Kardiale Mehrschicht Computertomographie : Eignung von „Niedrig-Kontrast-Datensätzen“ zur linksventrikulären Volumetrie bei Patienten mit hypertropher Kardiomyopathie variabler Ausprägung

Introduction: Late enhanced multi-slice computed tomography (leMDCT) introduced for the visualization of late enhancement (LE) indicating intramyocardial fibrosis in Hypertrophic Cardiomyopathy (HCM) leaves the left-ventricular (LV) cavity with low contrast at the time of scanning. With regard to potentential risk stratification we analysed whether leMDCT-datasets additionally allow for volumetric LV assessment. Methods: We prospectively included HCM-patients to perform leMDCT (64 slice-CT) followed by the gold standard, cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) (1.5T). Dye was injected 7 minutes (Iopromid; 150mL) in leMDCT and 12 minutes (Gadolinium; 15mL 0.15mmoL/kgBW) in LGE-CMR before scanning. After creating three groups (0=no, 1=borderline and 2=sufficient LV-contrast) all reconstructed short cardiac axis views were manually and semiautomatically assessed and correlated with regard to LV muscle mass (MM) and other prognostically relevant volumetric parameters. Results: Mean age was 64.2±14 years of age. The three groups of varying contrast differed in weight and body mass index (p<0.05). Besides two datasets (7.7%) without contrast the datasets with borderline and sufficient contrast had received 1.8±0.3 ml/kgBW and 2.2±0.4 ml/kgBW, respectively. In leMDCT semiautomatic assessment of LV-MM of the groups with borderline and sufficient LV-contrast resulted in 172±30.8 gMM and 147.4±64.8 gMM, respectively, while manual assessment resulted in 166.5±33.3 gMM and 159.4±60.4 gMM, respectively. Overall Intra-/inter-observer variability showed an accuracy of 0.9±8.6 gMM and 0.8±9.2 gMM, respectively, for semiautomatic assessment and -2.2±7.3 gMM and 1±12.4 gMM, respectively, for manual assessment. All of the above measures correlated well with CMR (r≥0,9).


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