Evaluation of dual energy computed tomography iodine mapping within the myocardial blood pool for detection of acute myocardial infarction: correlation with histopathological findings in a porcine model

OBJECTIVE: We assessed the diagnostic value of “one-step” dual energy CT (DECT) in combination with coronary CT angiography and iodine mapping within the myocardial blood pool in detecting acute myocardial infarction (AMI). METHODS: Five minipigs were subjected to transcatheter embolization of coronary artery with a gelatin sponge to induce AMI. Arterial-phase myocardial DECT imaging was carried out 1 h before and 24 h after embolism of the coronary. Color-coded iodine maps were used to evaluate myocardial blood pool deficits in the 17-segment model. Myocardial DECT imaging 24 h after MI induction was used for final comparison with post-mortem histology. RESULTS: We found a sensitivity of 95.55% and a specificity of 95%, respectively, for AMI detection by DECT-based iodine mapping within the myocardial blood pool. The dose–length product values were 219.4 ± 60.9 mGy.cm (172–321 mGy.cm) and the effective radiation dose was 5.7 ± 1.5 mSv (4.4–8.3 mSv). CONCLUSION: This experimental study demonstrated that DECT-based iodine mapping shows a high value for the detection of myocardial perfusion defects in the first-pass myocardial perfusion. Hybrid heart images obtained by coronary CT angiography and DECT-based iodine mapping may yield valuable data and help clinicians accurately identify cases requiring further treatment after AMI. ADVANCES IN KNOWLEDGE: This study demonstrated that DECT-based iodine mapping is a promising new technique for the detection of myocardial perfusion defects in the first-pass myocardial perfusion.