Dual-Energy CT for the Assessment of Chronic Myocardial Infarction in Patients With Chronic Coronary Artery Disease: Comparison With 3-T MRI

OBJECTIVE: The purpose of this article is to compare the performance of dual-energy CT with that of 3-T MRI with late enhancement for the detection of chronic myocardial infarction during first-pass coronary CT angiography (CTA). SUBJECTS AND METHODS: Thirty-six patients underwent coronary CTA for the assessment of coronary bypass graft patency on a first-generation dual-source CT scanner in dual-energy mode. Gray-scale images (100 kV, 140 kV, and blended virtual 120 kV) were assessed for areas of hypodense myocardium during the arterial phase. In addition, a color-coded map of myocardial iodine distribution was calculated from the dual-energy data for perfusion analysis. Dual-energy CT data were compared with data from 3-T MRI with late enhancement, which served as the reference standard for scar detection using the American Heart Association's 17-segment model of the left ventricle. RESULTS: One hundred one (17%) of 612 myocardial segments in 22 (61%) of 36 patients showed late enhancement on MRI. Although myocardial iodine mapping was prone to artifacts, mostly arising from sternal wires (70% sensitivity), 100-kV gray-scale images showed the highest sensitivity (80%) for the detection of myocardial scar. Blended virtual 120-kV images with lower noise and higher resolution had the best diagnostic accuracy (77% sensitivity, 97% specificity, 85% positive predictive value, 96% negative predictive value, and 94% accuracy). CONCLUSION: Detection of chronic myocardial infarction on color-coded iodine distribution analysis with first-generation dual-energy CT is impeded by thoracic metallic devices. This group of patients benefits more from adequate blending of high- and low-kilovoltage gray-scale images. Further technical improvements are desirable to lower artifact burden and improve sensitivity on myocardial iodine distribution mapping.