Improved Diagnosis of Detection of Late Enhancement in Left Ventricular Myocardium Using 2nd Generation 320-Slice CT Reconstructed with FIRST in Non-Ischemic Cardiomyopathy

Abstract

Forward Projected Model-based Iterative Reconstruction SoluTion (FIRST) is a new reconstruction technique using CT, which provides successful reconstruction of high-quality CT images, especially in low contrast imaging. To evaluate improvements in the diagnostic accuracy of the detection of abnormal late enhancement (LE) in left-ventricular myocardium (LVM) using 320-slice CT with FIRST, we compared this modality with previous CT methods in patients with non-ischemic cardiomyopathy or a cardiac tumor.This was a retrospective study of 88 patients (56 males; 57 ± 15 years) suspected of having non-ischemic myocardial disease or a cardiac tumor. The first 52 consecutive patients (Group 1) underwent 16-slice CT at 140 kV tube voltage and an average tube current of 337 ± 20 mA, and 1.5 T MRI. The next 18 patients (Group 2) underwent 1st generation 320-slice CT at 120 kV tube voltage and an average tube current of 255 ± 106 mA, and 1.5T MRI; the remaining 18 patients (Group 3) underwent 2nd generation 320-slice CT with FIRST, at 80 kV tube voltage and a tube current of 800 mA, and 1.5T or 3T MRI.On patient-based analysis, no significant differences were observed between the 3 groups. For segment-based analysis, the specificity and overall accuracy were significantly higher (both P < 0.05) in Group 3 than in Group 1. Positive predictive value (PPV) was significantly higher in Group 3 than in Groups 1 and 2.The diagnostic accuracy of LE on CT for detecting myocardial fibrosis determined by late gadolinium-enhanced MRI was improved with the use of 2nd generation 320-slice CT with FIRST, in particular regarding specificity, PPV, and overall accuracy.

Improved Diagnostic Performance of New-generation 320-slice Computed Tomography with Forward-projected Model-based Iterative Reconstruction SoluTion for the Assessment of Late Enhancement in Left Ventricular Myocardium

“…On cardiac CT, all patients underwent early-phase acquisitions at 30 to 40 seconds after the injection of contrast media for the evaluation of coronary artery stenosis in the early-phase CT images. They also underwent late-phase acquisitions at about 6 to 8 minutes after the injection of contrast (without additional contrast injection), as contrast defects in the LVM or cardiac lumen were suspected in the early-phase images and myocardial damage or luminal thrombus were suspected ( 5 , 8 , 9 ). The slice thickness was 0.5 mm, and the prospective ECG gating acquisition was selected in both groups to reduce the radiation dose.…”

“…Forward-projected Model-based Iterative Reconstruction SoluTion (FIRST), a recently developed imaging reconstruction technique, has been proposed for use with new-generation 320-slice CT and can provide high-quality CT images even in a low-radiation scan setting ( 7 ). Furthermore, in addition to such improvements in the reconstruction technique, mechanical improvements have also been achieved with new-generation 320-slice CT devices, as the maximum tube current and gantry rotation speed have been increased ( 8 ).…”

“…We previously reported on the improvement in the diagnostic performance of new-generation 320-slice CT with FIRST for detecting LE compared with previous settings ( 8 ). However, only patients with non-ischemic myocardial disease were included in that study, and the number of subjects who underwent CT examinations using new generation CT was small in that study ( 8 ).…”

Current Status and Challenges of NRF2 as a Potential Therapeutic Target for Diabetic Cardiomyopathy

“…[1][2][3] Eventually, the structure and function of the heart become impaired without coronary artery disease and hypertension, a disorder known as diabetic cardiomyopathy (DCM). [4][5][6][7] Although ischemic heart disease is the most frequent cause of heart failure and death in diabetic patients, DCM is increasingly recognized as a clinically relevant entity. [6][7][8][9] It is estimated that about 12% of the diabetic patients develop DCM.…”

“…[4][5][6][7] Although ischemic heart disease is the most frequent cause of heart failure and death in diabetic patients, DCM is increasingly recognized as a clinically relevant entity. [6][7][8][9] It is estimated that about 12% of the diabetic patients develop DCM. 10) The pathogenesis of DCM is predominantly related to the overgeneration of reactive oxygen species (ROS) as well as impaired antioxidant ability in diabetes mellitus.…”