Update on Cardiovascular Applications of Multienergy CT

Advances in scanner technology enabling shorter scan times, improvements in spatial and temporal resolution, and more dose-efficient data reconstruction coupled with rapidly growing evidence from clinical trials have established computed tomography (CT) as an important imaging modality in the evaluation of cardiovascular disorders. Multienergy (or spectral or dual-energy) CT is a relatively recent advance in which attenuation data from different energies are used to characterize materials beyond what is possible at conventional CT. Current technologies for multienergy CT are either source based (ie, dual source, rapid kilovoltage switching, dual spin, and split beam) or detector based (ie, dual layer and photon counting), and material-based decomposition occurs in either image or projection space. In addition to conventional diagnostic images, multienergy CT provides image sets such as iodine maps, virtual nonenhanced, effective atomic number, and virtual monoenergy (VM) images as well as data at the elemental level (CT fingerprinting), which can complement and in some areas overcome the limitations posed by conventional CT methods. In myocardial perfusion imaging, iodine maps improve the sensitivity of perfusion defects, and VM images improve the specificity by decreasing artifacts. Iodine maps are also useful in improving the performance of CT in delayed-enhancement imaging. In pulmonary perfusion imaging, iodine maps enhance the sensitivity of detection of both acute and chronic pulmonary emboli. Low-energy (as measured in kiloelectron volts) VM images allow enhancement of vascular contrast, which can either be used to lower contrast dose or salvage a suboptimal contrast-enhanced study. High-energy VM images can be used to decrease or eliminate artifacts such as beam-hardening and metallic artifacts. Virtual nonenhanced images have similar attenuation as true nonenhanced images and help in reducing radiation dose by eliminating the need for the latter in multiphasic vascular studies. Other potential applications of multienergy CT include calcium scoring from virtual nonenhanced images created from coronary CT angiograms and myocardial iron quantification.