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Dual-contrast agent photon-counting computed tomography of the heart: initial experience

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Abstract

To determine the feasibility of dual—contrast agent imaging of the heart using photon-counting detector (PCD) computed tomography (CT) to simultaneously assess both first-pass and late enhancement of the myocardium. An occlusion-reperfusion canine model of myocardial infarction was used. Gadolinium-based contrast was injected 10 min prior to PCD CT. Iodinated contrast was infused immediately prior to PCD CT, thus capturing late gadolinium enhancement as well as first-pass iodine enhancement. Gadolinium and iodine maps were calculated using a linear material decomposition technique and compared to single-energy (conventional) images. PCD images were compared to in vivo and ex vivo magnetic resonance imaging (MRI) and histology. For infarct versus remote myocardium, contrast-to-noise ratio (CNR) was maximal on late enhancement gadolinium maps (CNR 9.0 ± 0.8, 6.6 ± 0.7, and 0.4 ± 0.4, p < 0.001 for gadolinium maps, single-energy images, and iodine maps, respectively). For infarct versus blood pool, CNR was maximum for iodine maps (CNR 11.8 ± 1.3, 3.8 ± 1.0, and 1.3 ± 0.4, p < 0.001 for iodine maps, gadolinium maps, and single-energy images, respectively). Combined first-pass iodine and late gadolinium maps allowed quantitative separation of blood pool, scar, and remote myocardium. MRI and histology analysis confirmed accurate PCD CT delineation of scar. Simultaneous multi-contrast agent cardiac imaging is feasible with photon-counting detector CT. These initial proof-of-concept results may provide incentives to develop new k-edge contrast agents, to investigate possible interactions between multiple simultaneously administered contrast agents, and to ultimately bring them to clinical practice.

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Acknowledgements

We wish to thank Drs. André Henning, Friederike Schöck, Pooyan Sahbaee, Katharina Hahn, Bernhard Krauss, Martin Sedlmair, and Thomas Allmendinger from Siemens Healthcare for building and maintaining the prototype scanner and its reconstruction pipeline.

Funding

This study is supported by the NIH intramural research program (ZIACL090019; ZIAEB000072) and a collaborative research agreement with Siemens Medical Solutions.

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Correspondence to Amir Pourmorteza.

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Conflict of interest

This study was supported by a collaborative research agreement with Siemens Healthcare (Forchheim, Germany). Authors who are not employees of or consultants for Siemens had control of inclusion of any data and information that might present a conflict of interest for the authors who are employed by Siemens.

Ethical approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted.

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Symons, R., Cork, T.E., Lakshmanan, M.N. et al. Dual-contrast agent photon-counting computed tomography of the heart: initial experience. Int J Cardiovasc Imaging 33, 1253–1261 (2017). https://doi.org/10.1007/s10554-017-1104-4

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