CT-derived myocardial extracellular volume: current evidence, clinical utility, and the emerging role of photon-counting CT-a systematic review.
Eur Radiol ExpSep 22, 2026 (epub)
Jacopo D'Argenzio, Francesco Stucchi, Valentina Tambè et al.
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In 30 seconds
This systematic review evaluated the clinical utility of CT-derived myocardial extracellular volume (ECV) across various cardiovascular diseases. Analyzing 113 studies, it found a significant increase in publications, particularly in 2025. The review highlights the potential of photon-counting CT for ECV assessment, despite substantial methodological heterogeneity and inconsistent cutoff reporting.
Key findings
- 113 studies were included, with a notable increase in publications over the last 3 years.
- ECV was assessed using single-energy CT (65 studies), dual-energy CT (34 studies), and photon-counting CT (14 studies).
- Only 38 studies reported ECV cutoff values, indicating a lack of standardization.
- The mean Newcastle-Ottawa Scale score for study quality was 6.33 ± 1.42.
Why it matters
Understanding the role of CT-derived ECV can enhance noninvasive assessment of diffuse myocardial fibrosis, which is crucial for managing various cardiovascular conditions. The integration of photon-counting CT may improve routine cardiac imaging practices.