Application of spectral computed tomography dual-substance separation technology for diagnosing left ventricular thrombus

OBJECTIVE To investigate the value of spectral computed tomography (CT) dual-substance separation technology for diagnosing left ventricular (LV) thrombus. METHODS In this observational case-control study, spectral CT scans were conducted in patients with and without LV thrombi. Densities in the regions of the LV cavity, papillary muscles and LV thrombus were observed on 140 kVp mixed-energy and 70 keV single-energy images. Iodine and blood were chosen as the base material pair, the densities were observed and the iodine and blood concentrations were quantitatively measured. RESULTS A total of 24 patients were enrolled in this study. On iodine-based density images, both the LV thrombus and papillary muscles showed low-attenuation shadows. On blood-based density images, comparable high-density attenuation was found in the LV thrombus and LV cavity, while relative hypodensity was noted in the papillary muscles. Iodine and blood densities were significantly lower in papillary muscles than in the LV cavity. Iodine densities were significantly lower in the LV thrombus than the LV cavity, whereas blood densities in the two areas did not differ significantly. CONCLUSIONS Spectral CT dual-substance separation technology and its derived images of iodine- and blood- based densities provide a new, simple, and feasible semiquantitative method to detect LV thrombus that warrants further investigation.