Applied Sciences (May 2024)

Delayed Enhancement in Cardiac CT: A Potential Alternative to Cardiac MRI? Technical Updates and Clinical Considerations

  • Domenico De Stefano,
  • Federica Vaccarino,
  • Domiziana Santucci,
  • Marco Parillo,
  • Antonio Nenna,
  • Francesco Loreni,
  • Chiara Ferrisi,
  • Omar Giacinto,
  • Raffaele Barbato,
  • Ciro Mastroianni,
  • Mario Lusini,
  • Massimo Chello,
  • Bruno Beomonte Zobel,
  • Rosario Francesco Grasso,
  • Eliodoro Faiella

DOI
https://doi.org/10.3390/app14104275
Journal volume & issue
Vol. 14, no. 10
p. 4275

Abstract

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Despite cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) being the current gold standard for non-invasive myocardial characterization and fibrosis quantification, its accessibility is limited, particularly in acute settings and in certain patient populations with contraindications to magnetic resonance imaging. Late iodine enhancement (LIE) in computed tomography (CT) imaging has emerged as a potential alternative, capitalizing on the similarities in the contrast kinetics between gadolinium and iodinated contrast agents. Studies have investigated LIE-CT’s effectiveness in myocardial infarction (MI) detection, revealing promising outcomes alongside some disparities compared to LGE-CMR. LIE-CT also proves beneficial in diagnosing non-ischemic heart diseases such as myocarditis, hypertrophic cardiomyopathy, and sarcoidosis. While LIE-CT demonstrates good accuracy in detecting certain myocardial pathologies, including acute MI and chronic fibrotic changes, it has limitations, such as the inability to detect diffuse myocardial enhancement. Nonetheless, thanks to the availability of optimized protocols with minimal radiation doses and contrast medium administration, integrating LIE-CT into cardiac CT protocols could enhance its clinical utility, particularly in acute settings, providing valuable prognostic and management insights across a spectrum of cardiac ischemic and non-ischemic conditions.

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