Photon-counting computed tomography showed excellent agreement with cardiac magnetic resonance for late enhancement extent (r=0.998; P<0.001) and detected LGE with high accuracy (AUC 0.994).
Observational (n=182)
Does photon-counting computed tomography (PCCT) characterize left ventricular hypertrophy as accurately as cardiac magnetic resonance (CMR) in patients with a left ventricular hypertrophic phenotype?
PCCT provides highly accurate, CMR-comparable assessment of ventricular geometry, function, and myocardial tissue characterization in patients with left ventricular hypertrophy, offering a viable alternative when CMR is contraindicated.
Effect estimate: r = 0.998
p-value: p=<0.001
BACKGROUND: Photon-counting computed tomography (PCCT) combines high spatial resolution with spectral imaging and can provide morphologic, functional, and tissue assessment in hypertrophic hearts. OBJECTIVES: The authors investigated whether PCCT characterizes left ventricular hypertrophy (LVH) as accurately as cardiac magnetic resonance (CMR) overall and across hypertrophic phenotypes. METHODS: Consecutive patients with LVH (n = 182; 72 with hypertrophic cardiomyopathy, 47 with amyloid transthyretin cardiomyopathy, and 63 with secondary LVH) underwent PCCT including late iodine enhancement (LIE) and PCCT-derived extracellular volume (ECV). Eighty-three patients (46%) also underwent CMR within ±12 months (median interval: -12 days). Agreement was assessed for morphofunctional indices, ECV, and LIE vs late gadolinium enhancement (LGE). RESULTS: PCCT differentiated etiologies through distinctive tissue patterns. Transthyretin cardiac amyloidosis showed the highest left ventricular mass index (median: 104 g/m2), the greatest LIE extent (median: 17/17 segments), and the highest ECV (median: 47%). Hypertrophic cardiomyopathy showed patchy fibrosis (median 4 enhanced segments) with intermediate ECV (31%), whereas secondary LVH displayed minimal enhancement (median: 0 segments) and the lowest ECV (28%). In paired examinations, PCCT correlated closely with CMR for left ventricular mass index and left ventricular ejection fraction (r = 0.963 and r = 0.947; P < 0.001 for both) and for ECV (r = 0.868; P < 0.001). LIE extent strongly agreed with LGE extent (r = 0.998; P < 0.001); segment-wise LIE/LGE agreement was 99% to 100%, and PCCT detected CMR-LGE with excellent accuracy (AUC: 0.994; sensitivity 99%; specificity 100%). Global PCCT-derived ECV showed excellent inter-reader agreement (ICC: 0.98). CONCLUSIONS: PCCT provides CMR-comparable assessment of ventricular geometry, function, and myocardial fibrosis/ECV while enabling coronary angiography, supporting its use when CMR is contraindicated, impractical, or nondiagnostic.
“When cardiac MR (CMR) is nondiagnostic, impractical or contraindicated, photon-counting computed tomography (PCCT) provides an assessment of ventricular geometry, function and myocardial fibrosis/PCCT-derived extracellular volume (ECV), that is comparable to CMR, while enabling angiography, in pa...”
Gori et al. (2026) conducted an observational in Left ventricular hypertrophy (n=182). Photon-counting computed tomography (PCCT) vs. Cardiac magnetic resonance (CMR) was evaluated on Agreement for morphofunctional indices, ECV, and LIE vs late gadolinium enhancement (LGE) (r = 0.998, p=<0.001). Photon-counting computed tomography showed excellent agreement with cardiac magnetic resonance for late enhancement extent (r=0.998; P<0.001) and detected LGE with high accuracy (AUC 0.994).