Single-source dual energy CT to assess myocardial extracellular volume fraction in aortic stenosis before transcatheter aortic valve implantation (TAVI)

Dubourg, B.; Dacher, J.-N.; Durand, Éric; Caudron, Jérôme; Bubenheim, Michael; Eltchaninoff, Hélène; Serfaty, Jean-Michel

doi:10.1016/j.diii.2021.03.003

Cited by 15 publications

(19 citation statements)

References 35 publications

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“…Altogether, the ECV values reported in the present study are in line with the data available with CMR. This is not a surprising finding, considering the high concordance between these modalities for ECV quantification as demonstrated by recent comparative studies which permits the use of this biomarker for multiple prospects [8,11,14,21]. Hence, we showed recently that ECV enabled by DECT allows a prediction of cardiac complications in acute myocarditis [34].…”

Section: Discussionsupporting

confidence: 64%

“…The novelty of the present study is the use of CT in a suspected population of myocarditis and as so the report of ECV values which can be the starting point for its implementation in clinical routine. In the same line, few studies have reported the ECV values of different cardiopathies such as heart failure, global cardiomyopathies, cardiac amyloidosis or in aortic stenosis patients [ 14 , 21 , 22 ]. Taken together, these studies are holding great promises for cardiac CT imaging because of its many advantages.…”

Section: Discussionmentioning

confidence: 99%

“…Myocardial ECV increases related to myocardial fibroses, cardiac amyloid or edema [ 8 ]. CMR is the reference to measure ECV, but some previous studies showed that ECV can also be successfully determined with computed tomography, whether with single-energy computed tomography (SECT) or with dual-energy computed tomography (DECT), with a high correlation between ECV measurements derived from CT, histologic quantification, and CMR [ 9 , 10 , 11 , 12 , 13 , 14 ]. Hence, CT can effectively be considered as an interesting alternative to CMR.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Performance of Extracellular Volume Quantified by Dual-Layer Dual-Energy CT for Detection of Acute Myocarditis

Restier

Boccalini

Congi

et al. 2021

JCM

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Background: Myocardial extracellular volume (ECV) is a marker of the myocarditis inflammation burden and can be used for acute myocarditis diagnosis. Dual-energy computed tomography (DECT) enables its quantification with high concordance with cardiac magnetic resonance (CMR). Purpose: To investigate the diagnostic performance of myocardial ECV quantified on a cardiac dual-layer DECT in a population of patients with suspected myocarditis, in comparison to CMR. Methods: 78 patients were included in this retrospective monocenter study, 60 were diagnosed with acute myocarditis and 18 patients were considered as a control population, based on the 2009 Lake and Louise criteria. All subjects underwent a cardiac DECT in acute phase consisted in an arterial phase followed by a late iodine enhancement phase at 10 min after injection (1.2 mL/kg, iodinated contrast agent). ECV was calculated using the hematocrit level measured the day of DECT examinations. Non-parametric analyses have been used to test the differences between groups and the correlations between the variables. A ROC curve has been used to identify the optimal ECV cut-off discriminating value allowing the detection of acute myocarditis cases. A p value < 0.05 has been considered as significant. Results: The mean ECV was significantly higher (p < 0.001) for the myocarditis group compared to the control (34.18 ± 0.43 vs. 30.04 ± 0.53%). A cut-off value of ECV = 31.60% (ROC AUC = 0.835, p < 0.001) allows to discriminate the myocarditis with a sensitivity of 80% and a specificity of 78% (positive predictive value = 92.3%, negative predictive value = 53.8% and accuracy = 79.5%). Conclusion: Myocardial ECV enabled by DECT allows to diagnose the acute myocarditis with a cut-off at 31.60% for a sensitivity of 80% and specificity of 78%.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic Performance of Extracellular Volume Quantified by Dual-Layer Dual-Energy CT for Detection of Acute Myocarditis

Restier

Boccalini

Congi

et al. 2021

JCM

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“…We found median ECV values of 30.5%, which is in good agreement with values reported in the literature for patients with severe aortic stenosis. 6,7,11,34 Considering the transmural ECV gradients, we found significant endoepicardial gradients for the anterior, lateral, and posterior walls of the left ventricle. This fibrosis gradient has already been previously described in patients with severe aortic stenosis and may be reflective of a reparative response to low-endocardial perfusion and consecutive myocardial ischemia.…”

Section: Discussionmentioning

confidence: 78%

Extracellular Volume Quantification With Cardiac Late Enhancement Scanning Using Dual-Source Photon-Counting Detector CT

et al. 2022

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Objectives: The aim of this study was to evaluate the feasibility and accuracy of cardiac late enhancement (LE) scanning for extracellular volume (ECV) quantification with dual-source photon-counting detector computed tomography (PCD-CT). Materials and Methods: In this institutional review board-approved study, 30 patients (mean age, 79 years; 12 women; mean body mass index, 28 kg/m 2 ) with severe aortic stenosis undergoing PCD-CT as part of their preprocedural workup for transcatheter aortic valve replacement were included. The scan protocol consisted of a nonenhanced calcium-scoring scan, coronary CT angiography (CTA) followed by CTA of the thoracoabdominal aorta, and a low-dose LE scan 5 minutes after the administration of 100 mL contrast media (all scans electrocardiogram-gated). Virtual monoenergetic (65 keV) and dual-energy (DE) iodine images were reconstructed from the LE scan. Extracellular volume was calculated using the iodine ratios of myocardium and blood-pool of the LE scan, and additionally based on single-energy (SE) subtraction of the nonenhanced scan from the LE scan. Three-dimensional analysis was performed automatically for the whole-heart myocardial volume by matching a heart model generated from the respective coronary CTA data. Bland-Altman and correlation analysis were used to compare the ECV values determined by both methods. Results: The median dose length product for the LE scan was 84 mGy•cm (interquartile range, 69; 125 mGy•cm). Extracellular volume quantification was feasible in all patients. The median ECV value was 30.5% (interquartile range, 28.4%-33.6%). Two focal ECV elevations matched known prior myocardial infarction. The DE-and SE-based ECV quantification correlated well (r = 0.87, P < 0.001). Bland-Altman analysis showed small mean errors between DE-and SE-based ECV quantification (0.9%; 95% confidence interval, 0.1%-1.6%) with narrow limits of agreement (−3.3% to 5.0%). Conclusions: Dual-source PCD-CT enables accurate ECV quantification using an LE cardiac DE scan at low radiation dose. Extracellular volume calculation from iodine ratios of the LE scan obviates the need for acquisition of a true nonenhanced scan and is not affected by potential misregistration between 2 separate scans.

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“…Измерение ВММ основано на измерении разницы в концентрации внеклеточного индикатора (в случае методов лучевой диагностики -контрастного препарата) между миокардом и кровотоком в момент равновесной концентрации в сочетании с измерением объема распределения крови (традиционно оценивается как: 1-уровень гематокрита (Ht)) [6,7].…”

Section: Introductionunclassified

Detection of extracellular myocardial matrix with Dual Energy computed tomography: systematic review and meta-analysis

Lisitskaya

Vershinina

Мершина

et al. 2022

Medicinskaâ vizualizaciâ

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Background. The amount of extracellular myocardial matrix is a non-invasive tool for quantitative assessment of myocardial fibrosis. MRI with late gadolinium-enhancement is considered to be the “Gold standard” of non-invasive practice. Dual Energy computed tomography is a new non-invasive approach for detection of myocardial fibrosis and its prognostic value remains unclear.The purpose of this study was to summarize all available data and to study prognostic value of DECT for the detection of fibrotic changes in myocardium.Methods. We searched MEDLINE, EMBASE, Cochrane, SCOPUS and Web of Science for cohort studies up to October 2021 that reported myocardial extracellular volume fraction quantification using contrast enhanced dual energy CT or/and MRI with delayed enhancement.Results. Eleven studies met eligibility criteria. A systematic analysis demonstrated the difference in extracellular volume fraction in patients with fibrotic and inflammation changes of the myocardium, as well as good comparability between DECT and MRI. The value of extracellular volume fraction in myocardium with fibrotic or inflammatory changes was higher than in healthy tissue, which makes it possible to use the ECV as a non-invasive marker of myocardial fibrosis.

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Single-source dual energy CT to assess myocardial extracellular volume fraction in aortic stenosis before transcatheter aortic valve implantation (TAVI)

Cited by 15 publications

References 35 publications

Diagnostic Performance of Extracellular Volume Quantified by Dual-Layer Dual-Energy CT for Detection of Acute Myocarditis

Diagnostic Performance of Extracellular Volume Quantified by Dual-Layer Dual-Energy CT for Detection of Acute Myocarditis

Extracellular Volume Quantification With Cardiac Late Enhancement Scanning Using Dual-Source Photon-Counting Detector CT

Detection of extracellular myocardial matrix with Dual Energy computed tomography: systematic review and meta-analysis

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