Myocardial Late Enhancement With Photon-Counting Detector CT in Spontaneous Coronary Artery Dissection

作者：Konstantin Klambauer, Ernst Klotz, Lukas J. Moser, Tobias Kälin, Andrea Biondo, Victor Schweiger, Victor Mergen, Costanza Lisi, Michael Würdinger, Rabea Schlenker, Davide Di Vece, Alexander Gotschy, Martin Reiner, Jelena-R. Ghadri, Verena Wilzeck, Matthias Eberhard, Christian Templin, Robert Manka, Hatem Alkadhi · 发表于：Investigative Radiology · 年份：2025 · DOI：10.1097/rli.0000000000001203 · 被引用次数：10 · 研究领域：Cardiovascular Issues in Pregnancy、Cardiac Imaging and Diagnostics、Cardiac Structural Anomalies and Repair

OBJECTIVES: Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and myocardial infarction. Accurate diagnosis is crucial for appropriate management. This study aimed to compare late enhancement (LE) imaging using photon-counting detector (PCD)-CT with cardiac MRI in patients with SCAD in the acute phase and during follow-up and to introduce a novel approach for visualizing myocardial extracellular volume (ECV) distribution in the myocardium. MATERIALS AND METHODS: This single-center prospective study enrolled patients with SCAD diagnosed with invasive coronary angiography. LE iodine imaging with spectral dual-source PCD-CT and cardiac MRI was performed early after symptom onset and at short-term follow-up. CT included coronary angiography and LE imaging (5 minutes after contrast). LE CT was assessed using the combination of conventional LE images, overlay images, polar maps, and with newly developed atlas maps. Atlas maps represent 2-dimensional maps with prefiltering applied to enable a simpler and more intuitive reading of ECV distribution across the myocardium. Cardiac MRI served as the reference standard for identifying pathologic myocardial segments based on late gadolinium enhancement (LGE) and edema on T2-weighted and T2-mapping images. Agreement between modalities was evaluated using Cohen's κ. RESULTS: Seventeen patients (median age, 44 years [interquartile range, 36-52]; 11 women) underwent 24 LE CT and cardiac MRI scans. Sixteen...