Myocardial extracellular volume measurement using cardiac computed tomography

Myocardial fibrosis is a common endpoint of many cardiac diseases and increasingly recognized as a predictor of heart failure, arrhythmia, and death. Recent studies have utilised cardiac computed tomography (CT) scans with delayed phase imaging to quantify diffuse fibrosis of the myocardium. CT extracellular volume (CT-ECV) measurement correlates well with CMR and histological myocardial fibrosis. Furthermore, CT-ECV predicts outcomes such as death, heart failure and arrhythmia in various disease states. This review summarizes the rationale and methodology behind CT-ECV measurement and provides a detailed summary of the current clinical evidence for the use of CT-ECV. Graphical abstract Cardiac Computed Tomography Extracellular Volume Assessment (CT-ECV) offers rapid and accurate quantification of myocardial fibrosis. This modality requires additional delayed imaging which allows for assessment of iodine concentrations in the myocardium. This concentration correlates to the degree of myocardial fibrosis. CT-ECV can be used to identify myocardial disease and prognosticate for future risk of cardiovascular outcomes