Abstract 4173: Adenosine Stress Dual-Energy CT of the Heart for Diagnosing Myocardial Ischemia and Viability Compared with Cardiac MRI and SPECT: Initial Experience
Dual-energy CT (DECT) can detect changes in the myocardial blood pool. Whether this technique can also diagnose reversible ischemia has not been evaluated. We hypothesized that DECT rest-, stress-, and delayed enhancement imaging can diagnose fixed/reversible myocardial perfusion defects (PD) and viability. We prospectively enrolled 10 patients with suspected coronary artery disease who underwent adenosine stress/rest SPECT, adenosine stress/rest perfusion and delayed enhancement cMRI, and ECG-gated adenosine stress/rest and delayed enhancement DECT. Two independent, blinded observers evaluated SPECT, cMRI and DECT for fixed/reversible PD and cMRI and DECT for delayed enhancement based on the AHA 17-segment model. All patients were successfully imaged with all three modalities without adverse events. 170 myocardial segments were analyzed of which 15 were abnormal at cMRI. Interreader agreement for detection of fixed/reversible PD and delayed enhancement at DECT was excellent (k=0.9). Compared with cMRI, DECT and SPECT had 100% (88%) sensitivity, 99% (97%) specificity, and 99% (96%) accuracy for detecting fixed PD. Reversible ischemia was detected with 100% (100%) sensitivity, 100% (90%) specificity, and 100% (92%) accuracy by DECT and SPECT. Compared with cMRI, DECT detected myocardial segments showing delayed enhancement with 100% sensitivity, 100% specificity, and 100% accuracy. Adenosine stress and delayed enhancement DECT are technically feasible. Compared to cMRI, DECT shows good agreement for delayed enhancement and equal or better performance than SPECT for detection of myocardial ischemia.