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Intraindividual Comparison of Ultrahigh-Spatial-Resolution Photon-Counting Detector CT and Energy-Integrating Detector CT for Coronary Stenosis Measurement

医学 冠状动脉疾病 狭窄 放射科 血管造影 核医学 冠状动脉造影 内科学 心肌梗塞
作者
M. Vecsey-Nagy,Giuseppe Tremamunno,U. Joseph Schoepf,Chiara Gnasso,Emese Zsarnóczay,Nicola Fink,Dmitrij Kravchenko,Moritz C. Halfmann,Gerald S. Laux,Jim O’Doherty,Bálint Szilveszter,Pál Maurovich‐Horvat,Ismail Kabakus,Pál Surányi,Ákos Varga‐Szemes,Tilman Emrich
出处
期刊:Circulation-cardiovascular Imaging [Lippincott Williams & Wilkins]
卷期号:17 (10) 被引量:5
标识
DOI:10.1161/circimaging.124.017112
摘要

BACKGROUND: A recent simulation study proposed that stenosis measurements on coronary computed tomography (CT) angiography are influenced by the improved spatial resolution of photon-counting detector (PCD)-CT. The aim of the current study was to evaluate the impact of ultrahigh-spatial-resolution (UHR) on coronary stenosis measurements and Coronary Artery Disease Reporting and Data System (CAD-RADS) reclassification rates in patients undergoing coronary CT angiography on both PCD-CT and energy-integrating detector (EID)-CT and to compare measurements against quantitative coronary angiography. METHODS: Patients with coronary calcification on EID-CT (collimation, 192×0.6 mm) were prospectively enrolled for a research coronary CT angiography with UHR PCD-CT (collimation, 120×0.2 mm) within 30 days (between April 1, 2023 and January 31, 2024). PCD-CT was acquired with the same or lower CT dose index and equivalent contrast media volume as EID-CT. Percentage diameter stenosis (PDS) for calcified, partially calcified, and noncalcified lesions were compared between scanners. Patient-level reclassification rates for CAD-RADS were evaluated. The accuracy of PDS measurements was validated against quantitative coronary angiography in patients who underwent invasive coronary angiography. RESULTS: In total, PDS of 278 plaques were quantified in 49 patients (calcified, 202; partially calcified, 51; noncalcified, 25). PCD-CT-based PDS values were lower than EID-CT measurements for calcified (45.1±20.7 versus 54.6±19.2%; P <0.001) and partially calcified plaques (44.3±19.6 versus 54.9±20.0%; P <0.001), without significant differences for noncalcified lesions (39.1±15.2 versus 39.0±16.0%; P =0.98). The reduction in stenosis degrees led to a 49.0% (24/49) reclassification rate to a lower CAD-RADS with PCD-CT. In a subset of 12 patients with 56 lesions, UHR–based PDS values showed higher agreement with quantitative coronary angiography (mean difference, 7.3%; limits of agreement, −10.7%/25.2%) than EID-CT measurements (mean difference, 17.4%; limits of agreement, −6.9%/41.7%). CONCLUSIONS: Compared with conventional EID-CT, UHR PCD-CT results in lower PDS values and more accurate stenosis measurements in coronary plaques with calcified components and leads to a substantial Coronary Artery Disease Reporting and Data System reclassification rate in 49.0% of patients.
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