Dual-contrast agent photon-counting computed tomography of the heart: initial experience

Int J Cardiovasc Imaging. 2017 Aug;33(8):1253-1261. doi: 10.1007/s10554-017-1104-4. Epub 2017 Mar 13.


To determine the feasibility of dual-contrast agent imaging of the heart using photon-counting detector (PCD) computed tomography (CT) to simultaneously assess both first-pass and late enhancement of the myocardium. An occlusion-reperfusion canine model of myocardial infarction was used. Gadolinium-based contrast was injected 10 min prior to PCD CT. Iodinated contrast was infused immediately prior to PCD CT, thus capturing late gadolinium enhancement as well as first-pass iodine enhancement. Gadolinium and iodine maps were calculated using a linear material decomposition technique and compared to single-energy (conventional) images. PCD images were compared to in vivo and ex vivo magnetic resonance imaging (MRI) and histology. For infarct versus remote myocardium, contrast-to-noise ratio (CNR) was maximal on late enhancement gadolinium maps (CNR 9.0 ± 0.8, 6.6 ± 0.7, and 0.4 ± 0.4, p < 0.001 for gadolinium maps, single-energy images, and iodine maps, respectively). For infarct versus blood pool, CNR was maximum for iodine maps (CNR 11.8 ± 1.3, 3.8 ± 1.0, and 1.3 ± 0.4, p < 0.001 for iodine maps, gadolinium maps, and single-energy images, respectively). Combined first-pass iodine and late gadolinium maps allowed quantitative separation of blood pool, scar, and remote myocardium. MRI and histology analysis confirmed accurate PCD CT delineation of scar. Simultaneous multi-contrast agent cardiac imaging is feasible with photon-counting detector CT. These initial proof-of-concept results may provide incentives to develop new k-edge contrast agents, to investigate possible interactions between multiple simultaneously administered contrast agents, and to ultimately bring them to clinical practice.

Keywords: Cardiac imaging techniques; Computed tomography; Contrast media; Myocardial infarction; Photon-counting CT; Spectral CT.

Publication types

  • Comparative Study
  • Validation Study

MeSH terms

  • Animals
  • Cicatrix / diagnostic imaging
  • Cicatrix / pathology
  • Contrast Media / administration & dosage*
  • Disease Models, Animal
  • Dogs
  • Feasibility Studies
  • Heart / diagnostic imaging*
  • Image Interpretation, Computer-Assisted
  • Iopamidol / administration & dosage*
  • Linear Models
  • Magnetic Resonance Imaging
  • Meglumine / administration & dosage*
  • Myocardial Infarction / diagnostic imaging*
  • Myocardial Infarction / pathology
  • Myocardial Reperfusion Injury / diagnostic imaging*
  • Myocardial Reperfusion Injury / pathology
  • Myocardium / pathology
  • Organometallic Compounds / administration & dosage*
  • Photons*
  • Potassium Chloride / administration & dosage*
  • Predictive Value of Tests
  • Proof of Concept Study
  • Reproducibility of Results
  • Signal-To-Noise Ratio
  • Time Factors
  • Tomography, X-Ray Computed / methods*


  • Contrast Media
  • Organometallic Compounds
  • Potassium Chloride
  • Meglumine
  • Iopamidol
  • gadoterate meglumine