1
|
Hagar MT, Soschynski M, Saffar R, Molina-Fuentes MF, Weiss J, Rau A, Schuppert C, Ruile P, Faby S, Schibilsky D, von Zur Muehlen C, Schlett CL, Bamberg F, Krauss T. Ultra-high-resolution photon-counting detector CT in evaluating coronary stent patency: a comparison to invasive coronary angiography. Eur Radiol 2024; 34:4273-4283. [PMID: 38177617 PMCID: PMC11213791 DOI: 10.1007/s00330-023-10516-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/02/2023] [Accepted: 10/25/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES To determine the diagnostic accuracy of ultra-high-resolution photon-counting detector CT angiography (UHR PCD-CTA) for evaluating coronary stent patency compared to invasive coronary angiography (ICA). METHODS Consecutive, clinically referred patients with prior coronary stent implantation were prospectively enrolled between August 2022 and March 2023 and underwent UHR PCD-CTA (collimation, 120 × 0.2 mm). Two radiologists independently analyzed image quality of the in-stent lumen using a 5-point Likert scale, ranging from 1 ("excellent") to 5 ("non-diagnostic"), and assessed all coronary stents for the presence of in-stent stenosis (≥ 50% lumen narrowing). The diagnostic accuracy of UHR PCD-CTA was determined, with ICA serving as the standard of reference. RESULTS A total of 44 coronary stents in 18 participants (mean age, 83 years ± 6 [standard deviation]; 12 women) were included in the analysis. In 3/44 stents, both readers described image quality as non-diagnostic, whereas reader 2 noted a fourth stent to have non-diagnostic image quality. In comparison to ICA, UHR PCD-CTA demonstrated a sensitivity, specificity, and accuracy of 100% (95% CI [confidence interval] 47.8, 100), 92.3% (95% CI 79.1, 98.4), and 93.2% (95% CI 81.3, 98.6) for reader 1 and 100% (95% CI 47.8, 100), 87.2% (95% CI 72.6, 95.7), and 88.6% (95% CI 75.4, 96.2) for reader 2, respectively. Both readers observed a 100% negative predictive value (36/36 stents and 34/34 stents). Stent patency inter-reader agreement was 90.1%, corresponding to a substantial Cohen's kappa value of 0.72. CONCLUSIONS UHR PCD-CTA enables non-invasive assessment of coronary stent patency with high image quality and diagnostic accuracy. CLINICAL RELEVANCE STATEMENT Ultra-high-resolution photon-counting detector CT angiography represents a reliable and non-invasive method for assessing coronary stent patency. Its high negative predictive value makes it a promising alternative over invasive coronary angiography for the rule-out of in-stent stenosis. KEY POINTS • CT-based evaluation of coronary stent patency is limited by stent-induced artifacts and spatial resolution. • Ultra-high-resolution photon-counting detector CT accurately evaluates coronary stent patency compared to invasive coronary angiography. • Photon-counting detector CT represents a promising method for the non-invasive rule-out of in-stent stenosis.
Collapse
Affiliation(s)
- Muhammad Taha Hagar
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Hugstetter Straße 55, Freiburg im Breisgau, 79106, Germany.
| | - Martin Soschynski
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Hugstetter Straße 55, Freiburg im Breisgau, 79106, Germany
| | - Ruben Saffar
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Hugstetter Straße 55, Freiburg im Breisgau, 79106, Germany
| | - Moisés Felipe Molina-Fuentes
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Hugstetter Straße 55, Freiburg im Breisgau, 79106, Germany
| | - Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Hugstetter Straße 55, Freiburg im Breisgau, 79106, Germany
| | - Alexander Rau
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Hugstetter Straße 55, Freiburg im Breisgau, 79106, Germany
| | - Christopher Schuppert
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Hugstetter Straße 55, Freiburg im Breisgau, 79106, Germany
| | - Philipp Ruile
- Department of Cardiology, Faculty of Medicine, University Hospital Freiburg Heart Centre, Freiburg, Germany, University of Freiburg, Freiburg, Germany
| | - Sebastian Faby
- Computed Tomography, Siemens Healthcare GmbH, Forchheim, 91301, Germany
| | - David Schibilsky
- Department of Cardiac and Vascular Surgery, Freiburg University, Freiburg, Germany
| | - Constantin von Zur Muehlen
- Department of Cardiology, Faculty of Medicine, University Hospital Freiburg Heart Centre, Freiburg, Germany, University of Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Hugstetter Straße 55, Freiburg im Breisgau, 79106, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Hugstetter Straße 55, Freiburg im Breisgau, 79106, Germany
| | - Tobias Krauss
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Hugstetter Straße 55, Freiburg im Breisgau, 79106, Germany
| |
Collapse
|
2
|
Vecsey-Nagy M, Varga-Szemes A, Schoepf UJ, Tremamunno G, Fink N, Zsarnoczay E, Szilveszter B, Graafen D, Halfmann MC, Vattay B, Boussoussou M, O'Doherty J, Suranyi PS, Maurovich-Horvat P, Emrich T. Ultra-high resolution coronary CT angiography on photon-counting detector CT: bi-centre study on the impact of quantum iterative reconstruction on image quality and accuracy of stenosis measurements. Eur J Radiol 2024; 176:111517. [PMID: 38805884 DOI: 10.1016/j.ejrad.2024.111517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE To assess the impact of different quantum iterative reconstruction (QIR) levels on objective and subjective image quality of ultra-high resolution (UHR) coronary CT angiography (CCTA) images and to determine the effect of strength levels on stenosis quantification using photon-counting detector (PCD)-CT. METHOD A dynamic vessel phantom containing two calcified lesions (25 % and 50 % stenosis) was scanned at heart rates of 60, 80 and 100 beats per minute with a PCD-CT system. In vivo CCTA examinations were performed in 102 patients. All scans were acquired in UHR mode (slice thickness0.2 mm) and reconstructed with four different QIR levels (1-4) using a sharp vascular kernel (Bv64). Image noise, signal-to-noise ratio (SNR), sharpness, and percent diameter stenosis (PDS) were quantified in the phantom, while noise, SNR, contrast-to-noise ratio (CNR), sharpness, and subjective quality metrics (noise, sharpness, overall image quality) were assessed in patient scans. RESULTS Increasing QIR levels resulted in significantly lower objective image noise (in vitro and in vivo: both p < 0.001), higher SNR (both p < 0.001) and CNR (both p < 0.001). Sharpness and PDS values did not differ significantly among QIRs (all pairwise p > 0.008). Subjective noise of in vivo images significantly decreased with increasing QIR levels, resulting in significantly higher image quality scores at increasing QIR levels (all pairwise p < 0.001). Qualitative sharpness, on the other hand, did not differ across different levels of QIR (p = 0.15). CONCLUSIONS The QIR algorithm may enhance the image quality of CCTA datasets without compromising image sharpness or accurate stenosis measurements, with the most prominent benefits at the highest strength level.
Collapse
Affiliation(s)
- Milan Vecsey-Nagy
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Heart and Vascular Centre, Semmelweis University, 68. Varosmajor street, Budapest 1122, Hungary
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States.
| | - Giuseppe Tremamunno
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University, Hospital Via di Grottarossa 1035-1039 00189 Rome, Italy
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, Munich 81377, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Koranyi Sandor street 2, Budapest 1083, Hungary
| | - Bálint Szilveszter
- Heart and Vascular Centre, Semmelweis University, 68. Varosmajor street, Budapest 1122, Hungary
| | - Dirk Graafen
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, Mainz 55131, Germany
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, Mainz 55131, Germany
| | - Borbála Vattay
- Heart and Vascular Centre, Semmelweis University, 68. Varosmajor street, Budapest 1122, Hungary
| | - Melinda Boussoussou
- Heart and Vascular Centre, Semmelweis University, 68. Varosmajor street, Budapest 1122, Hungary
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Siemens Medical Solutions USA Inc, 40 Liberty Boulevard, Malvern, PA 19355, United States
| | - Pal Spruill Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Koranyi Sandor street 2, Budapest 1083, Hungary
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, United States; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, Mainz 55131, Germany
| |
Collapse
|
3
|
Mergen V, Ehrbar N, Moser LJ, Harmes JC, Manka R, Alkadhi H, Eberhard M. Synthetic hematocrit from virtual non-contrast images for myocardial extracellular volume evaluation with photon-counting detector CT. Eur Radiol 2024:10.1007/s00330-024-10865-7. [PMID: 38935123 DOI: 10.1007/s00330-024-10865-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/07/2024] [Accepted: 04/30/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To assess the accuracy of a synthetic hematocrit derived from virtual non-contrast (VNC) and virtual non-iodine images (VNI) for myocardial extracellular volume (ECV) computation with photon-counting detector computed tomography (PCD-CT). MATERIALS AND METHODS Consecutive patients undergoing PCD-CT including a coronary CT angiography (CCTA) and a late enhancement (LE) scan and having a blood hematocrit were retrospectively included. In the first 75 patients (derivation cohort), CCTA and LE scans were reconstructed as VNI at 60, 70, and 80 keV and as VNC with quantum iterative reconstruction (QIR) strengths 2, 3, and 4. Blood pool attenuation (BPmean) was correlated to blood hematocrit. In the next 50 patients (validation cohort), synthetic hematocrit was calculated using BPmean. Myocardial ECV was computed using the synthetic hematocrit and compared with the ECV using the blood hematocrit as a reference. RESULTS In the derivation cohort (49 men, mean age 79 ± 8 years), a correlation between BPmean and blood hematocrit ranged from poor for VNI of CCTA at 80 keV, QIR2 (R2 = 0.12) to moderate for VNI of LE at 60 keV, QIR4; 70 keV, QIR3 and 4; and VNC of LE, QIR3 and 4 (all, R2 = 0.58). In the validation cohort (29 men, age 75 ± 14 years), synthetic hematocrit was calculated from VNC of the LE scan, QIR3. Median ECV was 26.9% (interquartile range (IQR), 25.5%, 28.8%) using the blood hematocrit and 26.8% (IQR, 25.4%, 29.7%) using synthetic hematocrit (VNC, QIR3; mean difference, -0.2%; limits of agreement, -2.4%, 2.0%; p = 0.33). CONCLUSION Synthetic hematocrit calculated from VNC images enables an accurate computation of myocardial ECV with PCD-CT. CLINICAL RELEVANCE STATEMENT Virtual non-contrast images from cardiac late enhancement scans with photon-counting detector CT allow the calculation of a synthetic hematocrit, which enables accurate computation of myocardial extracellular volume. KEY POINTS Blood hematocrit is mandatory for conventional myocardial extracellular volume computation. Synthetic hematocrit can be calculated from virtual non-iodine and non-contrast photon-counting detector CT images. Synthetic hematocrit from virtual non-contrast images enables computation of the myocardial extracellular volume.
Collapse
Affiliation(s)
- Victor Mergen
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolas Ehrbar
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas J Moser
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Johannes C Harmes
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Robert Manka
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Eberhard
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Radiology, Spitäler fmi AG, Spital Interlaken, Unterseen, Switzerland.
| |
Collapse
|
4
|
Goo HW, Chen SJ, Siripornpitak S, Abdul Latiff H, Borhanuddin BK, Leong MC, Zhong YM, Kim YJ. Contemporary multimodality non-invasive cardiac imaging protocols for tetralogy of Fallot. Pediatr Radiol 2024; 54:1075-1092. [PMID: 38782776 DOI: 10.1007/s00247-024-05942-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024]
Abstract
Tetralogy of Fallot is the most prevalent cyanotic congenital heart disease, requiring lifelong multimodality non-invasive cardiac imaging, such as echocardiography, cardiothoracic computed tomography, and cardiac magnetic resonance imaging. As imaging techniques continuously evolve and are gradually integrated into clinical practice, there is a critical need to update multimodality imaging protocols. Over the last two decades, cardiothoracic computed tomography imaging techniques have advanced remarkably, significantly enhancing its role in evaluating patients with tetralogy of Fallot. In this review, we describe contemporary multimodality non-invasive cardiac imaging protocols for tetralogy of Fallot, emphasizing the expanding role of cardiothoracic computed tomography. Additionally, we present standardized reporting forms designed to facilitate the clinical adoption of these protocols.
Collapse
Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Shyh-Jye Chen
- Department of Medical Imaging, Medical College and Hospital, National Taiwan University, Taipei, Taiwan
| | - Suvipaporn Siripornpitak
- Department of Diagnostic and Therapeutic Radiology, Mahidol University Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand
| | - Haifa Abdul Latiff
- Paediatric and Congenital Heart Centre, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Ming Chen Leong
- Paediatric and Congenital Heart Centre, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Yu Min Zhong
- Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai, China
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Qin L, Zhou S, Dong H, Li J, Zhang R, Yang C, Liu P, Xu Z, Yan F, Yang W. Improvement of coronary stent visualization using ultra-high-resolution photon-counting detector CT. Eur Radiol 2024:10.1007/s00330-024-10760-1. [PMID: 38676731 DOI: 10.1007/s00330-024-10760-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES This study aimed to compare the image quality and diagnostic performance of standard-resolution (SR) and ultra-high-resolution (UHR) coronary CT angiography (CCTA) based on photon-counting detector CT (PCD-CT) of coronary stents and explore the best reconstruction kernel for stent imaging. METHODS From July 2023 to September 2023, patients were enrolled to undergo CCTA using a dual-source PCD-CT system after coronary angioplasty with stent placement. SR images with a slice thickness/increment of 0.6/0.4 mm were reconstructed using a vascular kernel (Bv48), while UHR images with a slice thickness/increment of 0.2/0.2 mm were reconstructed using vascular kernels of six sharpness levels (Bv48, Bv56, Bv60, Bv64, Bv72, and Bv76). The in-stent lumen diameters were evaluated. Subjective image quality was also evaluated by a 5-point Likert scale. Invasive coronary angiography was conducted in 12 patients (25 stents). RESULTS Sixty-nine patients (68.0 [61.0, 73.0] years, 46 males) with 131 stents were included. All UHR images had significantly larger in-stent lumen diameter than SR images (p < 0.001). Specifically, UHR-Bv72 and UHR-Bv76 for in-stent lumen diameter (2.17 [1.93, 2.63] mm versus 2.20 [1.93, 2.59] mm) ranked the two best kernels. The subjective analysis demonstrated that UHR-Bv72 images had the most pronounced effect on reducing blooming artifacts, showcasing in-stent lumen and stent demonstration, and diagnostic confidence (p < 0.001). Furthermore, SR and UHR-Bv72 images showed a diagnostic accuracy of 78.3% (95% confidence interval [CI]: 56.3%-92.5%) and 88.0% (95%CI: 68.8%-97.5%), respectively. CONCLUSION UHR CCTA by PCD-CT leads to significantly improved visualization and diagnostic performance of coronary stents, and Bv72 is the optimal reconstruction kernel showing the stent struts and in-stent lumen. CLINICAL RELEVANCE STATEMENT The significantly improved visualization of coronary stents using ultra-high resolution CCTA could increase the diagnostic accuracy for in-stent restenosis and avoid unnecessary invasive quantitative coronary angiography, thus changing the clinical management for patients after percutaneous coronary intervention. KEY POINTS Coronary stent imaging is challenging with energy-integrating detector CT due to "blooming artifacts." UHR images using a PCD-CT enhanced coronary stent visualization. UHR coronary stent imaging demonstrated improved diagnostic accuracy in clinical settings.
Collapse
Affiliation(s)
- Le Qin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Shanshui Zhou
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, No. 150 Ruijin Er Road, Shanghai, 200025, China
| | - Haipeng Dong
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Jiqiang Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Ruiyan Zhang
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Chendie Yang
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Peng Liu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Zhihan Xu
- CT Collaboration, Siemens Healthineers, 399 West Haiyang Road, Shanghai, 200126, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, No. 150 Ruijin Er Road, Shanghai, 200025, China
| | - Wenjie Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China.
| |
Collapse
|
6
|
Meloni A, Maffei E, Clemente A, De Gori C, Occhipinti M, Positano V, Berti S, La Grutta L, Saba L, Cau R, Bossone E, Mantini C, Cavaliere C, Punzo B, Celi S, Cademartiri F. Spectral Photon-Counting Computed Tomography: Technical Principles and Applications in the Assessment of Cardiovascular Diseases. J Clin Med 2024; 13:2359. [PMID: 38673632 PMCID: PMC11051476 DOI: 10.3390/jcm13082359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Spectral Photon-Counting Computed Tomography (SPCCT) represents a groundbreaking advancement in X-ray imaging technology. The core innovation of SPCCT lies in its photon-counting detectors, which can count the exact number of incoming x-ray photons and individually measure their energy. The first part of this review summarizes the key elements of SPCCT technology, such as energy binning, energy weighting, and material decomposition. Its energy-discriminating ability represents the key to the increase in the contrast between different tissues, the elimination of the electronic noise, and the correction of beam-hardening artifacts. Material decomposition provides valuable insights into specific elements' composition, concentration, and distribution. The capability of SPCCT to operate in three or more energy regimes allows for the differentiation of several contrast agents, facilitating quantitative assessments of elements with specific energy thresholds within the diagnostic energy range. The second part of this review provides a brief overview of the applications of SPCCT in the assessment of various cardiovascular disease processes. SPCCT can support the study of myocardial blood perfusion and enable enhanced tissue characterization and the identification of contrast agents, in a manner that was previously unattainable.
Collapse
Affiliation(s)
- Antonella Meloni
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.)
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.C.); (C.D.G.); (M.O.)
| | - Erica Maffei
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico SYNLAB SDN, 80131 Naples, Italy; (E.M.); (C.C.); (B.P.)
| | - Alberto Clemente
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.C.); (C.D.G.); (M.O.)
| | - Carmelo De Gori
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.C.); (C.D.G.); (M.O.)
| | - Mariaelena Occhipinti
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.C.); (C.D.G.); (M.O.)
| | - Vicenzo Positano
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.)
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.C.); (C.D.G.); (M.O.)
| | - Sergio Berti
- Diagnostic and Interventional Cardiology Department, Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy;
| | - Ludovico La Grutta
- Department of Radiology, University Hospital “P. Giaccone”, 90127 Palermo, Italy;
| | - Luca Saba
- Department of Radiology, University Hospital of Cagliari, 09042 Monserrato (CA), Italy; (L.S.); (R.C.)
| | - Riccardo Cau
- Department of Radiology, University Hospital of Cagliari, 09042 Monserrato (CA), Italy; (L.S.); (R.C.)
| | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, 80131 Naples, Italy;
| | - Cesare Mantini
- Department of Radiology, “G. D’Annunzio” University, 66100 Chieti, Italy;
| | - Carlo Cavaliere
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico SYNLAB SDN, 80131 Naples, Italy; (E.M.); (C.C.); (B.P.)
| | - Bruna Punzo
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico SYNLAB SDN, 80131 Naples, Italy; (E.M.); (C.C.); (B.P.)
| | - Simona Celi
- BioCardioLab, Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy;
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.C.); (C.D.G.); (M.O.)
| |
Collapse
|
7
|
Zsarnoczay E, Pinos D, Schoepf UJ, Fink N, O'Doherty J, Gnasso C, Griffith J, Vecsey-Nagy M, Suranyi P, Maurovich-Horvat P, Emrich T, Varga-Szemes A. Intra-individual comparison of coronary CT angiography-based FFR between energy-integrating and photon-counting detector CT systems. Int J Cardiol 2024; 399:131684. [PMID: 38151162 DOI: 10.1016/j.ijcard.2023.131684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA)-based fractional flow reserve (CT-FFR) allows for noninvasive determination of the functional severity of anatomic lesions in patients with coronary artery disease. The aim of this study was to intra-individually compare CT-FFR between photon-counting detector (PCD) and conventional energy-integrating detector (EID) CT systems. METHODS In this single-center prospective study, subjects who underwent clinically indicated CCTA on an EID-CT system were recruited for a research CCTA on PCD-CT within 30 days. Image reconstruction settings were matched as closely as possible between EID-CT (Bv36 kernel, iterative reconstruction strength level 3, slice thickness 0.5 mm) and PCD-CT (Bv36 kernel, quantum iterative reconstruction level 3, virtual monoenergetic level 55 keV, slice thickness 0.6 mm). CT-FFR was measured semi-automatically using a prototype on-site machine learning algorithm by two readers. CT-FFR analysis was performed per-patient and per-vessel, and a CT-FFR ≤ 0.75 was considered hemodynamically significant. RESULTS A total of 22 patients (63.3 ± 9.2 years; 7 women) were included. Median time between EID-CT and PCD-CT was 5.5 days. Comparison of CT-FFR values showed no significant difference and strong agreement between EID-CT and PCD-CT in the per-vessel analysis (0.88 [0.74-0.94] vs. 0.87 [0.76-0.93], P = 0.096, mean bias 0.02, limits of agreement [LoA] -0.14/0.19, r = 0.83, ICC = 0.92), and in the per-patient analysis (0.81 [0.60-0.86] vs. 0.76 [0.64-0.86], P = 0.768, mean bias 0.02, LoA -0.15/0.19, r = 0.90, ICC = 0.93). All included patients were classified into the same category (CT-FFR > 0.75 vs ≤0.75) with both CT systems. CONCLUSIONS CT-FFR evaluation is feasible with PCD-CT and it shows a strong agreement with EID-CT-based evaluation when images are similarly reconstructed.
Collapse
Affiliation(s)
- Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Daniel Pinos
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Siemens Medical Solutions USA Inc, Malvern, USA
| | - Chiara Gnasso
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Joseph Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | - Milán Vecsey-Nagy
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany.
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| |
Collapse
|
8
|
Vattay B, Boussoussou M, Vecsey-Nagy M, Kolossváry M, Juhász D, Kerkovits N, Balogh H, Nagy N, Vértes M, Kiss M, Kubovje A, Merkely B, Maurovich Horvat P, Szilveszter B. Qualitative and quantitative image quality of coronary CT angiography using photon-counting computed tomography: Standard and Ultra-high resolution protocols. Eur J Radiol 2024; 175:111426. [PMID: 38493558 DOI: 10.1016/j.ejrad.2024.111426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE We aimed to identify the optimal reconstruction settings based on qualitative and quantitative image quality parameters on standard and ultra-high resolution (UHR) images using photon-counting CT (PCCT). METHOD We analysed 45 patients, 29 with standard and 16 with UHR acquisition, applying both smoother and sharper kernel settings. Coronary CT angiography images were performed on a dual-source PCCT system using standard (0.4/0.6 mm slice thickness, Bv40/Bv44 kernels, QIR levels 0-4) or UHR acquisition (0.2/0.4 mm slice thickness, Bv44/Bv56 kernels, QIR levels 0-4). Qualitative image quality was assessed using a 4-point Likert scale. Image noise (SD), signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated in both the proximal and distal segments. RESULTS On standard resolution, larger slice thickness resulted in an average increase of 12.5 % in CNR, whereas sharper kernel led to an average 8.7 % decrease in CNR. Highest CNR was measured on 0.6 mm, Bv40, QIR4 images and lowest on 0.4 mm, Bv44, QIR0 images: 25.8 ± 4.1vs.8.3 ± 1.6 (p < 0.001). On UHR images, highest CNR was observed on 0.4 mm, Bv40, QIR4 and lowest on 0.2 mm, Bv56 and QIR0 images: 21.5 ± 3.9vs.3.6 ± 0.8 (p < 0.001). Highest qualitative image quality was found on images with Bv44 kernel and QIR level 3/4 with both slice thicknesses on standard reconstruction. Additionally, Bv56 with QIR4 on 0.2 mm slice thickness images showed highest subjective image quality. Preserved distal vessel visualization was detected using QIR 2-4, Bv56 and 0.2 mm slice thickness. CONCLUSIONS Photon-counting CT demonstrated high qualitative and quantitative image quality for the assessment of coronaries and stents.
Collapse
Affiliation(s)
- Borbála Vattay
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary
| | - Melinda Boussoussou
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary
| | - Milán Vecsey-Nagy
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary
| | - Márton Kolossváry
- Gottsegen National Cardiovascular Center, 29 Haller Utca, 1096, Budapest, Hungary; Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Bécsi Ut 96/B, 1034, Budapest, Hungary
| | - Dénes Juhász
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary
| | - Nóra Kerkovits
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Hanna Balogh
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Norbert Nagy
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Miklós Vértes
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Máté Kiss
- Siemens Healthcare GmbH, Forchheim, Germany
| | - Anikó Kubovje
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary
| | - Pál Maurovich Horvat
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Korányi Sándor Street 2., Hungary
| | - Bálint Szilveszter
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Városmajor Street 68., Hungary.
| |
Collapse
|
9
|
Hollý S, Chmelík M, Suchá S, Suchý T, Beneš J, Pátrovič L, Juskanič D. Photon-counting CT using multi-material decomposition algorithm enables fat quantification in the presence of iron deposits. Phys Med 2024; 118:103210. [PMID: 38219560 DOI: 10.1016/j.ejmp.2024.103210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/29/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024] Open
Abstract
PURPOSE A new generation of CT detectors were recently developed with the ability to measure individual photon's energy and thus provide spectral information. The aim of this work was to assess the performance of simultaneous fat and iron quantification using a clinical photon-counting CT (PCCT) and its comparison to dual-energy CT (DECT), MRS and MRI at 3 T. METHODS Two 3D printed cylindrical phantoms with 32 samples (n = 12 fat fractions between 0 % and 100 %, n = 20 with mixtures of fat and iron) were scanned with PCCT and DECT scanners for comparison. A three-material decomposition approach was used to estimate the volume fractions of fat (FF), iron and soft tissue. The same phantoms were examined by MRI (6-echo DIXON, a.k.a. Q-DIXON) and MRS (multi-echo STEAM, a.k.a. HISTO) at 3 T for comparison. RESULTS PCCT, DECT, MRI and MRS computed FFs showed correlation with reference fat fraction values in samples with no iron (r > 0.98). PCCT decomposition showed slightly weaker correlation with FFref in samples with added iron (r = 0.586) compared to MRI (r = 0.673) and MRS (r = 0.716) methods. On the other hand, it showed no systematic over- or underestimation. Surprisingly, DECT decomposition-derived FF showed strongest correlation (r = 0.758) in these samples, however systematic overestimation was observed. FF values computed by three-material PCCT decomposition, DECT decomposition, MRI and MRS were unaffected by iron concentration. CONCLUSIONS This in-vitro study shows for the first time that photon-counting computed tomography may be used for quantification of fat content in the presence of iron deposits.
Collapse
Affiliation(s)
- Samuel Hollý
- JESSENIUS - diagnostic center, Nitra, Slovakia; Institute of Biophysics and Informatics, First Faculty of Medicine Charles University, Prague, Czech Republic
| | - Marek Chmelík
- JESSENIUS - diagnostic center, Nitra, Slovakia; Department of Technical Disciplines in Health Care, Faculty of Health Care, University of Prešov, Slovakia.
| | - Slavomíra Suchá
- Department of Technical Disciplines in Health Care, Faculty of Health Care, University of Prešov, Slovakia
| | - Tomáš Suchý
- Department of Technical Disciplines in Health Care, Faculty of Health Care, University of Prešov, Slovakia
| | - Jiři Beneš
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | | | - Dominik Juskanič
- JESSENIUS - diagnostic center, Nitra, Slovakia; Medical Faculty, Commenius University in Bratislava, Slovakia
| |
Collapse
|
10
|
Gruschwitz P, Hartung V, Ergün S, Peter D, Lichthardt S, Huflage H, Hendel R, Pannenbecker P, Augustin AM, Kunz AS, Feldle P, Bley TA, Grunz JP. Comparison of ultrahigh and standard resolution photon-counting CT angiography of the femoral arteries in a continuously perfused in vitro model. Eur Radiol Exp 2023; 7:83. [PMID: 38110729 PMCID: PMC10728414 DOI: 10.1186/s41747-023-00398-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/17/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND With the emergence of photon-counting CT, ultrahigh-resolution (UHR) imaging can be performed without dose penalty. This study aims to directly compare the image quality of UHR and standard resolution (SR) scan mode in femoral artery angiographies. METHODS After establishing continuous extracorporeal perfusion in four fresh-frozen cadaveric specimens, photon-counting CT angiographies were performed with a radiation dose of 5 mGy and tube voltage of 120 kV in both SR and UHR mode. Images were reconstructed with dedicated convolution kernels (soft: Body-vascular (Bv)48; sharp: Bv60; ultrasharp: Bv76). Six radiologists evaluated the image quality by means of a pairwise forced-choice comparison tool. Kendall's concordance coefficient (W) was calculated to quantify interrater agreement. Image quality was further assessed by measuring intraluminal attenuation and image noise as well as by calculating signal-to-noise ratio (SNR) and contrast-to-noise ratios (CNR). RESULTS UHR yielded lower noise than SR for identical reconstructions with kernels ≥ Bv60 (p < 0.001). UHR scans exhibited lower intraluminal attenuation compared to SR (Bv60: 406.4 ± 25.1 versus 418.1 ± 30.1 HU; p < 0.001). Irrespective of scan mode, SNR and CNR decreased while noise increased with sharper kernels but UHR scans were objectively superior to SR nonetheless (Bv60: SNR 25.9 ± 6.4 versus 20.9 ± 5.3; CNR 22.7 ± 5.8 versus 18.4 ± 4.8; p < 0.001). Notably, UHR scans were preferred in subjective assessment when images were reconstructed with the ultrasharp Bv76 kernel, whereas SR was rated superior for Bv60. Interrater agreement was high (W = 0.935). CONCLUSIONS Combinations of UHR scan mode and ultrasharp convolution kernel are able to exploit the full image quality potential in photon-counting CT angiography of the femoral arteries. RELEVANCE STATEMENT The UHR scan mode offers improved image quality and may increase diagnostic accuracy in CT angiography of the peripheral arterial runoff when optimized reconstruction parameters are chosen. KEY POINTS • UHR photon-counting CT improves image quality in combination with ultrasharp convolution kernels. • UHR datasets display lower image noise compared with identically reconstructed standard resolution scans. • Scans in UHR mode show decreased intraluminal attenuation compared with standard resolution imaging.
Collapse
Affiliation(s)
- Philipp Gruschwitz
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany.
| | - Viktor Hartung
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Süleyman Ergün
- Institute of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany
| | - Dominik Peter
- Department of General, Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Sven Lichthardt
- Department of General, Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Robin Hendel
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Pauline Pannenbecker
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Anne Marie Augustin
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Andreas Steven Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Philipp Feldle
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| |
Collapse
|
11
|
Flohr T, Schmidt B, Ulzheimer S, Alkadhi H. Cardiac imaging with photon counting CT. Br J Radiol 2023; 96:20230407. [PMID: 37750856 PMCID: PMC10646663 DOI: 10.1259/bjr.20230407] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
CT of the heart, in particular ECG-controlled coronary CT angiography (cCTA), has become clinical routine due to rapid technical progress with ever new generations of CT equipment. Recently, CT scanners with photon-counting detectors (PCD) have been introduced which have the potential to address some of the remaining challenges for cardiac CT, such as limited spatial resolution and lack of high-quality spectral data. In this review article, we briefly discuss the technical principles of photon-counting detector CT, and we give an overview on how the improved spatial resolution of photon-counting detector CT and the routine availability of spectral data can benefit cardiac applications. We focus on coronary artery calcium scoring, cCTA, and on the evaluation of the myocardium.
Collapse
Affiliation(s)
- Thomas Flohr
- Siemens Healthcare GmbH, Computed Tomography, Forchheim, Germany
| | - Bernhard Schmidt
- Siemens Healthcare GmbH, Computed Tomography, Forchheim, Germany
| | - Stefan Ulzheimer
- Siemens Healthcare GmbH, Computed Tomography, Forchheim, Germany
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
12
|
Mergen V, Sartoretti T, Cundari G, Serifovic M, Higashigaito K, Allmendinger T, Schmidt B, Flohr T, Manka R, Eberhard M, Alkadhi H. The Importance of Temporal Resolution for Ultra-High-Resolution Coronary Angiography: Evidence From Photon-Counting Detector CT. Invest Radiol 2023; 58:767-774. [PMID: 37222522 DOI: 10.1097/rli.0000000000000987] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE The aim of this study was to assess the effect of temporal resolution on subjective and objective image quality of coronary computed tomography angiography (CCTA) in the ultra-high-resolution (UHR) mode with dual-source photon-counting detector (PCD) CT. MATERIALS AND METHODS This retrospective, institutional review board-approved study evaluated 30 patients (9 women; mean age, 80 ± 10 years) undergoing UHR CCTA with a clinical dual-source PCD-CT scanner. Images were acquired with a tube voltage of 120 kV and using a collimation of 120 × 0.2 mm. Gantry rotation time was 0.25 seconds. Each scan was reconstructed using both single-source and dual-source data resulting in an image temporal resolution of 125 milliseconds and 66 milliseconds, respectively. The average heart rate and the heart rate variability were recorded. Images were reconstructed with a slice thickness of 0.2 mm, quantum iterative reconstruction strength level 4, and using the Bv64 and Bv72 kernel for patients without and with coronary stents, respectively. For subjective image quality, 2 experienced readers rated motion artifacts and vessel delineation, or in-stent lumen visualization using 5-point discrete visual scales. For objective image quality, signal-to-noise ratio, contrast-to-noise ratio, stent blooming artifacts, and vessel and stent sharpness were quantified. RESULTS Fifteen patients had coronary stents, and 15 patients had no coronary stents. The mean heart rate and heart rate variability during data acquisition were 72 ± 10 beats per minute and 5 ± 6 beats per minute, respectively. Subjective image quality in the right coronary artery, left anterior descending, and circumflex artery was significantly superior in 66 milliseconds reconstructions compared with 125 milliseconds reconstructions for both readers (all P 's < 0.01; interreader agreement, Krippendorff α = 0.84-1.00). Subjective image quality deteriorated significantly at higher heart rates for 125 milliseconds (ρ = 0.21, P < 0.05) but not for 66 milliseconds reconstructions (ρ = 0.11, P = 0.22). No association was found between heart rate variability and image quality for both 125 milliseconds (ρ = 0.09, P = 0.33) and 66 milliseconds reconstructions (ρ = 0.13, P = 0.17), respectively. Signal-to-noise ratio and contrast-to-noise ratio were similar between 66 milliseconds and 125 milliseconds reconstructions (both P 's > 0.05), respectively. Stent blooming artifacts were significantly lower on 66 milliseconds than on 125 milliseconds reconstructions (46.7% ± 10% vs 52.9% ± 8.9%, P < 0.001). Higher sharpness was found in 66 milliseconds than in 125 milliseconds reconstructions both in native coronary arteries (left anterior descending artery: 1031 ± 265 ∆HU/mm vs 819 ± 253 ∆HU/mm, P < 0.01; right coronary artery: 884 ± 352 ∆HU/mm vs 654 ± 377 ∆HU/mm, P < 0.001) and stents (5318 ± 3874 ∆HU/mm vs 4267 ± 3521 ∆HU/mm, P < 0.001). CONCLUSIONS Coronary angiography with PCD-CT in the UHR mode profits considerably from a high temporal resolution, resulting in less motion artifacts, superior vessel delineation and in-stent lumen visualization, less stent blooming artifacts, and superior vessel and stent sharpness.
Collapse
Affiliation(s)
- Victor Mergen
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland (V.M., T.S., G.C., M.S., K.H., R.M., M.E., H.A.); Department of Radiological, Oncological, and Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy (G.C.); Siemens Healthcare GmbH, Computed Tomography, Forchheim, Germany (T.A., B.S., T.F.); and Institute of Radiology, Spitäler fmi AG, Spital Interlaken, Unterseen, Switzerland (M.E.)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Iwata N, Sakamoto M, Sakou T, Uno T, Kurosaki M. Utility of follow-up ultra-high-resolution CT angiography with model-based iterative reconstruction after flow diverter treatment for cerebral aneurysms. LA RADIOLOGIA MEDICA 2023; 128:1262-1270. [PMID: 37658197 DOI: 10.1007/s11547-023-01692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/27/2023] [Indexed: 09/03/2023]
Abstract
PURPOSE Follow-up examinations after flow diverter (FD) treatment for cerebral aneurysms typically involve magnetic resonance imaging (MRI) or digital subtraction angiography (DSA). However, MRI is prone to vascular defects due to metal artifacts from FD, and DSA carries a risk of ischemic complications. In the context of computed tomography angiography (CTA), this study compares the efficacy of ultra-high-resolution CT (UHRCT) and novel reconstruction techniques, such as model-based iterative reconstruction (MBIR), against conventional methods such as filtered back projection (FBP) and hybrid iterative reconstruction (IR), to determine if they are a viable alternative to DSA in clinical settings. MATERIALS AND METHODS A phantom study was conducted with the full-width half-maximum considered as the FD thickness. This study compared three reconstruction methods: MBIR, FBP, and hybrid IR. A clinical study was also conducted with 21 patients who underwent follow-up CTA after FD treatment. The FD's visibility was assessed using a 4-point scale in FBP, hybrid IR, and MBIR compared to cone-beam CT (CBCT) with angiographic systems. RESULTS In the phantom study, FBP, hybrid IR, and MBIR visualized thinner FD thicknesses and improved detail rendering in that order. MBIR proved to be significantly superior in both the phantom and clinical study. CONCLUSION UHRCT with MBIR is highly effective for follow-up evaluations after FD treatment and may become the first-choice modality in the future.
Collapse
Affiliation(s)
- Naoki Iwata
- Department of Clinical Radiology, Tottori University Hospital, Tottori, Japan.
| | - Makoto Sakamoto
- Department of Clinical Radiology, Tottori University Hospital, Tottori, Japan
| | - Toshio Sakou
- Department of Clinical Radiology, Tottori University Hospital, Tottori, Japan
| | - Tetsuji Uno
- Department of Clinical Radiology, Tottori University Hospital, Tottori, Japan
| | - Masamichi Kurosaki
- Department of Clinical Radiology, Tottori University Hospital, Tottori, Japan
| |
Collapse
|
14
|
Fink N, Zsarnoczay E, Schoepf UJ, O'Doherty J, Halfmann MC, Allmendinger T, Hagenauer J, Griffith JP, Vecsey-Nagy M, Pinos D, Ebersberger U, Ricke J, Varga-Szemes A, Emrich T. Impact of Cardiac Motion on coronary artery calcium scoring using a virtual non-iodine algorithm on photon-counting detector CT: a dynamic phantom study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2083-2092. [PMID: 37452987 DOI: 10.1007/s10554-023-02912-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
This study assessed the impact of cardiac motion and in-vessel attenuation on coronary artery calcium (CAC) scoring using virtual non-iodine (VNI) against virtual non-contrast (VNC) reconstructions on photon-counting detector CT. Two artificial vessels containing calcifications and different in-vessel attenuations (500, 800HU) were scanned without (static) and with cardiac motion (60, 80, 100 beats per minute [bpm]). Images were post-processed using a VNC and VNI algorithm at 70 keV and quantum iterative reconstruction (QIR) strength 2. Calcium mass, Agatston scores, cardiac motion susceptibility (CMS)-indices were compared to physical mass, static scores as well as between reconstructions, heart rates and in-vessel attenuations. VNI scores decreased with rising heart rate (p < 0.01) and showed less underestimation than VNC scores (p < 0.001). Only VNI scores were similar to the physical mass at static measurements, and to static scores at 60 bpm. Agatston scores using VNI were similar to static scores at 60 and 80 bpm. Standard deviation of CMS-indices was lower for VNI-based than for VNC-based CAC scoring. VNI scores were higher at 500 than 800HU (p < 0.001) and higher than VNC scores (p < 0.001) with VNI scores at 500 HU showing the lowest deviation from the physical reference. VNI-based CAC quantification is influenced by cardiac motion and in-vessel attenuation, but least when measuring Agatston scores, where it outperforms VNC-based CAC scoring.
Collapse
Affiliation(s)
- Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Medical Imaging Center, Semmelweis University, Korányi Sándor utca 2, Budapest, 1083, Hungary
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA.
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Siemens Medical Solutions, Malvern, PA, 19355, USA
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of Johannes Gutenberg- University, Langenbeckstr. 1, Mainz, 55131, Germany
| | | | - Junia Hagenauer
- Siemens Healthcare GmbH, Siemensstr. 1, Forchheim, 91301, Germany
- Faculty of Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Krankenhausstr. 12, Erlangen, 91054, Germany
| | - Joseph P Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Milán Vecsey-Nagy
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Varosmajor utca 68, Budapest, 1122, Hungary
| | - Daniel Pinos
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Ullrich Ebersberger
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, 80636, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center of Johannes Gutenberg- University, Langenbeckstr. 1, Mainz, 55131, Germany
- German Centre for Cardiovascular Research, Mainz, 55131, Germany
| |
Collapse
|
15
|
Stein T, Taron J, Verloh N, Doppler M, Rau A, Hagar MT, Faby S, Baltas D, Westermann D, Ayx I, Schönberg SO, Nikolaou K, Schlett CL, Bamberg F, Weiss J. Photon-counting computed tomography of coronary and peripheral artery stents: a phantom study. Sci Rep 2023; 13:14806. [PMID: 37684412 PMCID: PMC10491813 DOI: 10.1038/s41598-023-41854-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Accurate small vessel stent visualization using CT remains challenging. Photon-counting CT (PCD-CT) may help to overcome this issue. We systematically investigate PCD-CT impact on small vessel stent assessment compared to energy-integrating-CT (EID). 12 water-contrast agent filled stents (3.0-8 mm) were scanned with patient-equivalent phantom using clinical PCD-CT and EID-CT. Images were reconstructed using dedicated vascular kernels. Subjective image quality was evaluated by 5 radiologists independently (5-point Likert-scale; 5 = excellent). Objective image quality was evaluated by calculating multi-row intensity profiles including edge rise slope (ERS) and coefficient-of-variation (CV). Highest overall reading scores were found for PCD-CT-Bv56 (3.6[3.3-4.3]). In pairwise comparison, differences were significant for PCD-CT-Bv56 vs. EID-CT-Bv40 (p ≤ 0.04), for sharpness and blooming respectively (all p < 0.05). Highest diagnostic confidence was found for PCD-CT-Bv56 (p ≤ 0.2). ANOVA revealed a significant effect of kernel strength on ERS (p < 0.001). CV decreased with stronger PCD-CT kernels, reaching its lowest in PCD-CT-Bv56 and highest in EID-CT reconstruction (p ≤ 0.05). We are the first study to verify, by phantom setup adapted to real patient settings, PCD-CT with a sharp vascular kernel provides the most favorable image quality for small vessel stent imaging. PCD-CT may reduce the number of invasive coronary angiograms, however, more studies needed to apply our results in clinical practice.
Collapse
Affiliation(s)
- Thomas Stein
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Jana Taron
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Rau
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Muhammad Taha Hagar
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Faby
- Computed Tomography, Siemens Healthcare GmbH, Forchheim, Germany
| | - Dimos Baltas
- Division of Medical Physics, Department of Radiation Oncology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Interdisciplinary Vascular Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Isabelle Ayx
- Department of Radiology and Nuclear Medicine, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefan O Schönberg
- Department of Radiology and Nuclear Medicine, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
16
|
Eriksen E, Neghabat O, Larsen TH, Saeed S, Bleie Ø. Long-term multimodality imaging follow-up of ST-segment elevation myocardial infarction patients treated with bioresorbable vascular scaffold: advantages and challenges. Coron Artery Dis 2023; 34:415-424. [PMID: 37191924 DOI: 10.1097/mca.0000000000001249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
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.
Collapse
Affiliation(s)
- Erlend Eriksen
- Department of Heart Disease, Haukeland University Hospital
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Omeed Neghabat
- Department of Cardiology, Aarhus University Hospital
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Terje H Larsen
- Department of Heart Disease, Haukeland University Hospital
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital
| | - Øyvind Bleie
- Department of Heart Disease, Haukeland University Hospital
| |
Collapse
|
17
|
Michael AE, Schoenbeck D, Becker-Assmann J, Niehoff JH, Flohr T, Schmidt B, Panknin C, Baer-Beck M, Hickethier T, Maintz D, Bunck AC, Borggrefe J, Wiemer M, Rudolph V, Kroeger JR. Coronary stent imaging in photon counting computed Tomography: Optimization of reconstruction kernels in a phantom. Eur J Radiol 2023; 166:110983. [PMID: 37480648 DOI: 10.1016/j.ejrad.2023.110983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/05/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Imaging stents and in-stent stenosis remains a challenge in coronary computed tomography angiography (CCTA). In comparison to conventional Computed Tomography, Photon Counting CT (PCCT) provides decisive clinical advantages, among other things by providing low dose ultra-high resolution imaging of coronary arteries. This work investigates the image quality in CCTA using clinically established kernels and those optimized for the imaging of cardiac stents in PCCT, both for in-vitro stent imaging in 400 μm standard resolution mode (SRM) and 200 μm Ultra High Resolution Mode (UHR). METHODS Based on experimental scans, vascular reconstruction kernels (Bv56, Bv64, Bv72) were optimized. In an established phantom, 10 different coronary stents with 3 mm diameter were scanned in the first clinically available PCCT. Scans were reconstructed with clinically established and optimized kernels. Four readers measured visible stent lumen, performed ROI-based density measurements and rated image quality. RESULTS Regarding the visible stent lumen, UHR is significantly superior to SRM (p < 0.001). In all levels, the optimized kernels are superior to the clinically established kernels (p < 0.001). One optimized kernel showed a significant reduction of noise compared to the clinically established kernels. Overall image quality is improved with optimized kernels. CONCLUSIONS In a phantom study PCCT UHR with optimized kernels for stent imaging significantly improves the ability to assess the in-stent lumen of small cardiac stents. We recommend using UHR with an optimized sharp vascular reconstruction kernel (Bv72uo) for imaging of cardiac stent.
Collapse
Affiliation(s)
- Arwed Elias Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany.
| | - Denise Schoenbeck
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany.
| | - Jendrik Becker-Assmann
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany.
| | - Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany.
| | | | | | | | | | - Tilman Hickethier
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Alexander Christian Bunck
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany.
| | - Marcus Wiemer
- Department of Cardiology and Internal Intensive Care, Johannes Wesling University Hospital, Minden, Germany.
| | - Volker Rudolph
- Department of General and Interventional Cardiology and Angiology, HDZ NRW, Ruhr University Bochum, Bochum, Germany.
| | - Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany.
| |
Collapse
|
18
|
Mastrodicasa D, Aquino GJ, Ordovas KG, Vargas D, Fleischmann D, Abbara S, Hanneman K. Radiology: Cardiothoracic Imaging Highlights 2022. Radiol Cardiothorac Imaging 2023; 5:e230042. [PMID: 37404783 PMCID: PMC10316293 DOI: 10.1148/ryct.230042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/07/2023] [Accepted: 05/08/2023] [Indexed: 07/06/2023]
Abstract
Since its inaugural issue in 2019, Radiology: Cardiothoracic Imaging has disseminated the latest scientific advances and technical developments in cardiac, vascular, and thoracic imaging. In this review, we highlight select articles published in this journal between October 2021 and October 2022. The scope of the review encompasses various aspects of coronary artery and congenital heart diseases, vascular diseases, thoracic imaging, and health services research. Key highlights include changes in the revised Coronary Artery Disease Reporting and Data System 2.0, the value of coronary CT angiography in informing prognosis and guiding treatment decisions, cardiac MRI findings after COVID-19 vaccination or infection, high-risk features at CT angiography to identify patients with aortic dissection at risk for late adverse events, and CT-guided fiducial marker placement for preoperative planning for pulmonary nodules. Ongoing research and future directions include photon-counting CT and artificial intelligence applications in cardiovascular imaging. Keywords: Pediatrics, CT Angiography, CT-Perfusion, CT-Spectral Imaging, MR Angiography, PET/CT, Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR), Cardiac, Pulmonary, Vascular, Aorta, Coronary Arteries © RSNA, 2023.
Collapse
|
19
|
Verelst E, Buls N, De Mey J, Nieboer KH, Vandenbergh F, Crotty D, Deak P, Sundvall A, Holmin S, De Smet A, Provyn S, Van Gompel G. 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. Eur Radiol Exp 2023; 7:23. [PMID: 37097376 PMCID: PMC10130245 DOI: 10.1186/s41747-023-00333-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/23/2023] [Indexed: 04/26/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Emma Verelst
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZB), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZB), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Johan De Mey
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZB), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Koenraad Hans Nieboer
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZB), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Frans Vandenbergh
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZB), Laarbeeklaan 101, 1090, Brussels, Belgium
| | | | - Paul Deak
- GE Healthcare, Waukesha, WI, 53188, USA
| | - Albert Sundvall
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, 171 74, Stockholm, Sweden
| | - Aron De Smet
- Anatomical Research Training and Education, Vrije Universiteit Brussel, 1090, Brussels, Belgium
| | - Steven Provyn
- Anatomical Research Training and Education, Vrije Universiteit Brussel, 1090, Brussels, Belgium
| | - Gert Van Gompel
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZB), Laarbeeklaan 101, 1090, Brussels, Belgium
| |
Collapse
|