Dual-Energy Computed Tomography for Integrative Imaging of Coronary Artery Disease: Principles and Clinical Applications

Kang, Doo Kyoung; Schoepf, U. Joseph; Bastarrika, Gorka; Nance, John W.; Abro, Joseph A.; Ruzsics, Balazs

doi:10.1053/j.sult.2010.05.004

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Volume 31, Issue 4 , Pages 276-291, August 2010

Dual-Energy Computed Tomography for Integrative Imaging of Coronary Artery Disease: Principles and Clinical Applications

Doo Kyoung Kang, MD
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea
U. Joseph Schoepf, MD
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC
- Address reprint requests to U. Joseph Schoepf, MD, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, MSC 226, Charleston, SC 29401
Gorka Bastarrika, MD, PhD
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
- Department of Radiology, University of Navarra, Pamplona, Spain
John W. Nance Jr, MD
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
Joseph A. Abro, MA
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
Balazs Ruzsics, MD, PhD
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC

The introduction of coronary CT angiography (cCTA) has reinvigorated the debate whether management of patients with suspected coronary artery disease (CAD) should be primarily based on physiological, functional versus anatomical testing. Anatomical testing (i.e., cCTA or invasive catheterization) enables direct visualization and grading of coronary artery stenoses but has shortcomings for gauging the hemodynamic significance of lesions for myocardial perfusion. Rest/stress myocardial perfusion imaging (MPI) has been extensively validated for assessing the clinical significance of CAD by demonstrating fixed or reversible perfusion defects but has only limited anatomical information. There is growing evidence that contrast medium enhanced dual-energy cCTA (DECT) has potential for the comprehensive analysis of coronary artery morphology as well as changes in myocardial perfusion. DECT exploits the fact that tissues in the human body and iodine-based contrast media have unique absorption characteristics when penetrated with different X-ray energy levels, which enables mapping the iodine (and thus blood) distribution within the myocardium. The purpose of this communication is to describe the practical application of this technology for the comprehensive diagnosis of ischemic heart disease. We examine recent scientific findings in the context of current pivotal transitions in cardiovascular disease management and demonstrate the potential of cardiac DECT for the integrative assessment of patients with known or suspected CAD within a single CT-based protocol.