The Evaluation of Dual-Energy Myocardial Perfusion Imaging for the Detection of Acute Myocardial Infarction by Using the Second Generation Dual-Source CT in a Porcine Model

Objectives: To evaluate the diagnostic accuracy of “one-step” dual-energy combined coronary CT angiography and first-pass myocardial perfusion imaging for the detection of acute myocardial infarction by using the second generation dual-source CT compared with conventional digital subtraction angiography and histopathological findings in a porcine model. Methods: Five minipigs underwent transcatheter embolization of coronary using gelatin sponge to produce acute myocardial infarction. Arterial-phase myocardial DECT imaging were performed prior to and immediately and 24 hours after the procedure. A colour-coded iodine map was used for evaluation of myocardial perfusion defect using the 17-segment model. Two radiologists in consensus interpreted all iodine map imaging studies at DECT and coronary CT angiography images that were acquired during the DECT-acquisition. Statistical analysis for diagnostic accuracy was performed. Results: Following the coronary embolization, DECT iodine maps showed 45 infarcted segments and 40 non infarcted segments. Based on the per-segment analysis, the sensitivity, specificity, positive predictive value and negative predictive value were 93%, 95%, 95% and 93%, respectively. The corresponding values to per-territory analysis were 100%, 86%, 89% and 100% using histopathological findings as the reference standard. The average dose length product (DLP) was 219.4 ± 60.9 mGy.cm (172-321 mGy.cm). Conclusions: Our experimental study demonstrates that “one-step” dual-energy combined coronary CT angiography and first-pass myocardial perfusion imaging provides high diagnostic accuracy for detecting acute myocardial infarction and a comprehensive image quality of coronary artery with a relatively low dose of radiation in a porcine model.