Dual Energy CT of The HeartDual Energy CT of The Heart
U. Joseph Schoepf, U. Joseph Schoepf, MD, FAHA, FSCBTMD, FAHA, FSCBT‐‐MR, FSCCTMR, FSCCTProfessor of Radiology, Medicine, and PediatricsProfessor of Radiology, Medicine, and PediatricsDirector of Cardiovascular ImagingDirector of Cardiovascular Imaging
Consultant for / research support from
Bayer
Bracco
General Electric
Medrad
Siemens
Disclosures
Primary morphological vs. functional evaluation of CAD (i.e. SPECT vs. ICA, CTA)?Early attempts at CT imaging
Limited by experimental natureLimited by dedicated acquisition protocols
Hybrid Imaging (e.g. SPECT and CT)Dual‐energy CT for myocardial perfusion defectsDelayed enhancement dual‐energy CT Adenosine stress dual‐energy CT
Integrative CHD Imaging with CT
140kV
80 / 100kV
Integrative Imaging: DECT
7474‐‐yo woman yo woman with chest pain with chest pain and abnormal and abnormal SPECTSPECT
2x64x0.6mm, 2x64x0.6mm, 80kV/140kV80kV/140kV0.33 s rotation 0.33 s rotation timetime
DECT for Myocardial Ischemia
7474‐‐yo woman with chest pain yo woman with chest pain and abnormal SPECTand abnormal SPECTTight proximal stenosis D1Tight proximal stenosis D1
Morphology and Function: DECT
B. Ruzsics et al., Circulation 2008
7474‐‐yo woman yo woman with chest pain with chest pain and abnormal and abnormal SPECTSPECT
B. Ruzsics et al., Circulation 2008
Morphology and Function: DECT
DECT Postprocessing
F. Schwarz et al., Eur J Radiol 2008
JM Kerl et al., Eur Radiol 2010
DECT Radiation Dose
16‐Slice CT DSCT DECT12 ± 3.59 mSv 9.8 ± 4.77 mSv 4.54 ± 1.87 mSv
DE cCTA LAD
DECTSPECT
36 36 yoyo woman, DM I woman, DM I
hoho LAD infarctLAD infarct
Reversible Ischemia at Rest DECT
61 yo man, atypical chest pain
DECT Can Detect Subtle Pathology
Vliegenthart et al., AJR in press
Delayed Enhancement DECT
B. Ruzsics et al., HEART 2009
cCTA
Delayed
FirstPass
LAD
Delayed Enhancement DECT
B. Ruzsics et al., HEART, in press
Delayed Enhancement DECT
Ruszsics et al.,RSNA 2009
0 1 week‐1 month
Abnormal SPECT
rest and/or stress
Rest DECT
AdenosineDECT
DelayedDECT
(sequential)
Rest ceMRI(perfusion)
Adenosine ceMRI(perfusion)
Delayed Enhancement(viability)
Adenosine protocol: 140 µg/min/kg
Adenosine Stress DECT
B. Ruzsics et al., AHA 2008
LM
D1LAD
Reversible Ischemia
Adenosine Stress DECTAdenosine Stress DECT
Adenosine Adenosine Stress cMRIStress cMRI
Reversible Ischemia
Rest Stress Delayed
Reversible Ischemia
• Larger scan field of view (SFOV) for Dual Energy modes
• SFOV A/B‐detector: 50/33 cm
Next Generation DECT
33 cm
S1: 80 kV
x 10415
10
5
0 50 100 150
80 kV140 kV
photon energy (keV)
numbe
r of qua
nta
0.4 mm Sn
+ SPS
140 kV + SPS
S2: 140 kV
• Dual Energy with Selective Photon Shield
• Improved separationof low and high energies
• Noise reduction• Greater dose reserve
Next Generation DECT
83 msec 83 msec TTemporalemporal RResoesolution in Duallution in Dual‐‐Energy ModeEnergy Mode
165 msec 83 msec
DECT Temporal Resolution
Next Generation DECT
Rest
Stress
Quantitative DECT Perfusion
Promising developments for DECT imaging of the myocardial blood supply and viability CT not the primary method for evaluation of myocardial perfusionCTA is mainly aimed at imaging the coronariesCT a possibly attractive modality for integrative imaging of anatomy and perfusionFurther refinements in technique impending
Summary – Future Perspectives
[email protected]@musc.edu
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