New Applications of Cardiac Computed Tomography: Dual-Energy, Spectral, and Molecular CT Imaging.

Computed tomography (CT) has evolved into a powerful diagnostic tool, and it is impossible to imagine current clinical practice without CT imaging. Because of its widespread availability, ease of clinical application, superb sensitivity for the detection of coronary artery disease, and noninvasive nature, CT has become a valuable tool within the armamentarium of cardiologists. In the past few years, numerous technological advances in CT have occurred, including dual-energy CT, spectral CT, and CT-based molecular imaging. By harnessing the advances in technology, cardiac CT has advanced beyond the mere evaluation of coronary stenosis to an imaging tool that permits accurate plaque characterization, assessment of myocardial perfusion, and even probing of molecular processes that are involved in coronary atherosclerosis. Novel innovations in CT contrast agents and pre-clinical spectral CT devices have paved the way for CT-based molecular imaging.

[1]  Paul Knaapen,et al.  Diagnosing coronary artery disease with hybrid PET/CT: It takes two to tango , 2013, Journal of Nuclear Cardiology.

[2]  J. Schlomka,et al.  Multienergy photon-counting K-edge imaging: potential for improved luminal depiction in vascular imaging. , 2008, Radiology.

[3]  Z. Fayad,et al.  A fluorescent, paramagnetic and PEGylated gold/silica nanoparticle for MRI, CT and fluorescence imaging. , 2010, Contrast Media & Molecular Imaging.

[4]  E. Nygard,et al.  Photon counting energy dispersive detector arrays for x-ray imaging , 2007, 2007 IEEE Nuclear Science Symposium Conference Record.

[5]  U. Schoepf,et al.  Monoenergetic extrapolation of cardiac dual energy CT for artifact reduction , 2015, Acta radiologica.

[6]  Min Li,et al.  Diagnostic accuracy of dual-source CT coronary angiography in patients with atrial fibrillation: meta analysis. , 2013, European journal of radiology.

[7]  C. McCollough,et al.  Virtual monochromatic imaging in dual-source dual-energy CT: radiation dose and image quality. , 2011, Medical physics.

[8]  V. Torchilin,et al.  CT visualization of blood pool in rats by using long-circulating, iodine-containing micelles. , 1999, Academic radiology.

[9]  K. Taguchi,et al.  Vision 20/20: Single photon counting x-ray detectors in medical imaging. , 2013, Medical physics.

[10]  Michael Uder,et al.  Detection of coronary artery stenoses by low-dose, prospectively ECG-triggered, high-pitch spiral coronary CT angiography. , 2011, JACC. Cardiovascular imaging.

[11]  Zahi A Fayad,et al.  Noninvasive detection of macrophages using a nanoparticulate contrast agent for computed tomography , 2007, Nature Medicine.

[12]  R. Cury,et al.  Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography. , 2009, Journal of the American College of Cardiology.

[13]  Ting-Yim Lee,et al.  Quantitative myocardial CT perfusion: a pictorial review and the current state of technology development. , 2011, Journal of cardiovascular computed tomography.

[14]  S. Wise Nanocarriers as an emerging platform for cancer therapy , 2007 .

[15]  Thomas Flohr,et al.  High-pitch spiral acquisition: a new scan mode for coronary CT angiography. , 2009, Journal of cardiovascular computed tomography.

[16]  Zhonghua Sun,et al.  Prospective versus retrospective ECG-gated multislice CT coronary angiography: a systematic review of radiation dose and diagnostic accuracy. , 2012, European journal of radiology.

[17]  U. Schoepf,et al.  Detection of coronary artery stenosis with sub-milliSievert radiation dose by prospectively ECG-triggered high-pitch spiral CT angiography and iterative reconstruction , 2013, European Radiology.

[18]  Xin Jin,et al.  Preliminary experimental results from a MARS Micro-CT system. , 2012, Journal of X-ray science and technology.

[19]  J. Schlomka,et al.  Experimental feasibility of multi-energy photon-counting K-edge imaging in pre-clinical computed tomography , 2008, Physics in medicine and biology.

[20]  Zhao-qi Zhang,et al.  Incremental value of dual-energy CT to coronary CT angiography for the detection of significant coronary stenosis: comparison with quantitative coronary angiography and single photon emission computed tomography , 2011, The International Journal of Cardiovascular Imaging.

[21]  Effect of dual-source cardiac computed tomography on patient radiation dose in a clinical setting: comparison to single-source imaging. , 2008, Journal of cardiovascular computed tomography.

[22]  S. Achenbach,et al.  Assessment of nonstenotic coronary lesions by 64-slice multidetector computed tomography in comparison to intravascular ultrasound: evaluation of nonculprit coronary lesions. , 2009, Journal of cardiovascular computed tomography.

[23]  S. Achenbach,et al.  Prospectively ECG-triggered high-pitch coronary angiography with third-generation dual-source CT at 70 kVp tube voltage: feasibility, image quality, radiation dose, and effect of iterative reconstruction. , 2014, Journal of cardiovascular computed tomography.

[24]  Konstantin Nikolaou,et al.  Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound. , 2004, Journal of the American College of Cardiology.

[25]  E. Merkle,et al.  Calcified vascular plaque specimens: assessment with cardiac dual-energy multidetector CT in anthropomorphically moving heart phantom. , 2008, Radiology.

[26]  J. Leipsic,et al.  Reduced iodine load with CT coronary angiography using dual-energy imaging: a prospective randomized trial compared with standard coronary CT angiography. , 2014, Journal of cardiovascular computed tomography.

[27]  A. Marx,et al.  Attenuation-based characterization of coronary atherosclerotic plaque: comparison of dual source and dual energy CT with single-source CT and histopathology. , 2011, European journal of radiology.

[28]  U. Schoepf,et al.  Iterative reconstruction to preserve image quality and diagnostic accuracy at reduced radiation dose in coronary CT angiography: an intraindividual comparison. , 2013, JACC. Cardiovascular imaging.

[29]  J. Leipsic,et al.  Prospectively ECG-triggered rapid kV-switching dual-energy CT for quantitative imaging of myocardial perfusion. , 2012, JACC. Cardiovascular imaging.

[30]  Jan Grimm,et al.  An X-ray computed tomography imaging agent based on long-circulating bismuth sulphide nanoparticles , 2006, Nature materials.

[31]  Thomas Frauenfelder,et al.  High-pitch coronary CT angiography with third generation dual-source CT: limits of heart rate , 2014, The International Journal of Cardiovascular Imaging.

[32]  S. Achenbach,et al.  Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. , 2010, European heart journal.

[33]  J. Stehli,et al.  First experience with single-source, dual-energy CCTA for monochromatic stent imaging. , 2015, European heart journal cardiovascular Imaging.

[34]  D N Slatkin,et al.  Single-and dual-energy CT with monochromatic synchrotron x-rays. , 1997, Physics in medicine and biology.

[35]  W. Kalender,et al.  Prospectively ECG-triggered high-pitch spiral acquisition for coronary CT angiography using dual source CT: technique and initial experience , 2009, European Radiology.

[36]  Jörg Hausleiter,et al.  Radiation Dose Estimates From Cardiac Multislice Computed Tomography in Daily Practice: Impact of Different Scanning Protocols on Effective Dose Estimates , 2006, Circulation.

[37]  G. Feuchtner,et al.  Diagnostic accuracy of high-pitch dual-source CT for the assessment of coronary stenoses: first experience , 2009, European Radiology.

[38]  Thilo Hannemann,et al.  First results from a hybrid prototype CT scanner for exploring benefits of quantum-counting in clinical CT , 2012, Medical Imaging.

[39]  Borut Marincek,et al.  Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate control , 2006, European Radiology.

[40]  Axel Thran,et al.  An early investigation of ytterbium nanocolloids for selective and quantitative "multicolor" spectral CT imaging. , 2012, ACS nano.

[41]  R. Virmani,et al.  Concept of vulnerable/unstable plaque. , 2010, Arteriosclerosis, thrombosis, and vascular biology.

[42]  S. Ko,et al.  Direct comparison of stress- and rest-dual-energy computed tomography for detection of myocardial perfusion defect , 2014, The International Journal of Cardiovascular Imaging.

[43]  U. Schoepf,et al.  First-arterial-pass dual-energy CT for assessment of myocardial blood supply: do we need rest, stress, and delayed acquisition? Comparison with SPECT. , 2014, Radiology.

[44]  M. Goddard,et al.  Dual-energy computed tomography imaging to determine atherosclerotic plaque composition: A prospective study with tissue validation , 2014, Journal of cardiovascular computed tomography.

[45]  Simon Wildermuth,et al.  Performance of turbo high-pitch dual-source CT for coronary CT angiography: first ex vivo and patient experience , 2014, European Radiology.

[46]  U. Schoepf,et al.  Comparison of dual-energy computed tomography of the heart with single photon emission computed tomography for assessment of coronary artery stenosis and of the myocardial blood supply. , 2009, The American journal of cardiology.

[47]  Takayuki Abe,et al.  Feasibility of coronary artery calcium scoring on virtual unenhanced images derived from single-source fast kVp-switching dual-energy coronary CT angiography. , 2014, Journal of cardiovascular computed tomography.

[48]  N. Paul,et al.  Perioperative β-Blockers : Use With Caution Perioperative β Blockers in Patients Having Non-Cardiac Surgery : A Meta-Analysis , 2010 .

[49]  C. Fink,et al.  Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: initial results. , 2012, European journal of radiology.

[50]  Rafidah Zainon,et al.  Toward quantifying the composition of soft tissues by spectral CT with Medipix3. , 2012, Medical physics.

[51]  Thomas Lehnert,et al.  Dose levels at coronary CT angiography—a comparison of Dual Energy-, Dual Source- and 16-slice CT , 2011, European Radiology.

[52]  M. Lubberink,et al.  Quantitative relationship between coronary artery calcium score and hyperemic myocardial blood flow as assessed by hybrid 15O-water PET/CT imaging in patients evaluated for coronary artery disease , 2011, Journal of Nuclear Cardiology.

[53]  松本 一宏,et al.  Virtual monochromatic spectral imaging with fast kilovoltage switching : improved image quality as compared with that obtained with conventional 120-kVp CT , 2011 .

[54]  C. Unterberg-Buchwald,et al.  Head-to-head comparison of prospectively triggered vs retrospectively gated coronary computed tomography angiography: Meta-analysis of diagnostic accuracy, image quality, and radiation dose. , 2013, American heart journal.

[55]  W. Kalender,et al.  Image quality of ultra-low radiation exposure coronary CT angiography with an effective dose <0.1 mSv using high-pitch spiral acquisition and raw data-based iterative reconstruction , 2013, European Radiology.

[56]  E. Boerwinkle,et al.  From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. , 2003, Circulation.

[57]  Scott D Flamm,et al.  Feasibility of dual-energy CT in the arterial phase: Imaging after endovascular aortic repair. , 2010, AJR. American journal of roentgenology.

[58]  Martin Sedlmair,et al.  Assessment of an Advanced Image-Based Technique to Calculate Virtual Monoenergetic Computed Tomographic Images From a Dual-Energy Examination to Improve Contrast-To-Noise Ratio in Examinations Using Iodinated Contrast Media , 2014, Investigative radiology.

[59]  Udo Hoffmann,et al.  Characterization of non-calcified coronary atherosclerotic plaque by multi-detector row CT: comparison to IVUS. , 2007, Atherosclerosis.

[60]  Sachio Kuribayashi,et al.  Beam-hardening correction for virtual monochromatic imaging of myocardial perfusion via fast-switching dual-kVp 64-slice computed tomography: a pilot study using a human heart specimen. , 2012, Circulation journal : official journal of the Japanese Circulation Society.

[61]  Claudia Calcagno,et al.  Nanocrystal core high-density lipoproteins: a multimodality contrast agent platform. , 2008, Nano letters.

[62]  Daniel T Boll,et al.  Coronary stent patency: dual-energy multidetector CT assessment in a pilot study with anthropomorphic phantom. , 2008, Radiology.

[63]  S. Ko,et al.  Diagnostic performance of combined noninvasive anatomic and functional assessment with dual-source CT and adenosine-induced stress dual-energy CT for detection of significant coronary stenosis. , 2012, AJR. American journal of roentgenology.

[64]  M. Budoff,et al.  Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Indi , 2008, Journal of the American College of Cardiology.

[65]  U. Schoepf,et al.  Adenosine-stress dynamic myocardial perfusion imaging with second-generation dual-source CT: comparison with conventional catheter coronary angiography and SPECT nuclear myocardial perfusion imaging. , 2012, AJR. American journal of roentgenology.

[66]  G. Feuchtner,et al.  Low-dose, 128-slice, dual-source CT coronary angiography: accuracy and radiation dose of the high-pitch and the step-and-shoot mode , 2010, Heart.

[67]  C. Claussen,et al.  Tin-filter enhanced dual-energy-CT: image quality and accuracy of CT numbers in virtual noncontrast imaging. , 2013, Academic radiology.

[68]  Konstantin Nikolaou,et al.  Metal artifact reduction by dual energy computed tomography using monoenergetic extrapolation , 2011, European Radiology.

[69]  J. Leipsic,et al.  Substantial iodine volume load reduction in CT angiography with dual-energy imaging: insights from a pilot randomized study , 2014, The International Journal of Cardiovascular Imaging.

[70]  Jiang Hsieh,et al.  Quantitative myocardial perfusion imaging using rapid kVp switch dual-energy CT: preliminary experience. , 2011, Journal of cardiovascular computed tomography.

[71]  R. Cury,et al.  Coronary artery imaging with single-source rapid kilovolt peak-switching dual-energy CT. , 2013, Radiology.

[72]  Antonio Colombo,et al.  From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part II. , 2003, Circulation.

[73]  P Douek,et al.  Photon counting spectral CT component analysis of coronary artery atherosclerotic plaque samples. , 2014, The British journal of radiology.

[74]  J. Stoker,et al.  Contrast induced nephropathy in patients undergoing intravenous (IV) contrast enhanced computed tomography (CECT) and the relationship with risk factors: a meta-analysis. , 2013, European journal of radiology.

[75]  Tobias A. Fuchs,et al.  Coronary artery calcium quantification from contrast enhanced CT using gemstone spectral imaging and material decomposition , 2014, The International Journal of Cardiovascular Imaging.

[76]  S. Ko,et al.  Myocardial perfusion imaging using adenosine-induced stress dual-energy computed tomography of the heart: comparison with cardiac magnetic resonance imaging and conventional coronary angiography , 2010, European Radiology.

[77]  Fabien Hyafil,et al.  Quantification of Inflammation Within Rabbit Atherosclerotic Plaques Using the Macrophage-Specific CT Contrast Agent N1177: A Comparison with 18F-FDG PET/CT and Histology , 2009, Journal of Nuclear Medicine.

[78]  J. Leipsic,et al.  Dual-energy CT and its potential use for quantitative myocardial CT perfusion. , 2012, Journal of cardiovascular computed tomography.

[79]  S. Schoenberg,et al.  Cost-effectiveness of substituting dual-energy CT for SPECT in the assessment of myocardial perfusion for the workup of coronary artery disease. , 2012, European journal of radiology.

[80]  A. M. Rush,et al.  X-ray computed tomography imaging of breast cancer by using targeted peptide-labeled bismuth sulfide nanoparticles. , 2011, Angewandte Chemie.

[81]  Z. Fayad,et al.  Nanoparticle contrast agents for computed tomography: a focus on micelles. , 2014, Contrast media & molecular imaging.

[82]  J. Leipsic,et al.  A prospective randomized controlled trial to assess the diagnostic performance of reduced tube voltage for coronary CT angiography. , 2011, AJR. American journal of roentgenology.

[83]  G. Hounsfield Computerized transverse axial scanning (tomography): Part I. Description of system. 1973. , 1973, The British journal of radiology.

[84]  G. Hounsfield Computerized transverse axial scanning (tomography). 1. Description of system. , 1973, The British journal of radiology.

[85]  G. Gazelle,et al.  Block-copolymer of polyethylene glycol and polylysine as a carrier of organic iodine: design of long-circulating particulate contrast medium for X-ray computed tomography. , 1997, Journal of drug targeting.

[86]  Yen-Wen Wu,et al.  Coronary Angiography by 64-Detector Row Computed Tomography Using Low Dose of Contrast Material with Saline Chaser: Influence of Total Injection Volume on Vessel Attenuation , 2007, Journal of computer assisted tomography.

[87]  G. Rodriguez-Granillo,et al.  Incremental value of myocardial perfusion over coronary angiography by spectral computed tomography in patients with intermediate to high likelihood of coronary artery disease. , 2015, European journal of radiology.

[88]  Axel Thran,et al.  Note: This Copy Is for Your Personal, Non-commercial Use Only. to Order Presentation-ready Copies for Distribution to Your Colleagues or Clients, Contact Us at Www.rsna.org/rsnarights. Atherosclerotic Plaque Composition: Analysis with Multicolor Ct and Targeted Gold Nanoparticles 1 Materials and Met , 2022 .