Photon-Counting Computed Tomography for Tissue Characterization in Patients With a Left Ventricular Hypertrophic...

Area of Science:

• Cardiovascular Imaging
• Radiology
• Medical Physics

Background:

• Photon-counting computed tomography (PCCT) offers advanced capabilities for assessing cardiac morphology and function.
• Hypertrophic hearts, including various forms of left ventricular hypertrophy (LVH), require accurate characterization for diagnosis and management.

Purpose of the Study:

• To evaluate the accuracy of PCCT in characterizing left ventricular hypertrophy (LVH) compared to cardiac magnetic resonance (CMR).
• To assess PCCT's ability to differentiate between various hypertrophic phenotypes based on tissue characteristics.

Main Methods:

• 182 patients with LVH underwent PCCT with late iodine enhancement (LIE) and extracellular volume (ECV) quantification.
• 83 patients also underwent CMR for comparison of morphofunctional indices, ECV, and fibrosis assessment (LIE vs. late gadolinium enhancement [LGE]).

Main Results:

• PCCT effectively differentiated hypertrophic cardiomyopathy, amyloid transthyretin cardiomyopathy, and secondary LVH based on tissue patterns, LIE extent, and ECV.
• PCCT demonstrated strong correlations with CMR for left ventricular mass index (r=0.963), ejection fraction (r=0.947), and ECV (r=0.868).
• LIE extent strongly agreed with LGE extent (r=0.998), with PCCT showing excellent accuracy in detecting myocardial fibrosis.

Conclusions:

• PCCT provides a comprehensive assessment of ventricular geometry, function, and myocardial tissue characteristics comparable to CMR.
• PCCT's ability to perform coronary angiography alongside tissue assessment makes it a versatile tool.
• PCCT is a valuable alternative to CMR, especially when CMR is contraindicated, impractical, or yields nondiagnostic results.