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OBJECTIVES
To evaluate image quality and diagnostic accuracy of selective monoenergetic reconstructions of late iodine enhancement (LIE) dual-energy computed tomography (DECT) for imaging of chronic myocardial infarction (CMI).

METHODS
Twenty patients with a history of coronary bypass surgery underwent cardiac LIE-DECT and late gadolinium enhancement (LGE) magnetic resonance imaging (MRI). LIE-DECT images were reconstructed as selective monoenergetic spectral images with photon energies of 40, 60, 80, and 100 keV and the standard linear blending setting (M_0.6). Images were assessed for late enhancement, transmural extent, signal characteristics and subjective image quality.

RESULTS
Seventy-nine myocardial segments (23 %) showed LGE. LIE-DECT detected 76 lesions. Images obtained at 80 keV and M_0.6 showed a high signal-to-noise ratio (15.9; 15.1), contrast-to-noise ratio (4.2; 4.0) and sensitivity (94.9 %; 92.4 %) while specificity was identical (99.6 %). Differences between these series were not statistically significant. Transmural extent of LIE was overestimated in both series (80 keV: 40 %; M_0.6: 35 %) in comparison to MRI. However, observers preferred 80 keV in 13/20 cases (65 %, κ = 0.634) over M_0.6 (4/20 cases) regarding subjective image quality.

CONCLUSIONS
Post-processing of LIE-DECT data with selective monoenergetic reconstructions at 80 keV significantly improves subjective image quality while objective image quality shows no significant difference compared to standard linear blending.

KEY POINTS
Late enhancement dual-energy CT allows for detection of chronic myocardial infarction. Monoenergetic reconstructions at 80 keV significantly improve subjective image quality. 80 keV and standard linear blending reconstructions show no significant differences. Extent of CMI detected with LIE-DECT is overestimated compared with MRI.