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<p>Spontaneous coronary artery dissection (SCAD) may cause myocardial infarction. Photon-counting detector computed tomography (PCD-CT) with late iodine enhancement (LIE) imaging enables myocardial extracellular volume (ECV) quantification. In this single-center, prospective study, we quantified myocardial ECV in patients with SCAD using LIE PCD-CT (<i>n</i> = 20 patients), and compared results with CMR (<i>n</i> = 13 patients). Global ECV<sub>CT</sub> was quantified in the entire myocardium; lesion ECV<sub>CT</sub> was quantified using a threshold-based approach with lesions exceeding an ECV<sub>CT</sub> of 40%. Relative lesion volume was calculated as the proportion of lesion to total myocardial volume. Global ECV<sub>CMR</sub> was calculated across all myocardial segments, lesion ECV<sub>CMR</sub> was derived from manual segmentation. In the 20 patients, lesion ECV<sub>CT</sub> was 45.2% (IQR 44.2–46.8%) compared to a global ECV<sub>CT</sub> of 28.5 ± 5.3%. Relative lesion volume strongly correlated with global ECV<sub>CT</sub> (ρ = 0.938, <i>P</i> &lt; 0.001). A global ECV<sub>CT</sub> cut-off of 28.5% predicted relative lesion volumes &lt; 5% with an AUC of 0.956 (95% CI 0.752–0.999) and a PPV of 82%. Global ECV<sub>CT</sub> (28.0 ± 5.2%) and global ECV<sub>CMR</sub> (29.3 ± 4.2%) was similar (<i>P</i> = 0.085, mean difference 1.4%, 95% limits of agreement: − 4.2 to 7.0%). Lesion ECV<sub>CT</sub> (45.2%, IQR 44.6–46.8) and lesion ECV<sub>CMR</sub> (45.0%, IQR 39.4–48.6) was similar (<i>P</i> = 0.340). In conclusion, LIE PCD-CT enables quantitative myocardial ECV assessment in SCAD patients, showing a good agreement with CMR.</p>

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Photon-counting detector computed tomography compared with cardiac magnetic resonance imaging for myocardial extracellular volume quantification in spontaneous coronary artery dissection

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  • 发表日期：

    2025年11月14日

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  • Konstantin Klambauer,
  • Andrea Biondo,
  • Ernst Klotz,
  • Lukas J. Moser,
  • Tristan Demmert,
  • Victor Schweiger,
  • Victor Mergen,
  • Michael Würdinger,
  • Davide Di Vece,
  • Alexander Gotschy,
  • Martin F. Reiner,
  • Jelena-R. Ghadri,
  • Verena C. Wilzeck,
  • Matthias Eberhard,
  • Christian Templin,
  • Robert Manka,
  • Hatem Alkadhi

摘要

Spontaneous coronary artery dissection (SCAD) may cause myocardial infarction. Photon-counting detector computed tomography (PCD-CT) with late iodine enhancement (LIE) imaging enables myocardial extracellular volume (ECV) quantification. In this single-center, prospective study, we quantified myocardial ECV in patients with SCAD using LIE PCD-CT (n = 20 patients), and compared results with CMR (n = 13 patients). Global ECVCT was quantified in the entire myocardium; lesion ECVCT was quantified using a threshold-based approach with lesions exceeding an ECVCT of 40%. Relative lesion volume was calculated as the proportion of lesion to total myocardial volume. Global ECVCMR was calculated across all myocardial segments, lesion ECVCMR was derived from manual segmentation. In the 20 patients, lesion ECVCT was 45.2% (IQR 44.2–46.8%) compared to a global ECVCT of 28.5 ± 5.3%. Relative lesion volume strongly correlated with global ECVCT (ρ = 0.938, P < 0.001). A global ECVCT cut-off of 28.5% predicted relative lesion volumes < 5% with an AUC of 0.956 (95% CI 0.752–0.999) and a PPV of 82%. Global ECVCT (28.0 ± 5.2%) and global ECVCMR (29.3 ± 4.2%) was similar (P = 0.085, mean difference 1.4%, 95% limits of agreement: − 4.2 to 7.0%). Lesion ECVCT (45.2%, IQR 44.6–46.8) and lesion ECVCMR (45.0%, IQR 39.4–48.6) was similar (P = 0.340). In conclusion, LIE PCD-CT enables quantitative myocardial ECV assessment in SCAD patients, showing a good agreement with CMR.