Quantitating myocardial fibrosis using extracellular extravascular volume determined from computed tomography myocardial perfusion imaging

Abstract

Abstract Purpose Both of extracellular extravascular volume (EEV) and extracellular volume fraction (ECV) were proposed to quantify enlargement of myocardial interstitial space due to myocardium loss or fibrosis. The study aimed to investigate the feasibility of using EEV derived from myocardial computed tomography (CT) perfusion imaging (VPCT) and extracellular volume quantification with single-energy subtraction CT (ECV− SECT) for quantifying myocardial fibrosis. Methods In this study, 17 patients with suspected and known coronary artery disease underwent examination using a dual-source CT scanner. The EEV− VPCT was derived from dynamic whole-heart myocardial perfusion imaging, and the ECV_SECT was calculated from late-enhanced images 5 min after bolus contrast injection by subtracting the noncontrast baseline. The late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging was used as a reference. Results In total, 11 patients and 73 segments exhibited positivity for LGE on CMR imaging. These were classified into three groups according to the segments: fibrotic segments (group I, n = 73), nonfibrotic segments in LGE-positive patients (group II, n = 103), and segments in LGE-negative patients (group III, n = 80). ECV− SECT, EEV− VPCT, myocardial blood flow (MBF), and myocardial blood volume (MBV) significantly differed among these groups (all P < 0.05). ECV− SECT was significantly higher and EEV− VPCT, MBF, and MBV were significantly lower in fibrotic myocardial segments than in nonfibrotic ones (all P < 0.01). ECV− SECT and EEV− VPCT independently affected myocardial fibrosis. There was no significant correlation between ECV− SECT and EEV− VPCT. The capability of EEV− VPCT to diagnose myocardial fibrosis was equivalent to that of ECV− SECT (area under the curve: 0.798 vs. 0.806, P = 0.844). ECV− SECT of > 41.2% and EEV− VPCT of < 10.3% indicated myocardial fibrosis. Conclusions EEV− VPCT is actually first-pass distribution volume that can feasibly be used to quantify myocardial fibrosis. Furthermore, the diagnostic efficacy of EEV− VPCT is comparable to that of ECV− SECT.