocardial Fibrosis Assessed as Extracellular Volume Fraction with Low-Radiation-Dose Cardiac CT

Nacif, Marcelo Souto; Kawel, Nadine; Lee, Jason J.; Chen, Xinjian; Yao, Jianhua; Zavodni, Anna; Sibley, Christopher T.; Lima, João A.C.; Liu, Songtao; Bluemke, David A.

doi:10.1148/radiol.12112458

Cited by 169 publications

(134 citation statements)

References 31 publications

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“…Through the dual-energy technique, measurements were only performed on the iodine maps of equilibrium contrast-enhanced cardiac CT, which resulted in accurate measurements of ECV with minimal misregistration. In one study, investigators reported a bias of 23.01%, with 95% limits of agreement from 22.82% to 8.85% for ECV measurement between MR imaging and CT (11). Another study demonstrated a bias of 1.40% but with wide 95% limits of agreement (234.70% to 31.90%) (12).…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…Although a few studies about myocardial ECV on cardiac CT images have been published (11)(12)(13)(14), a method involving both unenhanced (precontrast) and contrast-enhanced (postcontrast) CT is thought to be of limited use, because the myocardium and blood might not be easily differentiated on precontrast CT images, and misregistration between the pre-and postcontrast CT images might reduce accuracy.…”

Section: Study Populationmentioning

confidence: 99%

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Myocardial Extracellular Volume Fraction with Dual-Energy Equilibrium Contrast-enhanced Cardiac CT in Nonischemic Cardiomyopathy: A Prospective Comparison with Cardiac MR Imaging

Lee¹,

Im²,

Youn³

et al. 2016

Radiology

137

101

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Purpose To evaluate the feasibility of equilibrium contrast material-enhanced dual-energy cardiac computed tomography (CT) to determine extracellular volume fraction (ECV) in nonischemic cardiomyopathy (CMP) compared with magnetic resonance (MR) imaging. Materials and Methods This study was approved by the institutional review board; informed consent was obtained. Seven healthy subjects and 23 patients (six with hypertrophic CMP, nine with dilated CMP, four with amyloidosis, and four with sarcoidosis) (mean age ± standard deviation, 57.33 years ± 14.82; 19 male participants [63.3%]) were prospectively enrolled. Twelve minutes after contrast material injection (1.8 mL/kg at 3 mL/sec), dual-energy cardiac CT was performed. ECV was measured by two observers independently. Hematocrit levels were compared between healthy subjects and patients with the Mann-Whitney U test. In per-subject analysis, interobserver agreement for CT was assessed with the intraclass correlation coefficient (ICC), and intertest agreement between MR imaging and CT was assessed with Bland-Altman analysis. In per-segment analysis, Student t tests in the linear mixed model were used to compare ECV on CT images between healthy subjects and patients. Results Hematocrit level was 43.44% ± 1.80 for healthy subjects and 41.23% ± 5.61 for patients with MR imaging (P = .16) and 43.50% ± 1.92 for healthy subjects and 41.35% ± 5.92 for patients with CT (P = .15). For observer 1 in per-subject analysis, ECV was 34.18% ± 8.98 for MR imaging and 34.48% ± 8.97 for CT. For observer 2, myocardial ECV was 34.42% ± 9.03 for MR imaging and 33.98% ± 9.05 for CT. Interobserver agreement for ECV at CT was excellent (ICC = 0.987). Bland-Altman analysis between MR imaging and CT showed a small bias (-0.06%), with 95% limits of agreement of -1.19 and 1.79. Compared with healthy subjects, patients with hypertrophic CMP, dilated CMP, amyloidosis, and sarcoidosis had significantly higher myocardial ECV at dual-energy equilibrium contrast-enhanced cardiac CT (all P < .01) in per-segment analysis. Conclusion Myocardial ECV with dual-energy equilibrium contrast-enhanced CT showed good agreement with MR imaging findings, suggesting the potential of myocardial tissue characterization with CT. (©) RSNA, 2016.

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Section: Baseline Characteristicsmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Myocardial Extracellular Volume Fraction with Dual-Energy Equilibrium Contrast-enhanced Cardiac CT in Nonischemic Cardiomyopathy: A Prospective Comparison with Cardiac MR Imaging

Lee¹,

Im²,

Youn³

et al. 2016

Radiology

137

101

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“…Whilst CCT has been used to accurately demonstrate ventricular myocardial fibrosis 115,116 CMR remains the accepted standard. 117 Improvements in CMR techniques in recent years have allowed them to be applied to thin-walled structures such as the LA.…”

Section: Scar Formationmentioning

confidence: 99%

The Role of Left Atrial Imaging in the Management of Atrial Fibrillation

Walters

Ellims

Kalman

2015

Progress in Cardiovascular Diseases

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“…An experimental ECVF calculation equation has been proposed in our previous work, 10 but the principle behind the ECVF calculation has not been elucidated so far. In this section, we present the derivation of the ECVF calculation equation based on the tissue compartmental model.…”

Section: A Principle Of Ecvf Calculation Using Dual-phase Ct Imagesmentioning

confidence: 99%

“…Therefore, we sought to use a dual-phase cardiac CT to determine ECVF and demonstrated the successful substitution of cardiac CT for cardiac MR in ECVF analysis in our previous work. 10 However, the low contrast sensitivity and poor quality of the low dose CT images pose a significant challenge in integrating this novel technique into the clinic practice.…”

Section: Introductionmentioning

confidence: 99%

A framework to measure myocardial extracellular volume fraction using dual‐phase low dose CT images

Liu

Nacif

et al. 2013

Medical Physics

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Purpose: Myocardial extracellular volume fraction (ECVF) is a surrogate imaging biomarker of diffuse myocardial fibrosis, a hallmark of pathologic ventricular remodeling. Low dose cardiac CT is emerging as a promising modality to detect diffuse interstitial myocardial fibrosis due to its fast acquisition and low radiation; however, the insufficient contrast in the low dose CT images poses great challenge to measure ECVF from the image. Methods: To deal with this difficulty, the authors present a complete ECVF measurement framework including a point-guided myocardial modeling, a deformable model-based myocardium segmentation, nonrigid registration of pre-and post-CT, and ECVF calculation. Results: The proposed method was evaluated on 20 patients by two observers. Compared to the manually delineated reference segmentations, the accuracy of our segmentation in terms of true positive volume fraction (TPVF), false positive volume fraction (FPVF), and average surface distance (ASD), were 92.18% ± 3.52%, 0.31% ± 0.10%, 0.69 ± 0.14 mm, respectively. The interobserver variability measured by concordance correlation coefficient regarding TPVF, FPVF, and ASD were 0.95, 0.90, 0.94, respectively, demonstrating excellent agreement. Bland-Altman method showed 95% limits of agreement between ECVF at CT and ECVF at MR. Conclusions: The proposed framework demonstrates its efficiency, accuracy, and noninvasiveness in ECVF measurement and dramatically advances the ECVF at cardiac CT toward its clinical use.

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Interstitial Myocardial Fibrosis Assessed as Extracellular Volume Fraction with Low-Radiation-Dose Cardiac CT

Cited by 169 publications

References 31 publications

Myocardial Extracellular Volume Fraction with Dual-Energy Equilibrium Contrast-enhanced Cardiac CT in Nonischemic Cardiomyopathy: A Prospective Comparison with Cardiac MR Imaging

Myocardial Extracellular Volume Fraction with Dual-Energy Equilibrium Contrast-enhanced Cardiac CT in Nonischemic Cardiomyopathy: A Prospective Comparison with Cardiac MR Imaging

The Role of Left Atrial Imaging in the Management of Atrial Fibrillation

A framework to measure myocardial extracellular volume fraction using dual‐phase low dose CT images

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