Dual-contrast agent photon-counting computed tomography of the heart: initial experience

Rolf Symons, Tyler E. Cork, Manu N. Lakshmanan, Robert Evers, Cynthia Davies-Venn, Kelly A. Rice, Marvin L. Thomas, Chia Ying Liu, Steffen Kappler, Stefan Ulzheimer, Veit Sandfort, David A. Bluemke, Amir Pourmorteza

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


To determine the feasibility of dual—contrast agent imaging of the heart using photon-counting detector (PCD) computed tomography (CT) to simultaneously assess both first-pass and late enhancement of the myocardium. An occlusion-reperfusion canine model of myocardial infarction was used. Gadolinium-based contrast was injected 10 min prior to PCD CT. Iodinated contrast was infused immediately prior to PCD CT, thus capturing late gadolinium enhancement as well as first-pass iodine enhancement. Gadolinium and iodine maps were calculated using a linear material decomposition technique and compared to single-energy (conventional) images. PCD images were compared to in vivo and ex vivo magnetic resonance imaging (MRI) and histology. For infarct versus remote myocardium, contrast-to-noise ratio (CNR) was maximal on late enhancement gadolinium maps (CNR 9.0 ± 0.8, 6.6 ± 0.7, and 0.4 ± 0.4, p < 0.001 for gadolinium maps, single-energy images, and iodine maps, respectively). For infarct versus blood pool, CNR was maximum for iodine maps (CNR 11.8 ± 1.3, 3.8 ± 1.0, and 1.3 ± 0.4, p < 0.001 for iodine maps, gadolinium maps, and single-energy images, respectively). Combined first-pass iodine and late gadolinium maps allowed quantitative separation of blood pool, scar, and remote myocardium. MRI and histology analysis confirmed accurate PCD CT delineation of scar. Simultaneous multi-contrast agent cardiac imaging is feasible with photon-counting detector CT. These initial proof-of-concept results may provide incentives to develop new k-edge contrast agents, to investigate possible interactions between multiple simultaneously administered contrast agents, and to ultimately bring them to clinical practice.

Original languageEnglish (US)
Pages (from-to)1253-1261
Number of pages9
JournalInternational Journal of Cardiovascular Imaging
Issue number8
StatePublished - Aug 1 2017


  • Cardiac imaging techniques
  • Computed tomography
  • Contrast media
  • Myocardial infarction
  • Photon-counting CT
  • Spectral CT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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