Stent imaging on a clinical dual-source photon-counting detector CT system—impact of luminal attenuation and sharp kernels on lumen visibility

Decker, Josua A.; O’Doherty, Jim; Schoepf, U. Joseph; Todoran, Thomas M.; Aquino, Gilberto; Brandt, Verena; Baruah, Dhiraj; Fink, Nicola; Zsarnóczay, Emese; Flohr, Thomas; Schmidt, Bernhard; Allmendinger, Thomas; Risch, Franka; Varga-Szemes, Ákos; Emrich, Tilman

doi:10.1007/s00330-022-09283-4

Cited by 26 publications

(14 citation statements)

References 33 publications

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“…We did not evaluate the impact of different reconstruction kernels. However, this could be a valuable approach to further improve qualitative and quantitative evaluations of stent appearance [ 27 ]. Lastly, being a first hand-on experience study, only a limited number of samples were considered.…”

Section: Discussionmentioning

confidence: 99%

Stent appearance in a novel silicon-based photon-counting CT prototype: ex vivo phantom study in head-to-head comparison with conventional energy-integrating CT

et al. 2023

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Background In this study, stent appearance in a novel silicon-based photon-counting computed tomography (Si-PCCT) prototype was compared with a conventional energy-integrating detector CT (EIDCT) system. Methods An ex vivo phantom was created, consisting of a 2% agar-water mixture, in which human-resected and stented arteries were individually embedded. Using similar technique parameters, helical scan data was acquired using a novel prototype Si-PCCT and a conventional EIDCT system at a volumetric CT dose index (CTDIvol) of 9 mGy. Reconstructions were made at 502 and 1502 mm2 field-of-views (FOVs) using a bone kernel and adaptive statistical iterative reconstruction with 0% blending. Using a 5-point Likert scale, reader evaluations were performed on stent appearance, blooming and inter-stent visibility. Quantitative image analysis was performed on stent diameter accuracy, blooming and inter-stent distinction. Qualitative and quantitative differences between Si-PCCT and EIDCT systems were tested with a Wilcoxon signed-rank test and a paired samples t-test, respectively. Inter- and intra-reader agreement was assessed using the intraclass correlation coefficient (ICC). Results Qualitatively, Si-PCCT images were rated higher than EIDCT images at 150-mm FOV, based on stent appearance (p = 0.026) and blooming (p = 0.015), with a moderate inter- (ICC = 0.50) and intra-reader (ICC = 0.60) agreement. Quantitatively, Si-PCCT yielded more accurate diameter measurements (p = 0.001), reduced blooming (p < 0.001) and improved inter-stent distinction (p < 0.001). Similar trends were observed for the images reconstructed at 50-mm FOV. Conclusions When compared to EIDCT, the improved spatial resolution of Si-PCCT yields enhanced stent appearance, more accurate diameter measurements, reduced blooming and improved inter-stent distinction. Key points • This study evaluated stent appearance in a novel silicon-based photon-counting computed tomography (Si-PCCT) prototype. • Compared to standard CT, Si-PCCT resulted in more accurate stent diameter measurements. • Si-PCCT also reduced blooming artefacts and improved inter-stent visibility.

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Section: Discussionmentioning

confidence: 99%

Stent appearance in a novel silicon-based photon-counting CT prototype: ex vivo phantom study in head-to-head comparison with conventional energy-integrating CT

et al. 2023

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“…The limitations of MSCT in heavy calcified vessels are well known, as well as limitations related to arrhythmia and stented vessels. The range of patients assessable by MSCT is continuously increasing with improved technology, starting from the early 64-slice MSCT and the dual 128- and 256-scanners used in our study, to photon-counting detectors now available [23]. The high sensitivity and safety of current technology make it likely that MSCT will replace conventional coronary angiography as the first investigation in a majority of patients where coronary artery disease is suspected, and in the follow-up after revascularization [24].…”

Section: Discussionmentioning

confidence: 99%

Long-term multimodality imaging follow-up of ST-segment elevation myocardial infarction patients treated with bioresorbable vascular scaffold: advantages and challenges

Eriksen

Neghabat

Larsen

et al. 2023

Coronary Artery Disease

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Background: Multislice computed tomography (MSCT) offers a non-invasive method of imaging bioresorbable scaffolds (BRS). Objectives: To investigate the advantages and challenges using MSCT in the follow-up after BRS implantation. Method: The BRS cohort consisting of 31 patients in the ‘BRS in STEMI’ trial was examined by multimodality imaging and followed long-term. Minimum lumen area (MLA) and average lumen area (ALA) were examined 12 and 36 months after BRS implantation with MSCT. Optical coherence tomography (OCT) at 12 months was used as a reference. Results: Measured by MSCT, the mean MLA was 0.05 ± 1.32 mm² (P = 0.85), but ALA was 1.32 (±2.59 mm², P = 0.015) greater than by OCT. ALA and MLA did not change significantly from 12 to 36 months. MSCT identified all cases of restenosis but missed one patient with massive malapposition. Conclusion: Our data support using MSCT in the follow-up after BRS implantation. Invasive investigation should still be considered for patients with unexplained symptoms.

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“…The high spatial resolution is evident in its enhanced imaging of coronary stent and in-stent lumens. 10,[12][13][14][15][16][17] It also improves visualization of coronary plaques, especially resulting from calcified lesions, 18,19 and therefore, increases accuracy in quantifying stenosis. 20,21 In addition, PCCT enables the reconstruction of multiple types of images from a single acquisition, offering several advantageous possibilities for enhancing image quality.…”

Section: Introductionmentioning

confidence: 99%

Thin slice photon‐counting CT coronary angiography compared to conventional CT: Objective image quality and clinical radiation dose assessment

van der Bie,

Bos,

Dijkshoorn

et al. 2024

Medical Physics

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BackgroundPhoton‐counting CT (PCCT) is the next‐generation CT scanner that enables improved spatial resolution and spectral imaging. For full spectral processing, higher tube voltages compared to conventional CT are necessary to achieve the required spectral separation. This generated interest in the potential influence of thin slice high tube voltage PCCT on overall image quality and consequently on radiation dose.PurposeThis study first evaluated tube voltages and radiation doses applied in patients who underwent coronary CT angiography with PCCT and energy‐integrating detector CT (EID‐CT). Next, image quality of PCCT and EID‐CT was objectively evaluated in a phantom study simulating different patient sizes at these tube voltages and radiation doses.MethodsWe conducted a retrospective analysis of clinical doses of patients scanned on a conventional and PCCT system. Average patient water equivalent diameters for different tube voltages were extracted from the dose reports for both EID‐CT and PCCT. A conical phantom made of polyethylene with multiple diameters (26/31/36 cm) representing different patient sizes and containing an iodine insert was scanned with a EID‐CT scanner using tube voltages and phantom diameters that match the patient scans and characteristics. Next, phantom scans were made with PCCT at a fixed tube voltage of 120 kV and with CTDIVOL values and phantom diameters identical to the EID‐CT scans. Clinical image reconstructions at 0.6 mm slice thickness for conventional CT were compared to PCCT images with 0.4 mm slice thickness. Image quality was quantified using the detectability index (d′), which estimated the visibility of a 3 mm diameter contrast‐enhanced coronary artery by considering noise, contrast, resolution, and human visual perception. Alongside d′, noise, contrast and resolution were also individually assessed. In addition, the influence of various kernels (Bv40/Bv44/Bv48/Bv56), quantum iterative reconstruction strengths (QIR, 3/4) and monoenergetic levels (40/45/50/55 keV) for PCCT on d′ was investigated.ResultsIn this study, 143 patients were included: 47 were scanned on PCCT (120 kV) and the remaining on EID‐CT (74 small‐sized at 70 kV, 18 medium‐sized at 80 kV and four large‐sized at 90 kV). EID‐CT showed 7%–17% higher d′ than PCCT with Bv40 kernel and strength four for small/medium patients. Lower monoenergetic images (40 keV) helped mitigate the difference to 1%–6%. For large patients, PCCT's detectability was up to 31% higher than EID‐CT. PCCT has thinner slices but similar noise levels for similar reconstruction parameters. The noise increased with lower keV levels in PCCT (≈30% increase), but higher QIR strengths reduced noise. PCCT's iodine contrast was stable across patient sizes, while EID‐CT had 33% less contrast in large patients than in small‐sized patients.ConclusionAt 120 kV, thin slice PCCT enables CCTA in phantom scans representing large patients without raising radiation dose or affecting vessel detectability. However, higher doses are needed for small and medium‐sized patients to obtain a similar image quality as in EID‐CT. The alternative of using lower mono‐energetic levels requires further evaluation in clinical practice.

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Stent imaging on a clinical dual-source photon-counting detector CT system—impact of luminal attenuation and sharp kernels on lumen visibility

Cited by 26 publications

References 33 publications

Stent appearance in a novel silicon-based photon-counting CT prototype: ex vivo phantom study in head-to-head comparison with conventional energy-integrating CT

Stent appearance in a novel silicon-based photon-counting CT prototype: ex vivo phantom study in head-to-head comparison with conventional energy-integrating CT

Long-term multimodality imaging follow-up of ST-segment elevation myocardial infarction patients treated with bioresorbable vascular scaffold: advantages and challenges

Thin slice photon‐counting CT coronary angiography compared to conventional CT: Objective image quality and clinical radiation dose assessment

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