Clinical potential of dual-energy cardiac CT in cardiac amyloidosis.
Clinical potential of dual-energy cardiac CT in cardiac amyloidosis.
复制标题
双能心脏 CT 在心脏淀粉样变性中的临床潜力。
DOI：
10.1080/13506129.2019.1582021
复制
发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Yamashita Y.
中科院分区：
文献类型：
--
作者：
Oda S;Nakaura T;Utsunomiya D;Hirakawa K;Takashio S;Izumiya Y;Tsujita K;Kawano Y;Okuno Y;Hata H;Matsuoka M;Yamashita T;Ueda M;Ando Y;Yamashita Y.
AMYLOID 2019，VOL. 26，NO. S1，91-92 https：//doi. org/10.1080/13506129.2019. 1582021用于诊断心脏病比LGE成像敏感。此外，心肌ECV是心脏淀粉样变性预后的生物标志物。然而，CMR成像禁忌用于植入起搏器、除颤器或其他植入式电子设备的患者。钆对比增强CMR也禁忌用于透析患者。与CMR相比，心脏计算机断层扫描（CT）由于其可访问性、快速采集时间、进行冠状动脉成像的能力以及适用于使用机械装置或透析的患者而被广泛使用。在这里，我们讨论了心脏CT与晚期碘增强（LIE）和CTECV成像使用双能量心脏CT的临床潜力。一位59岁男性患者，5年前因完全性房室传导阻滞植入起搏器，出现进行性呼吸困难和疲乏。经胸超声心动图显示向心性左心室肥厚，射血分数为47.7%。由于植入了起搏器，他被认为是CMR的禁忌症。作为CMR的替代方案，我们使用双层光谱探测器CT进行了双能量心脏CT扫描。心脏CT显示冠状动脉正常; LIE和CT-ECV成像显示整体内膜下增强和心肌CT-ECV显著升高（整体ECV，59%;图1）。最后，患者被诊断为遗传性心脏ATTR（Ser 50 Ile），心脏CT心肌LIE成像可以替代CMR-LGE成像，因为碘化造影剂的药代动力学与钆造影剂相当。此外，与传统的单能量采集相比，双能量CT采集可以实现更高程度的材料表征，从而增强了LIE成像的对比度分辨率。此外，碘密度图的双能量后处理技术有助于评价心肌ECV。与CMR相比，双能量CT甚至可以对使用机械设备或透析的患者进行，并提供心肌LIE和ECV的3D体积数据，以及沿着解剖冠状动脉病变。总的来说，这种使用双能量心脏CT的新技术可能是一种有用的工具，用于非侵入性评估心脏淀粉样变性。
AMYLOID 2019, VOL. 26, NO. S1, 91-92 https://doi. org/10.1080/13506129.2019. 1582021 sensitive than LGE imaging for diagnosing cardiac disease. In addition, myocardial ECV is a biomarker for prognosis of cardiac amyloidosis. Nevertheless, CMR imaging is contraindicated for patients with pacemakers, defibrillators, or other implanted electronic devices. Gadolinium contrastenhanced CMR is also contraindicated for patients on dialysis. In comparison with CMR, cardiac computed tomography (CT) is extensively used because of its accessibility, fast acquisition time, ability to perform coronary artery imaging, and its suitability for use in patients with mechanical devices or on dialysis. Here, we discuss clinical potential of cardiac CT with late iodine enhancement (LIE) and CTECV imaging using dual-energy cardiac CT. A 59-year-old male patient who had a pacemaker implanted for complete atrioventricular block 5years ago presented with progressive dyspnoea and fatigue. Transthoracic echocardiography revealed concentric left ventricular hypertrophy with a preserved ejection fraction of 47.7%. He was considered a contraindication for undergoing CMR because of an implanted pacemaker. As an alternative to CMR, we performed dual-energy cardiac CT scanning using a dual-layer spectral detector CT. Cardiac CT revealed normal coronary arteries; LIE and CT-ECV imaging revealed global subendocardial enhancement and substantially elevated myocardial CT-ECV (global ECV, 59%; Figure 1). Eventually, the patient was diagnosed with hereditary cardiac ATTR (Ser50Ile).Myocardial LIE imaging with cardiac CT could be a substitute to CMR-LGE imaging because the pharmacokinetics of iodinated contrast materials is equivalent to those of gadolinium contrast materials. In addition, dual-energy CT acquisition can enable a higher degree of material characterization than the conventional single-energy acquisition, which has led to enhanced contrast resolution in LIE imaging. In addition, dual-energy post-processing techniques of iodine density mapping have facilitated the evaluation of myocardial ECV. Compared with CMR, dual-energy CT can be performed even for patients with mechanical devices or on dialysis and provide the 3D volume data on the myocardial LIE and ECV, along with the anatomical coronary artery lesions. Overall, this novel technology using dualenergy cardiac CT could be a useful tool for non-invasive assessment of cardiac amyloidosis.