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Meta-Analysis
. 2025 Jun;35(6):3054-3067.
doi: 10.1007/s00330-024-11283-5. Epub 2024 Dec 19.

Diagnostic accuracy of late iodine enhancement on cardiac CT for myocardial tissue characterization: a systematic review and meta-analysis

Marco Gatti #  1 , Ovidio De Filippo #  2 , Gaia Cura Curà  3 , Veronica Dusi  2 , Umberto Di Vita  2 , Guglielmo Gallone  2 , Arianna Morena  2 , Anna Palmisano  4   5 , Elettra Pasinato  3 , Andrea Solano  2 , Gaetano Maria De Ferrari  2 , Antonio Esposito  4   5 , Paolo Fonio  3 , Riccardo Faletti  3 , Fabrizio D'Ascenzo  2
Affiliations
Meta-Analysis

Diagnostic accuracy of late iodine enhancement on cardiac CT for myocardial tissue characterization: a systematic review and meta-analysis

Marco Gatti et al. Eur Radiol. 2025 Jun.

Abstract

Purpose: to evaluate the diagnostic accuracy of late iodine enhancement (LIE) in cardiac computed tomography (CCT) compared to late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) for myocardial tissue characterization.

Materials and methods: EMBASE, PubMed/MEDLINE, and CENTRAL were searched for studies reporting the accuracy of LIE with LGE as the gold standard of reference. QUADAS-2 tool was used to assess the risk of bias. A bivariate random-effects model was used to analyze, pool, and plot the diagnostic performance measurements across studies. Pooled sensitivity, specificity, positive (+LR) and negative (-LR) likelihood ratio, diagnostic odds ratio (DOR), and hierarchical summary ROC curve (HSROC) were computed. Prospero registration number: CRD42023484045.

Results: Fourteen studies involving 526 patients and 5758 myocardial segments were included. At the patient level, LIE in CCT showed a pooled sensitivity of 0.96 (95% CI: 0.88-0.99), specificity of 0.95 (95% CI: 0.88-0.98) and the HSROC AUC of 0.98 (95% CI: 0.97-0.99). The +LR was 20.97 (95% CI: 7.54-58.38) and the -LR was 0.04 (95% CI: 0.01-0.13), resulting in a DOR of 535 (95% CI: 94-3024). At the segment level, sensitivity was 0.86 (95% CI: 0.79-0.91), specificity was 0.98 (95% CI: 0.96-0.99), and the HSROC AUC was 0.97 (95% CI:0.95-0.98). The +LR was 55.08 (95% CI: 19.94-152.16) and the -LR was 0.14 (95% CI: 0.09-0.22) with a DOR of 388 (95% CI: 113-1333). Dual-energy CCT improved segment-level sensitivity to 0.93 (95% CI: 0.88-0.96).

Conclusion: LIE in CCT shows excellent diagnostic accuracy when compared to LGE in CMR for myocardial tissue characterization, suggesting its potential as a promising alternative to CMR.

Key points: Question How does myocardial tissue characterization by late iodine enhancement (LIE) on cardiac CT (CCT) compare to late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR)? Findings LIE in CCT demonstrates excellent diagnostic accuracy, with high sensitivity and specificity at both patient and segment levels, using LGE in CMR as the reference. Clinical relevance LIE in CCT provides a reliable alternative to LGE in CMR, especially for patients for whom CMR is not available or feasible or is contraindicated, thus improving access to myocardial tissue characterization.

Keywords: Cardiac computed tomography; Magnetic resonance imaging; Meta-analysis; Myocardial infarction/diagnosis; Myocardium fibrosis.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Prof. Paolo Fonio. Conflict of interest: The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry: Dott. Marco Gatti kindly provided statistical advice for this manuscript. Informed consent: Written informed consent was not required for this study because the study is a systematic review and meta-analysis. Ethical approval: Institutional Review Board approval was not required because the study is a systematic review and meta-analysis. Study subjects or cohorts overlap: Some study subjects or cohorts have been previously reported in the papers included in the manuscript because the study is a systematic review and meta-analysis. Methodology: Systematic review and meta-analysis

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