TY - JOUR
T1 - Ultrahigh-Spatial-Resolution Photon-counting Detector CT Angiography of Coronary Artery Disease for Stenosis Assessment
AU - Halfmann, Moritz C.
AU - Bockius, Stefanie
AU - Emrich, Tilman
AU - Hell, Michaela
AU - Schoepf, U. Joseph
AU - Laux, Gerald S.
AU - Kavermann, Larissa
AU - Graafen, Dirk
AU - Gori, Tomasso
AU - Yang, Yang
AU - Klöckner, Roman
AU - Maurovich-Horvat, Pál
AU - Ricke, Jens
AU - Müller, Lukas
AU - Varga-Szemes, Akos
AU - Fink, Nicola
N1 - Publisher Copyright:
© RSNA, 2024.
PY - 2024/2
Y1 - 2024/2
N2 - Background: Coronary CT angiography is a first-line test in coronary artery disease but is limited by severe calcifications. Photoncounting- detector (PCD) CT improves spatial resolution. Purpose: To investigate the effect of improved spatial resolution on coronary stenosis assessment and reclassification. Materials and Methods: Coronary stenoses were evaluated prospectively in a vessel phantom (in vitro) containing two stenoses (25%, 50%), and retrospectively in patients (in vivo) who underwent ultrahigh-spatial-resolution cardiac PCD CT (from July 2022 to April 2023). Images were reconstructed at standard resolution (section thickness, 0.6 mm; increment, 0.4 mm; Bv44 kernel), high spatial resolution (section thickness, 0.4 mm; increment, 0.2 mm; Bv44 kernel), and ultrahigh spatial resolution (section thickness, 0.2; increment, 0.1 mm; Bv64 kernel). Percentages of diameter stenosis (DS) were compared between reconstructions. In vitro values were compared with the manufacturer specifications of the phantom and patient results were assessed regarding effects on Coronary Artery Disease Reporting and Data System (CAD-RADS) reclassification. Results: The in vivo sample included 114 patients (mean age, 68 years ± 9 [SD]; 71 male patients). In vitro percentage DS measurements were more accurate with increasing spatial resolution for both 25% and 50% stenoses (mean bias for standard resolution, high spatial resolution, and ultrahigh spatial resolution, respectively: 10.1%, 8.0%, and 2.3%; P < .001). In vivo results confirmed decreasing median percentage DS with increasing spatial resolution for calcified stenoses (n = 161) (standard resolution, high spatial resolution, and ultrahigh spatial resolution, respectively: 41.5% [IQR, 27.3%-58.2%], 34.8% [IQR, 23.7%-55.1%], and 26.7% [IQR, 18.6%-44.3%]; P < .001), whereas noncalcified (n = 13) and mixed plaques (n = 19) did not show evidence of a difference (P ≥ .88). Ultrahigh-spatial-resolution reconstructions led to reclassification of 62 of 114 (54.4%) patients to lower CADRADS category than that assigned using standard resolution. Conclusion: In vivo and in vitro coronary stenosis assessment improved for calcified stenoses by using ultrahigh-spatial-resolution PCD CT reconstructions, leading to lower percentage DS compared with standard resolution and clinically relevant rates of reclassification.
AB - Background: Coronary CT angiography is a first-line test in coronary artery disease but is limited by severe calcifications. Photoncounting- detector (PCD) CT improves spatial resolution. Purpose: To investigate the effect of improved spatial resolution on coronary stenosis assessment and reclassification. Materials and Methods: Coronary stenoses were evaluated prospectively in a vessel phantom (in vitro) containing two stenoses (25%, 50%), and retrospectively in patients (in vivo) who underwent ultrahigh-spatial-resolution cardiac PCD CT (from July 2022 to April 2023). Images were reconstructed at standard resolution (section thickness, 0.6 mm; increment, 0.4 mm; Bv44 kernel), high spatial resolution (section thickness, 0.4 mm; increment, 0.2 mm; Bv44 kernel), and ultrahigh spatial resolution (section thickness, 0.2; increment, 0.1 mm; Bv64 kernel). Percentages of diameter stenosis (DS) were compared between reconstructions. In vitro values were compared with the manufacturer specifications of the phantom and patient results were assessed regarding effects on Coronary Artery Disease Reporting and Data System (CAD-RADS) reclassification. Results: The in vivo sample included 114 patients (mean age, 68 years ± 9 [SD]; 71 male patients). In vitro percentage DS measurements were more accurate with increasing spatial resolution for both 25% and 50% stenoses (mean bias for standard resolution, high spatial resolution, and ultrahigh spatial resolution, respectively: 10.1%, 8.0%, and 2.3%; P < .001). In vivo results confirmed decreasing median percentage DS with increasing spatial resolution for calcified stenoses (n = 161) (standard resolution, high spatial resolution, and ultrahigh spatial resolution, respectively: 41.5% [IQR, 27.3%-58.2%], 34.8% [IQR, 23.7%-55.1%], and 26.7% [IQR, 18.6%-44.3%]; P < .001), whereas noncalcified (n = 13) and mixed plaques (n = 19) did not show evidence of a difference (P ≥ .88). Ultrahigh-spatial-resolution reconstructions led to reclassification of 62 of 114 (54.4%) patients to lower CADRADS category than that assigned using standard resolution. Conclusion: In vivo and in vitro coronary stenosis assessment improved for calcified stenoses by using ultrahigh-spatial-resolution PCD CT reconstructions, leading to lower percentage DS compared with standard resolution and clinically relevant rates of reclassification.
UR - http://www.scopus.com/inward/record.url?scp=85185705269&partnerID=8YFLogxK
U2 - 10.1148/radiol.231956
DO - 10.1148/radiol.231956
M3 - Journal articles
C2 - 38376407
AN - SCOPUS:85185705269
SN - 0033-8419
VL - 310
JO - Radiology
JF - Radiology
IS - 2
M1 - 231956
ER -