High Temporal Resolution Dual-Source Photon-Counting CT for Coronary Artery Disease: Initial Multicenter Clinical Experience

Abstract

The aim of this paper is to evaluate the diagnostic image quality of spectral dual-source photon-counting detector coronary computed tomography angiography (PCD-CCTA) for coronary artery disease in a multicenter study. The image quality (IQ), assessability, contrast-to-noise ratio (CNR), Agatston score, and radiation exposure were measured. Stenoses were quantified and compared with invasive coronary angiography, if available. A total of 92 subjects (65% male, age 58 ± 14 years) were analyzed. The prevalence of significant coronary artery disease (CAD) (stenosis ≥ 50%) was 17% of all patients, the range of the Agatston score was 0–2965 (interquartile range (IQR) 0–135). The IQ was very good (one, IQR one–two), the CNR was very high (20 ± 10), and 5% of the segments were rated non-diagnostic. The IQ and assessability were higher in proximal coronary segments (p < 0.001). Agatston scores up to 600 did not significantly affect the assessability of the coronary segments (p = 0.3). Heart rate influenced assessability only at a high-pitch mode (p = 0.009). For the invasive coronary angiography (ICA) subgroup (n = nine), the diagnostic performance for CAD per segment was high (sensitivity 92%, specificity 96%), although the limited number of patients who underwent both diagnostic modalities limits the generalization of this finding at this stage. PCD-CCTA provides good image quality for low and moderate levels of coronary calcifications.

Technical Basics and Clinical Benefits of Photon-Counting CT

“…Instead, they must be shown to have a positive impact on diagnostic accuracy and diagnostic confidence, and ideally to change the clinical management of patients. Initial studies already show an impact on diagnostic performance and diagnostic accuracy in various clinical fields, 46,68,77,86,87 and larger, more comprehensive clinical studies are sure to follow.…”

Imaging in translational cancer research

“…The exciting new possibilities of PCD CT imaging with increased resolution and decreased radiation exposure, as well as additional contrasts, are beginning to be explored in the first large-scale clinical studies, which are expected to shape the future of CT imaging 44 , 45 . Although only few PCD CTs are currently available, many more are expected to be found in hospitals and radiology cabinets.…”

Photon-counting CT-angiography in pre-TAVR aortic annulus assessment: effects of retrospective vs. prospective ECG-synchronization on prosthesis valve selection

“…ECG-reports during CTA acquisition were transferred as DICXOM data, maximum and minimum heart rate as well as medium heart rate were noted. To calculate heart rate variability during CTA acquisition, the following equation was applied, as previously reported: Calculation previously reported [ 16 ]: maximum heart rate – minimum heart rate/((maximum heart Rate + minimum heart rate)/2).…”