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Dual Energy CT Enhances Postmortem Heart Imaging

Publication Title: Applying dual energy computed tomography to postmortem coronary computed tomographic angiography

Summary

Question
This study investigated whether dual energy computed tomography (DECT) can be used in postmortem coronary computed tomographic angiography (PMcCTA) to distinguish between two types of contrast agents—iodine-based and gadolinium-based—and simultaneously assess coronary artery patency (whether arteries are open or blocked) and myocardial perfusion (blood flow in heart tissue).
Why it Matters
Cardiovascular disease is a leading cause of death worldwide, and postmortem imaging is increasingly being used to supplement or replace traditional autopsies in death investigations. PMcCTA offers advantages in visualizing coronary arteries and diagnosing causes of sudden cardiac death. However, most studies use aqueous (water-based) contrast agents, which can obscure smaller vessels and myocardial tissue. By introducing DECT and combining iodine and gadolinium contrast agents, this study aims to improve the accuracy of postmortem imaging and provide deeper insights into coronary artery disease and its effects on heart tissue. This has implications for forensic pathology, clinical imaging, and understanding cardiovascular disease mechanisms.
Methods
The researchers performed experiments using phantoms (models designed to mimic tissue and vessels) containing iodine and gadolinium contrast agents to evaluate DECT’s ability to differentiate these substances. They then conducted PMcCTA on six porcine hearts using sequential injections of aqueous gadolinium and lipophilic (fat-loving) iodinated Angiofil, followed by imaging with a single-source DECT scanner. The DECT images were processed using specialized software to separate the two contrast agents and visualize their distributions.
Key Findings
DECT successfully differentiated between iodine-based and gadolinium-based contrast agents and revealed their distinct distributions. Iodine remained confined to the coronary arteries, while gadolinium dispersed into the myocardial tissue, highlighting perfusion patterns. In one heart, DECT identified a myocardial infarction (heart tissue damage due to blocked blood flow), and in another, retained iodine from earlier imaging indicated reperfusion injury (damage caused by the return of blood flow). DECT’s ability to map these changes was particularly valuable in identifying areas of vascular obstruction and tissue injury.
Implications
The findings demonstrate that DECT can improve postmortem imaging by simultaneously assessing coronary artery patency and myocardial perfusion. This technique could enhance forensic investigations of sudden cardiac death and refine clinical imaging practices. Additionally, it offers new insights into the pathological changes associated with coronary artery disease, such as infarctions and reperfusion injuries, which could inform treatment strategies and imaging protocols in living patients.
Next Steps
The authors suggest applying this protocol to human decedents to further validate its effectiveness and include histopathologic correlation (comparison with tissue samples). This future research could deepen understanding of coronary artery disease and improve imaging techniques in both clinical and forensic settings.
Funding Information
This research was supported by the Radiological Society of North America (RSNA) Resident Research Grant #RR2208, and the National Institutes of Health (awards T32HL098069, S10RR025555, S10OD032277, R01HL121226, and R01HL137365). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Full Citation

Solomon N, Hoerner M, Vermillion B, Jang S, Sanchez H, Gosangi B, Staib L, Thorn S, Liu C, Sinusas A. Applying dual energy computed tomography to postmortem coronary computed tomographic angiography. Journal Of Cardiovascular Computed Tomography 2025, 20: 42-49. PMID: 41176442, PMCID: PMC12712555, DOI: 10.1016/j.jcct.2025.10.016.
This AI-assisted summary has been reviewed and approved by at least one of the study's authors to ensure it accurately reflects the research.

Authors

  • Nadia Solomon, MD, PhD, MSc, MA

    First Author
    Yale School of Medicine

    Assistant Professor of Radiology and Biomedical Imaging

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  • Albert Sinusas, MD

    Last Author
    Yale School of Medicine

    Professor of Medicine (Cardiology)

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Additional Yale School of Medicine Authors

Other Authors

  • Billy Vermillion;
  • Harold Sanchez

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