1
|
Tore D, Faletti R, Palmisano A, Salto S, Rocco K, Santonocito A, Gaetani C, Biondo A, Bozzo E, Giorgino F, Landolfi I, Menchini F, Esposito A, Fonio P, Gatti M. Cardiac computed tomography with late contrast enhancement: A review. Heliyon 2024; 10:e32436. [PMID: 38933964 PMCID: PMC11200357 DOI: 10.1016/j.heliyon.2024.e32436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 05/19/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Cardiac computed tomography (CCT) has assumed an increasingly significant role in the evaluation of coronary artery disease (CAD) during the past few decades, whereas cardiovascular magnetic resonance (CMR) remains the gold standard for myocardial tissue characterization. The discovery of late myocardial enhancement following intravenous contrast administration dates back to the 1970s with ex-vivo CT animal investigations; nevertheless, the clinical application of this phenomenon for cardiac tissue characterization became prevalent for CMR imaging far earlier than for CCT imaging. Recently the technical advances in CT scanners have made it possible to take advantage of late contrast enhancement (LCE) for tissue characterization in CCT exams. Moreover, the introduction of extracellular volume calculation (ECV) on cardiac CT images combined with the possibility of evaluating cardiac function in the same exam is making CCT imaging a multiparametric technique more and more similar to CMR. The aim of our review is to provide a comprehensive overview on the role of CCT with LCE in the evaluation of a wide range of cardiac conditions.
Collapse
Affiliation(s)
- Davide Tore
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Salto
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Katia Rocco
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Ambra Santonocito
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Clara Gaetani
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Andrea Biondo
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Elena Bozzo
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Fabio Giorgino
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Ilenia Landolfi
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesca Menchini
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Marco Gatti
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| |
Collapse
|
2
|
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
|
3
|
McCollough CH, Winfree TN, Melka EF, Rajendran K, Carter RE, Leng S. Photon-Counting Detector Computed Tomography Versus Energy-Integrating Detector Computed Tomography for Coronary Artery Calcium Quantitation. J Comput Assist Tomogr 2024; 48:212-216. [PMID: 37801651 PMCID: PMC10939985 DOI: 10.1097/rct.0000000000001554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
OBJECTIVES Photon-counting detector (PCD) computed tomography (CT) offers improved spatial and contrast resolution, which can impact quantitative measurements. This work aims to determine in human subjects the effect of dual-source PCD-CT on the quantitation of coronary artery calcification (CAC) compared with dual-source energy-integrating detector (EID) CT in both 1- and 3-mm images. METHODS This prospective study enrolled patients receiving a clinical EID-CT CAC examination to undergo a research PCD-CT CAC examination. Axial images were reconstructed with a 512 × 512 matrix, 200-mm field of view, 3-mm section thickness/1.5-mm interval using a quantitative kernel (Qr36). Sharper kernels (Qr56/QIR strength 4 for PCD and Qr49/ADMIRE strength 5 for EID) were used to reconstruct images with 1-mm section thickness/0.5-mm interval. Pooled analysis was performed for all calcifications with nonzero values, and volume and Agatston scores were compared between EID-CT and PCD-CT. A Wilcoxon signed-rank test was performed with P < 0.05 considered statistically significant. RESULTS In 21 subjects (median age, 58 years; range, 50-75 years; 13 male [62%]) with a total of 42 calcified arteries detected at 3 mm and 46 calcified arteries at 1-mm images, EID-CT CAC volume and Agatston scores were significantly lower than those of PCD-CT ( P ≤ 0.001). At 3-mm thickness, the mean (standard deviation) volume and Agatston score for EID-CT were 55.5 (63.4) mm 3 and 63.8 (76.9), respectively, and 61.5 (69.4) mm 3 and 70.4 (85.3) for PCD-CT ( P = 0.0001 and P = 0.0013). At 1-mm thickness, the mean (standard deviation) volume and score for EID-CT were 50.0 (56.3) mm 3 and 61.1 (69.3), respectively, and 59.5 (63.9) mm 3 and 72.5 (79.9) for PCD-CT ( P < 0.0001 for both). The applied radiation dose (volume CT dose index) for the PCD-CT scan was 2.1 ± 0.6 mGy, which was 13% lower than for the EID-CT scan (2.4 ± 0.7 mGy, P < 0.001). CONCLUSIONS Relative to EID-CT, PCD-CT demonstrated a small but significant increase in coronary artery calcium volume and Agatston score.
Collapse
Affiliation(s)
| | - Tim N Winfree
- From the Department of Radiology, Mayo Clinic, Rochester, MN
| | - Elnata F Melka
- From the Department of Radiology, Mayo Clinic, Rochester, MN
| | | | - Rickey E Carter
- Department of Health Science Research, Mayo Clinic, Jacksonville, FL
| | - Shuai Leng
- From the Department of Radiology, Mayo Clinic, Rochester, MN
| |
Collapse
|
4
|
Feldle P, Scheuber M, Grunz JP, Heidenreich JF, Pannenbecker P, Nora C, Huflage H, Bley TA, Petritsch B. Virtual non-iodine photon-counting CT-angiography for aortic valve calcification scoring. Sci Rep 2024; 14:4724. [PMID: 38413684 PMCID: PMC10899655 DOI: 10.1038/s41598-024-54918-9] [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: 12/05/2023] [Accepted: 02/18/2024] [Indexed: 02/29/2024] Open
Abstract
Photon-counting detector (PCD)-CT allows for reconstruction of virtual non-iodine (VNI) images from contrast-enhanced datasets. This study assesses the diagnostic performance of aortic valve calcification scoring (AVCS) derived from VNI datasets generated with a 1st generation clinical dual-source PCD-CT. AVCS was evaluated in 123 patients (statistical analysis only comprising patients with aortic valve calcifications [n = 56; 63.2 ± 11.6 years]), who underwent contrast enhanced electrocardiogram-gated (either prospective or retrospective or both) cardiac CT on a clinical PCD system. Patient data was reconstructed at 70 keV employing a VNI reconstruction algorithm. True non-contrast (TNC) scans at 70 keV without quantum iterative reconstruction served as reference in all individuals. Subgroup analysis was performed in 17 patients who received both, prospectively and retrospectively gated contrast enhanced scans (n = 8 with aortic valve calcifications). VNI images with prospective/retrospective gating had an overall sensitivity of 69.2%/56.0%, specificity of 100%/100%, accuracy of 85.4%/81.0%, positive predictive value of 100%/100%, and a negative predictive value of 78.2%/75.0%. VNI images with retrospective gating achieved similar results. For both gating approaches, AVCSVNI showed high correlation (r = 0.983, P < 0.001 for prospective; r = 0.986, P < 0.001 for retrospective) with AVCSTNC. Subgroup analyses demonstrated excellent intra-individual correlation between different acquisition modes (r = 0.986, P < 0.001). Thus, VNI images derived from cardiac PCD-CT allow for excellent diagnostic performance in the assessment of AVCS, suggesting potential for the omission of true non-contrast scans in the clinical workup of patients with aortic calcifications.
Collapse
Affiliation(s)
- Philipp Feldle
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany.
| | - Marit Scheuber
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Julius F Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Pauline Pannenbecker
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Conrads Nora
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| |
Collapse
|
5
|
Rajiah PS, Alkadhi H, Van Mieghem NM, Budde RPJ. Utility of Photon Counting CT in Transcatheter Structural Heart Disease Interventions. Semin Roentgenol 2024; 59:32-43. [PMID: 38388095 DOI: 10.1053/j.ro.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 02/24/2024]
Affiliation(s)
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolas M Van Mieghem
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ricardo P J Budde
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
6
|
Simon J, Hrenkó Á, Kerkovits NM, Nagy K, Vértes M, Balogh H, Nagy N, Munkácsi T, Emrich T, Varga-Szemes A, Boussoussou M, Vattay B, Vecsey-Nagy M, Kolossváry M, Szilveszter B, Merkely B, Maurovich-Horvat P. Photon-counting detector CT reduces the rate of referrals to invasive coronary angiography as compared to CT with whole heart coverage energy-integrating detector. J Cardiovasc Comput Tomogr 2024; 18:69-74. [PMID: 38097408 DOI: 10.1016/j.jcct.2023.11.079] [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: 08/09/2023] [Revised: 10/19/2023] [Accepted: 11/24/2023] [Indexed: 02/26/2024]
Abstract
BACKGROUND We sought to compare the degree of maximal stenosis and the rate of invasive coronary angiography (ICA) recommendations in patients who underwent coronary CT angiography (CCTA) with photon-counting detector CT (PCD-CT) versus those who underwent CCTA with whole heart coverage energy-integrating detector CT (EID-CT). METHODS In our retrospective single-center study, we included consecutive patients with suspected CAD who underwent CCTA performed with either PCD-CT or a 280-slice EID-CT. The degree of coronary stenosis was classified as no CAD, minimal (1-24 %), mild (25-49 %), moderate (50-69 %), severe stenosis (70-99 %), or occlusion. RESULTS A total of 812 consecutive patients were included in the analysis, 401 patients scanned with EID-CT and 411 patients with PCD-CT (mean age: 58.4 ± 12.4 years, 45.4 % female). Despite the higher total coronary artery calcium score (CACS) in the PCD-CT group (10 [interquartile range (IQR) = 0-152.8] vs 1 [IQR = 0-94], p < 0.001), obstructive CAD was more frequently reported in the EID-CT vs PCD-CT group (no CAD: 28.7 % vs 26.0 %, minimal: 23.2 % vs 30.9 %, mild: 19.7 % vs 23.4 %, moderate: 14.5 % vs 9.7 %, severe: 11.5 % vs 8.5 % and occlusion: 2.5 % vs 1.5 %, respectively, p = 0.025). EID-CT was independently associated with downstream ICA (OR = 2.76 [95%CI = 1.58-4.97] p < 0.001) in the overall patient population, in patients with CACS<400 (OR = 2.18 [95%CI = 1.13-4.39] p = 0.024) and in patients with CACS≥400 (OR = 3.83 [95%CI = 1.42-11.05] p = 0.010). CONCLUSION In patients who underwent CCTA with PCD-CT the number of subsequent ICAs was lower as compared to patients who were scanned with EID-CT. This difference was greater in patients with extensive coronary calcification.
Collapse
Affiliation(s)
- Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Áron Hrenkó
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Nóra Melinda Kerkovits
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Kristóf Nagy
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Miklós Vértes
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Hanna Balogh
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Norbert Nagy
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Tamás Munkácsi
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | | | - Borbála Vattay
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Milán Vecsey-Nagy
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- Gottsegen National Cardiovascular Center, Budapest, Hungary; Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Hungary
| | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary.
| |
Collapse
|
7
|
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
|
8
|
Turrion Gomollon AM, Mergen V, Sartoretti T, Polacin M, Nakhostin D, Puippe G, Alkadhi H, Euler A. Photon-Counting Detector CT Angiography for Endoleak Detection After Endovascular Aortic Repair: Triphasic CT With True Noncontrast Versus Biphasic CT With Virtual Noniodine Imaging. Invest Radiol 2023; 58:816-821. [PMID: 37358359 PMCID: PMC10581441 DOI: 10.1097/rli.0000000000000993] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/25/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES The aim of this study was to compare image quality and endoleak detection after endovascular abdominal aortic aneurysm repair between a triphasic computed tomography (CT) with true noncontrast (TNC) and a biphasic CT with virtual noniodine (VNI) images on photon-counting detector CT (PCD-CT). MATERIALS AND METHODS Adult patients after endovascular abdominal aortic aneurysm repair who received a triphasic examination (TNC, arterial, venous phase) on a PCD-CT between August 2021 and July 2022 were retrospectively included. Endoleak detection was evaluated by 2 blinded radiologists on 2 different readout sets (triphasic CT with TNC-arterial-venous vs biphasic CT with VNI-arterial-venous). Virtual noniodine images were reconstructed from the venous phase. The radiologic report with additional confirmation by an expert reader served as reference standard for endoleak presence. Sensitivity, specificity, and interreader agreement (Krippendorf α) were calculated. Image noise was assessed subjectively in patients using a 5-point scale and objectively calculating the noise power spectrum in a phantom. RESULTS One hundred ten patients (7 women; age, 76 ± 8 years) with 41 endoleaks were included. Endoleak detection was comparable between both readout sets with a sensitivity and specificity of 0.95/0.84 (TNC) versus 0.95/0.86 (VNI) for reader 1 and 0.88/0.98 (TNC) versus 0.88/0.94 (VNI) for reader 2. Interreader agreement for endoleak detection was substantial (TNC: 0.716, VNI: 0.756). Subjective image noise was comparable between TNC and VNI (4; IQR [4, 5] vs 4; IQR [4, 5], P = 0.44). In the phantom, noise power spectrum peak spatial frequency was similar between TNC and VNI (both f peak = 0.16 mm -1 ). Objective image noise was higher in TNC (12.7 HU) as compared with VNI (11.5 HU). CONCLUSIONS Endoleak detection and image quality were comparable using VNI images in biphasic CT as compared with TNC images in triphasic CT offering the possibility to reduce scan phases and radiation exposure.
Collapse
|
9
|
Douek PC, Boccalini S, Oei EHG, Cormode DP, Pourmorteza A, Boussel L, Si-Mohamed SA, Budde RPJ. Clinical Applications of Photon-counting CT: A Review of Pioneer Studies and a Glimpse into the Future. Radiology 2023; 309:e222432. [PMID: 37787672 PMCID: PMC10623209 DOI: 10.1148/radiol.222432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 03/24/2023] [Accepted: 04/11/2023] [Indexed: 10/04/2023]
Abstract
CT systems equipped with photon-counting detectors (PCDs), referred to as photon-counting CT (PCCT), are beginning to change imaging in several subspecialties, such as cardiac, vascular, thoracic, and musculoskeletal radiology. Evidence has been building in the literature underpinning the many advantages of PCCT for different clinical applications. These benefits derive from the distinct features of PCDs, which are made of semiconductor materials capable of converting photons directly into electric signal. PCCT advancements include, among the most important, improved spatial resolution, noise reduction, and spectral properties. PCCT spatial resolution on the order of 0.25 mm allows for the improved visualization of small structures (eg, small vessels, arterial walls, distal bronchi, and bone trabeculations) and their pathologies, as well as the identification of previously undetectable anomalies. In addition, blooming artifacts from calcifications, stents, and other dense structures are reduced. The benefits of the spectral capabilities of PCCT are broad and include reducing radiation and contrast material dose for patients. In addition, multiple types of information can be extracted from a single data set (ie, multiparametric imaging), including quantitative data often regarded as surrogates of functional information (eg, lung perfusion). PCCT also allows for a novel type of CT imaging, K-edge imaging. This technique, combined with new contrast materials specifically designed for this modality, opens the door to new applications for imaging in the future.
Collapse
Affiliation(s)
| | | | - Edwin H. G. Oei
- From the University of Lyon, INSA-Lyon, Claude Bernard Lyon 1
University, UJM-Saint Etienne, CNRS, Inserm, Villeurbanne, France (P.C.D., L.B.,
S.A.S.M.); Department of Cardiovascular and Thoracic Radiology, Louis Pradel
Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
(P.C.D., S.B., L.B., S.A.S.M.); Claude Bernard Lyon 1 University, Villeurbanne,
France (S.B.); Department of Radiology and Nuclear Medicine, Erasmus Medical
Center, Rotterdam, the Netherlands (E.H.G.O., R.P.J.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (D.P.C.); Department of
Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Department
of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga (A.P.);
and Winship Cancer Institute, Atlanta, Ga (A.P.)
| | - David P. Cormode
- From the University of Lyon, INSA-Lyon, Claude Bernard Lyon 1
University, UJM-Saint Etienne, CNRS, Inserm, Villeurbanne, France (P.C.D., L.B.,
S.A.S.M.); Department of Cardiovascular and Thoracic Radiology, Louis Pradel
Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
(P.C.D., S.B., L.B., S.A.S.M.); Claude Bernard Lyon 1 University, Villeurbanne,
France (S.B.); Department of Radiology and Nuclear Medicine, Erasmus Medical
Center, Rotterdam, the Netherlands (E.H.G.O., R.P.J.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (D.P.C.); Department of
Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Department
of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga (A.P.);
and Winship Cancer Institute, Atlanta, Ga (A.P.)
| | - Amir Pourmorteza
- From the University of Lyon, INSA-Lyon, Claude Bernard Lyon 1
University, UJM-Saint Etienne, CNRS, Inserm, Villeurbanne, France (P.C.D., L.B.,
S.A.S.M.); Department of Cardiovascular and Thoracic Radiology, Louis Pradel
Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
(P.C.D., S.B., L.B., S.A.S.M.); Claude Bernard Lyon 1 University, Villeurbanne,
France (S.B.); Department of Radiology and Nuclear Medicine, Erasmus Medical
Center, Rotterdam, the Netherlands (E.H.G.O., R.P.J.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (D.P.C.); Department of
Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Department
of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga (A.P.);
and Winship Cancer Institute, Atlanta, Ga (A.P.)
| | - Loic Boussel
- From the University of Lyon, INSA-Lyon, Claude Bernard Lyon 1
University, UJM-Saint Etienne, CNRS, Inserm, Villeurbanne, France (P.C.D., L.B.,
S.A.S.M.); Department of Cardiovascular and Thoracic Radiology, Louis Pradel
Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
(P.C.D., S.B., L.B., S.A.S.M.); Claude Bernard Lyon 1 University, Villeurbanne,
France (S.B.); Department of Radiology and Nuclear Medicine, Erasmus Medical
Center, Rotterdam, the Netherlands (E.H.G.O., R.P.J.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (D.P.C.); Department of
Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Department
of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga (A.P.);
and Winship Cancer Institute, Atlanta, Ga (A.P.)
| | - Salim A. Si-Mohamed
- From the University of Lyon, INSA-Lyon, Claude Bernard Lyon 1
University, UJM-Saint Etienne, CNRS, Inserm, Villeurbanne, France (P.C.D., L.B.,
S.A.S.M.); Department of Cardiovascular and Thoracic Radiology, Louis Pradel
Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
(P.C.D., S.B., L.B., S.A.S.M.); Claude Bernard Lyon 1 University, Villeurbanne,
France (S.B.); Department of Radiology and Nuclear Medicine, Erasmus Medical
Center, Rotterdam, the Netherlands (E.H.G.O., R.P.J.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (D.P.C.); Department of
Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Department
of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga (A.P.);
and Winship Cancer Institute, Atlanta, Ga (A.P.)
| | - Ricardo P. J. Budde
- From the University of Lyon, INSA-Lyon, Claude Bernard Lyon 1
University, UJM-Saint Etienne, CNRS, Inserm, Villeurbanne, France (P.C.D., L.B.,
S.A.S.M.); Department of Cardiovascular and Thoracic Radiology, Louis Pradel
Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
(P.C.D., S.B., L.B., S.A.S.M.); Claude Bernard Lyon 1 University, Villeurbanne,
France (S.B.); Department of Radiology and Nuclear Medicine, Erasmus Medical
Center, Rotterdam, the Netherlands (E.H.G.O., R.P.J.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (D.P.C.); Department of
Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Department
of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga (A.P.);
and Winship Cancer Institute, Atlanta, Ga (A.P.)
| |
Collapse
|
10
|
Rajiah PS, Dunning CAS, Rajendran K, Tandon Y, Ahmed Z, Larson N, Collins JD, Thorne J, Williamson E, Fletcher JG, McCollough C, Leng S. High-Pitch Multienergy Coronary CT Angiography in Dual-Source Photon-Counting Detector CT Scanner at Low Iodinated Contrast Dose. Invest Radiol 2023; 58:681-690. [PMID: 36822655 PMCID: PMC10591289 DOI: 10.1097/rli.0000000000000961] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the high-helical pitch, multienergy (ME) scanning mode of a clinical dual-source photon-counting detector (PCD) computed tomography (CT) and the benefit of virtual monoenergetic images (VMIs) for low-contrast-dose coronary CT angiography (CTA). MATERIALS AND METHODS High-pitch (3.2) ME coronary CTA was performed in PCD-CT in 27 patients using low contrast dose (30 mL of iohexol 350 mg/mL) and in 26 patients at routine contrast dose (60 mL). Low-energy-threshold 120 kV images (also known as T3D images) and 50 kiloelectron volts (50 keV) and 100 kiloelectron volts (100 keV) VMIs were reconstructed using a 1024 × 1024 matrix and 0.6-mm slices. The CT numbers, noise, and contrast-to-noise ratio (CNR) were measured in the ascending aorta (AA), left main coronary artery (LMCA), and distal left anterior descending (LAD) artery. Confidence in grading luminal stenosis with calcific plaque, noncalcific plaque, and stent was evaluated by 2 independent readers on a 0-100 scale (0 the lowest), and a CAD-RADS score was assigned. Image contrast enhancement, sharpness, noise, artifacts, and overall image quality were rated using a 5-point ordinal scale (1 the lowest). RESULTS The radiation doses (CTDI) in low- and routine-contrast cohorts were 2.5 ± 0.6 mGy and 3.1 ± 1.7 mGy, respectively ( P = 0.12). At all measured locations, the mean CT number was >300 HU in 120 kV (LMCA 382.9 ± 76.2, distal LAD 341.0 ± 53.9, AA 399.5 ± 76.1) and 50 keV images (LMCA 667.5 ± 139.9, distal LAD 578.1 ± 121.5, AA 700.8 ± 142.5) in the low-contrast cohort, with a 96% increase in CT numbers for 50 keV over 120 kV. The CT numbers were significantly higher ( P < 0.0001) in 50 keV than 120 kV and 100 keV VMI. The CNR was also significantly ( P < 0.0001) higher in 50 keV than 120 kV and 100 keV images in all vessels. Confidence in the assessment of luminal stenosis in the presence of calcific plaque was significantly higher ( P = 0.001) with the addition of 100 keV VMI (median score, 100) than using 50 keV alone (median score, 70) and 120 kV (median score, 70) for reader 1, but no significant differences were seen for reader 2 who had same median scores of 100 for all image types. The confidence in the assessment of luminal stenosis within a stent improved with the use of 100 keV images for both readers (reader 1: median scores for 50 + 100 keV = 100, 50 keV = 82.5, 120 kV = 82.5; reader 2: 50 + 100 keV = 100, 50 keV = 90, 120 kV = 90). There were no significant differences in confidence scores for assessment of luminal stenosis from noncalcific plaques for both readers. The reader-averaged qualitative scores for vascular enhancement and overall image quality were significantly higher for 50 keV VMI than for 120 kV images in both low- and routine-contrast dose cohorts. The image sharpness was nonsignificantly higher at 50 keV VMI than 120 kV images, and the artifact score was comparable for 50 keV VMI and 120 kV images. The noise was higher in 50 keV VMI than in 120 kV images. CONCLUSIONS High-pitch ME PCD-CT mode produced diagnostic quality coronary CTA images at low radiation and iodinated contrast doses. The availability of ME VMIs significantly improved the CNR, overall image quality, and confidence in assessment of luminal stenosis in the presence of calcific plaques and stents, and resulted in change of CAD-RADS categories in 9 patients.
Collapse
Affiliation(s)
| | - Chelsea A. S. Dunning
- Department of Radiology, Mayo Clinic, 200 First St SW Rochester, MN, United States 55905
| | - Kishore Rajendran
- Department of Radiology, Mayo Clinic, 200 First St SW Rochester, MN, United States 55905
| | - Yasmeen Tandon
- Department of Radiology, Mayo Clinic, 200 First St SW Rochester, MN, United States 55905
| | - Zaki Ahmed
- Department of Radiology, Mayo Clinic, 200 First St SW Rochester, MN, United States 55905
| | - Nicholas Larson
- Department of Radiology, Mayo Clinic, 200 First St SW Rochester, MN, United States 55905
| | - Jeremy D. Collins
- Department of Radiology, Mayo Clinic, 200 First St SW Rochester, MN, United States 55905
| | - Jamison Thorne
- Department of Radiology, Mayo Clinic, 200 First St SW Rochester, MN, United States 55905
| | - Eric Williamson
- Department of Radiology, Mayo Clinic, 200 First St SW Rochester, MN, United States 55905
| | - Joel G. Fletcher
- Department of Radiology, Mayo Clinic, 200 First St SW Rochester, MN, United States 55905
| | - Cynthia McCollough
- Department of Radiology, Mayo Clinic, 200 First St SW Rochester, MN, United States 55905
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, 200 First St SW Rochester, MN, United States 55905
| |
Collapse
|
11
|
Meloni A, Cademartiri F, Positano V, Celi S, Berti S, Clemente A, La Grutta L, Saba L, Bossone E, Cavaliere C, Punzo B, Maffei E. Cardiovascular Applications of Photon-Counting CT Technology: A Revolutionary New Diagnostic Step. J Cardiovasc Dev Dis 2023; 10:363. [PMID: 37754792 PMCID: PMC10531582 DOI: 10.3390/jcdd10090363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023] Open
Abstract
Photon-counting computed tomography (PCCT) is an emerging technology that can potentially transform clinical CT imaging. After a brief description of the PCCT technology, this review summarizes its main advantages over conventional CT: improved spatial resolution, improved signal and contrast behavior, reduced electronic noise and artifacts, decreased radiation dose, and multi-energy capability with improved material discrimination. Moreover, by providing an overview of the existing literature, this review highlights how the PCCT benefits have been harnessed to enhance and broaden the diagnostic capabilities of CT for cardiovascular applications, including the detection of coronary artery calcifications, evaluation of coronary plaque extent and composition, evaluation of coronary stents, and assessment of myocardial tissue characteristics and perfusion.
Collapse
Affiliation(s)
- Antonella Meloni
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.); (A.C.); (E.M.)
- Unità Operativa Complessa di Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.); (A.C.); (E.M.)
| | - Vicenzo Positano
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.); (A.C.); (E.M.)
- Unità Operativa Complessa di Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Simona Celi
- BioCardioLab, Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy;
| | - Sergio Berti
- Diagnostic and Interventional Cardiology Department, Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy;
| | - Alberto Clemente
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.); (A.C.); (E.M.)
| | - 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;
| | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, 80131 Naples, Italy;
| | - Carlo Cavaliere
- Department of Radiology, Istituto di Ricerca e Cura a Carattere Scientifico SynLab-SDN, 80131 Naples, Italy; (C.C.); (B.P.)
| | - Bruna Punzo
- Department of Radiology, Istituto di Ricerca e Cura a Carattere Scientifico SynLab-SDN, 80131 Naples, Italy; (C.C.); (B.P.)
| | - Erica Maffei
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.); (A.C.); (E.M.)
| |
Collapse
|
12
|
Garcelon C, Abascal J, Olivier C, Uk S, Si-Mohamed S, Ea HK, Douek P, Peyrin F, Chappard C. Quantification of cartilage and subchondral bone cysts on knee specimens based on a spectral photon-counting computed tomography. Sci Rep 2023; 13:11080. [PMID: 37422514 PMCID: PMC10329701 DOI: 10.1038/s41598-023-38238-y] [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: 10/04/2022] [Accepted: 07/05/2023] [Indexed: 07/10/2023] Open
Abstract
Spectral photon-counting computed tomography (SPCCT) is a new technique with the capability to provide mono-energetic (monoE) images with high signal to noise ratio. We demonstrate the feasibility of SPCCT to characterize at the same time cartilage and subchondral bone cysts (SBCs) without contrast agent in osteoarthritis (OA). To achieve this goal, 10 human knee specimens (6 normal and 4 with OA) were imaged with a clinical prototype SPCCT. The monoE images at 60 keV with isotropic voxels of 250 × 250 × 250 µm3 were compared with monoE synchrotron radiation CT (SR micro-CT) images at 55 keV with isotropic voxels of 45 × 45 × 45 µm3 used as benchmark for cartilage segmentation. In the two OA knees with SBCs, the volume and density of SBCs were evaluated in SPCCT images. In 25 compartments (lateral tibial (LT), medial tibial, (MT), lateral femoral (LF), medial femoral and patella), the mean bias between SPCCT and SR micro-CT analyses were 101 ± 272 mm3 for cartilage volume and 0.33 mm ± 0.18 for mean cartilage thickness. Between normal and OA knees, mean cartilage thicknesses were found statistically different (0.005 < p < 0.04) for LT, MT and LF compartments. The 2 OA knees displayed different SBCs profiles in terms of volume, density, and distribution according to size and location. SPCCT with fast acquisitions is able to characterize cartilage morphology and SBCs. SPCCT can be used potentially as a new tool in clinical studies in OA.
Collapse
Affiliation(s)
- Célestin Garcelon
- Paris Cité University, CNRS, INSERM, B3OA UMR 7052 U1273, Paris, France
| | - Juan Abascal
- University of Lyon, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1206, Lyon, France
| | - Cecile Olivier
- University of Lyon, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1206, Lyon, France
| | - Stéphanie Uk
- Paris Cité University, CNRS, INSERM, B3OA UMR 7052 U1273, Paris, France
| | - Salim Si-Mohamed
- University of Lyon, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1206, Lyon, France
| | - Hang-Korng Ea
- Rheumatology Department, University Paris Cité, Paris, France
| | - Philippe Douek
- University of Lyon, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1206, Lyon, France
| | - Francoise Peyrin
- University of Lyon, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1206, Lyon, France
| | - Christine Chappard
- Paris Cité University, CNRS, INSERM, B3OA UMR 7052 U1273, Paris, France.
| |
Collapse
|
13
|
Marsh JF, VanMeter PD, Rajendran K, Leng S, McCollough CH. Ex vivo coronary calcium volume quantification using a high-spatial-resolution clinical photon-counting-detector computed tomography. J Med Imaging (Bellingham) 2023; 10:043501. [PMID: 37408984 PMCID: PMC10319293 DOI: 10.1117/1.jmi.10.4.043501] [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: 09/21/2022] [Revised: 04/17/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose Coronary artery calcification (CAC) is an important indicator of coronary disease. Accurate volume quantification of CAC is challenging using computed tomography (CT) due to calcium blooming, which is a consequence of limited spatial resolution. Ex vivo coronary specimens were scanned on an ultra-high-resolution (UHR) clinical photon-counting detector (PCD) CT scanner, and the accuracy of CAC volume estimation was compared with a state-of-the-art conventional energy-integrating detector (EID) CT, a previous-generation investigational PCD-CT, and micro-CT. Approach CAC specimens (n = 13 ) were scanned on EID-CT and PCD-CT using matched parameters (120 kV, 9.3 mGy CTDI vol ). EID-CT images were reconstructed using our institutional routine clinical protocol for CAC quantification. UHR PCD-CT data were reconstructed using a sharper kernel. An image-based denoising algorithm was applied to the PCD-CT images to achieve similar noise levels as EID-CT. Micro-CT images served as the volume reference standard. Calcification images were segmented, and their volume estimates were compared. The CT data were further compared with previous work using an investigational PCD-CT. Results Compared with micro-CT, CT volume estimates had a mean absolute percent error of 24.1 % ± 25.6 % for clinical PCD-CT, 60.1 % ± 48.2 % for EID-CT, and 51.1 % ± 41.7 % for previous-generation PCD-CT. Clinical PCD-CT absolute percent error was significantly (p < 0.01 ) lower than both EID-CT and previous generation PCD-CT. The mean calcification CT number and contrast-to-noise ratio were both significantly (p < 0.01 ) higher in clinical PCD-CT relative to EID-CT. Conclusions UHR clinical PCD-CT showed reduced calcium blooming artifacts and further enabled improved accuracy of CAC quantification beyond that of conventional EID-CT and previous generation PCD-CT systems.
Collapse
Affiliation(s)
- Jeffrey F. Marsh
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | | | - Kishore Rajendran
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Shuai Leng
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | | |
Collapse
|
14
|
Dobrolinska MM, van der Werf NR, van der Bie J, de Groen J, Dijkshoorn M, Booij R, Budde RPJ, Greuter MJW, van Straten M. Radiation dose optimization for photon-counting CT coronary artery calcium scoring for different patient sizes: a dynamic phantom study. Eur Radiol 2023; 33:4668-4675. [PMID: 36729174 PMCID: PMC10290002 DOI: 10.1007/s00330-023-09434-1] [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: 10/19/2022] [Revised: 10/19/2022] [Accepted: 01/07/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE To systematically assess the radiation dose reduction potential of coronary artery calcium (CAC) assessments with photon-counting computed tomography (PCCT) by changing the tube potential for different patient sizes with a dynamic phantom. METHODS A hollow artery, containing three calcifications of different densities, was translated at velocities corresponding to 0, < 60, 60-75, and > 75 beats per minute within an anthropomorphic phantom. Extension rings were used to simulate average- and large -sized patients. PCCT scans were made with the reference clinical protocol (tube potential of 120 kilovolt (kV)), and with 70, 90, Sn100, Sn140, and 140 kV at identical image quality levels. All acquisitions were reconstructed at a virtual monoenergetic energy level of 70 keV. For each calcification, Agatston scores and contrast-to-noise ratios (CNR) were determined, and compared to the reference with Wilcoxon signed-rank tests, with p < 0.05 indicating significant differences. RESULTS A decrease in radiation dose (22%) was achieved at Sn100 kV for the average-sized phantom. For the large phantom, Sn100 and Sn140 kV resulted in a decrease in radiation doses of 19% and 3%, respectively. Irrespective of CAC density, Sn100 and 140 kVp did not result in significantly different CNR. Only at Sn100 kV were there no significant differences in Agatston scores for all CAC densities, heart rates, and phantom sizes. CONCLUSION PCCT at tube voltage of 100 kV with added tin filtration and reconstructed at 70 keV enables a ≥ 19% dose reduction compared to 120 kV, independent of phantom size, CAC density, and heart rate. KEY POINTS • Photon-counting CT allows for reduced radiation dose acquisitions (up to 19%) for coronary calcium assessment by reducing tube voltage while reconstructing at a normal monoE level of 70 keV. • Tube voltage reduction is possible for medium and large patient sizes, without affecting the Agatston score outcome.
Collapse
Affiliation(s)
- Magdalena M Dobrolinska
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesiain , Katowice, Katowice, Poland
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Niels R van der Werf
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Judith van der Bie
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joël de Groen
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marcel Dijkshoorn
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ronald Booij
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marcel J W Greuter
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Marcel van Straten
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
15
|
Zsarnóczay E, Varga-Szemes A, Emrich T, Szilveszter B, van der Werf NR, Mastrodicasa D, Maurovich-Horvat P, Willemink MJ. Characterizing the Heart and the Myocardium With Photon-Counting CT. Invest Radiol 2023; 58:505-514. [PMID: 36822653 DOI: 10.1097/rli.0000000000000956] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
ABSTRACT Noninvasive cardiac imaging has rapidly evolved during the last decade owing to improvements in computed tomography (CT)-based technologies, among which we highlight the recent introduction of the first clinical photon-counting detector CT (PCD-CT) system. Multiple advantages of PCD-CT have been demonstrated, including increased spatial resolution, decreased electronic noise, and reduced radiation exposure, which may further improve diagnostics and may potentially impact existing management pathways. The benefits that can be obtained from the initial experiences with PCD-CT are promising. The implementation of this technology in cardiovascular imaging allows for the quantification of coronary calcium, myocardial extracellular volume, myocardial radiomics features, epicardial and pericoronary adipose tissue, and the qualitative assessment of coronary plaques and stents. This review aims to discuss these major applications of PCD-CT with a focus on cardiac and myocardial characterization.
Collapse
Affiliation(s)
| | - Akos Varga-Szemes
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston
| | | | | | | | | | | | | |
Collapse
|
16
|
Si-Mohamed SA, Boccalini S, Villien M, Yagil Y, Erhard K, Boussel L, Douek PC. First Experience With a Whole-Body Spectral Photon-Counting CT Clinical Prototype. Invest Radiol 2023; 58:459-471. [PMID: 36822663 PMCID: PMC10259214 DOI: 10.1097/rli.0000000000000965] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/20/2023] [Indexed: 02/25/2023]
Abstract
ABSTRACT Spectral photon-counting computed tomography (SPCCT) technology holds great promise for becoming the next generation of computed tomography (CT) systems. Its technical characteristics have many advantages over conventional CT imaging. For example, SPCCT provides better spatial resolution, greater dose efficiency for ultra-low-dose and low-dose protocols, and tissue contrast superior to that of conventional CT. In addition, SPCCT takes advantage of several known approaches in the field of spectral CT imaging, such as virtual monochromatic imaging and material decomposition imaging. In addition, SPCCT takes advantage of a new approach in this field, known as K-edge imaging, which allows specific and quantitative imaging of a heavy atom-based contrast agent. Hence, the high potential of SPCCT systems supports their ongoing investigation in clinical research settings. In this review, we propose an overview of our clinical research experience of a whole-body SPCCT clinical prototype, to give an insight into the potential benefits for clinical human imaging on image quality, diagnostic confidence, and new approaches in spectral CT imaging.
Collapse
Affiliation(s)
- Salim A. Si-Mohamed
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, Villeurbanne, France
- Department of Radiology, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Sara Boccalini
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, Villeurbanne, France
- Department of Radiology, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | | | | | | | - Loic Boussel
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, Villeurbanne, France
- Department of Radiology, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Philippe C. Douek
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, Villeurbanne, France
- Department of Radiology, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| |
Collapse
|
17
|
Cademartiri F, Meloni A, Pistoia L, Degiorgi G, Clemente A, Gori CD, Positano V, Celi S, Berti S, Emdin M, Panetta D, Menichetti L, Punzo B, Cavaliere C, Bossone E, Saba L, Cau R, Grutta LL, Maffei E. Dual-Source Photon-Counting Computed Tomography-Part I: Clinical Overview of Cardiac CT and Coronary CT Angiography Applications. J Clin Med 2023; 12:jcm12113627. [PMID: 37297822 DOI: 10.3390/jcm12113627] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
The photon-counting detector (PCD) is a new computed tomography detector technology (photon-counting computed tomography, PCCT) that provides substantial benefits for cardiac and coronary artery imaging. Compared with conventional CT, PCCT has multi-energy capability, increased spatial resolution and soft tissue contrast with near-null electronic noise, reduced radiation exposure, and optimization of the use of contrast agents. This new technology promises to overcome several limitations of traditional cardiac and coronary CT angiography (CCT/CCTA) including reduction in blooming artifacts in heavy calcified coronary plaques or beam-hardening artifacts in patients with coronary stents, and a more precise assessment of the degree of stenosis and plaque characteristic thanks to its better spatial resolution. Another potential application of PCCT is the use of a double-contrast agent to characterize myocardial tissue. In this current overview of the existing PCCT literature, we describe the strengths, limitations, recent applications, and promising developments of employing PCCT technology in CCT.
Collapse
Affiliation(s)
| | - Antonella Meloni
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
- Department of Bioengineering, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Laura Pistoia
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Giulia Degiorgi
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Alberto Clemente
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Carmelo De Gori
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Vincenzo Positano
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
- Department of Bioengineering, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Simona Celi
- BioCardioLab, Department of Bioengineering, Fondazione Monasterio/CNR, 54100 Massa, Italy
| | - Sergio Berti
- Cardiology Unit, Ospedale del Cuore, Fondazione Monasterio/CNR, 54100 Massa, Italy
| | - Michele Emdin
- Department of Cardiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Daniele Panetta
- Institute of Clinical Physiology, National Council of Research, 56124 Pisa, Italy
| | - Luca Menichetti
- Institute of Clinical Physiology, National Council of Research, 56124 Pisa, Italy
| | - Bruna Punzo
- Department of Radiology, IRCCS SynLab-SDN, 80131 Naples, Italy
| | - Carlo Cavaliere
- Department of Radiology, IRCCS SynLab-SDN, 80131 Naples, Italy
| | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, 80131 Naples, Italy
| | - Luca Saba
- Department of Radiology, University Hospital, 09042 Monserrato, Italy
| | - Riccardo Cau
- Department of Radiology, University Hospital, 09042 Monserrato, Italy
| | - Ludovico La Grutta
- Department of Radiology, University Hospital "P. Giaccone", 90127 Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| |
Collapse
|
18
|
van der Bie J, van Straten M, Booij R, Bos D, Dijkshoorn ML, Hirsch A, Sharma SP, Oei EHG, Budde RPJ. Photon-counting CT: Review of initial clinical results. Eur J Radiol 2023; 163:110829. [PMID: 37080060 DOI: 10.1016/j.ejrad.2023.110829] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
Photon-counting computed tomography (PCCT) is a new technology that enables higher spatial resolution compared to conventional CT techniques, energy resolved imaging and spectral post-processing. This leads to improved contrast-to-noise ratio, artifact and potential dose reduction as well as elimination of electronic noise. Since the introduction of clinical PCCT in 2021, a shift has been observed from solely pre-clinical studies to clinical research (i.e. use of PCCT imaging in humans). This review article is focused on the initial clinical results of PCCT by explaining the current PCCT systems, the applications themselves and, the challenges of PCCT.
Collapse
Affiliation(s)
- Judith van der Bie
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Marcel van Straten
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Ronald Booij
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Daniel Bos
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Marcel L Dijkshoorn
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Alexander Hirsch
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Simran P Sharma
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Ricardo P J Budde
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| |
Collapse
|
19
|
Cao J, Bache S, Schwartz FR, Frush D. Pediatric Applications of Photon-Counting Detector CT. AJR Am J Roentgenol 2023; 220:580-589. [PMID: 36287620 DOI: 10.2214/ajr.22.28391] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Photon-counting detector (PCD) CT represents the most recent generational advance in CT technology. PCD CT has the potential to reduce image noise, improve spatial resolution and contrast resolution, and provide multispectral capability, all of which may be achieved with an overall decrease in the radiation dose. These effects may be used to reduce the iodinated contrast media dose and potentially obtain multiphase images through a single-acquisition technique. The benefits of PCD CT have previously been shown primarily in phantoms and adult patients. This article describes the application of PCD CT in children, as illustrated by clinical examples from a commercially available PCD CT system.
Collapse
Affiliation(s)
- Joseph Cao
- Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27705
| | - Steve Bache
- Department of Radiology, Clinical Imaging Physics Group, Duke University Medical Center, Durham, NC
| | | | - Donald Frush
- Department of Radiology, Division of Pediatric Radiology, Medical Physics Graduate Program, Duke University Medical Center, Durham, NC
| |
Collapse
|
20
|
Photon Counting Detector CT-Based Virtual Noniodine Reconstruction Algorithm for In Vitro and In Vivo Coronary Artery Calcium Scoring: Impact of Virtual Monoenergetic and Quantum Iterative Reconstructions. Invest Radiol 2023:00004424-990000000-00091. [PMID: 36822677 DOI: 10.1097/rli.0000000000000959] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of virtual monoenergetic imaging (VMI) and quantum iterative reconstruction (QIR) on the accuracy of coronary artery calcium scoring (CACS) using a virtual noniodine (VNI) reconstruction algorithm on a first-generation, clinical, photon counting detector computed tomography system. MATERIALS AND METHODS Coronary artery calcium scoring was evaluated in an anthropomorphic chest phantom simulating 3 different patient sizes by using 2 extension rings (small: 300 × 200 mm, medium: 350 × 250 mm, large: 400 × 300 mm) and in patients (n = 61; final analyses only in patients with coronary calcifications [n = 34; 65.4 ± 10.0 years; 73.5% male]), who underwent nonenhanced and contrast-enhanced, electrocardiogram-gated, cardiac computed tomography on a photon counting detector system. Phantom and patient data were reconstructed using a VNI reconstruction algorithm at different VMI (55-80 keV) and QIR (strength 1-4) levels (CACSVNI). True noncontrast (TNC) scans at 70 keV and QIR "off" were used as reference for phantom and patient studies (CACSTNC). RESULTS In vitro and in vivo CACSVNI showed strong correlation (r > 0.9, P < 0.001 for all) and excellent agreement (intraclass correlation coefficient > 0.9 for all) with CACSTNC at all investigated VMI and QIR levels. Phantom and patient CACSVNI significantly increased with decreasing keV levels (in vitro: from 475.2 ± 26.3 at 80 keV up to 652.5 ± 42.2 at 55 keV; in vivo: from 142.5 [7.4/737.7] at 80 keV up to 248.1 [31.2/1144] at 55 keV; P < 0.001 for all), resulting in an overestimation of CACSVNI at 55 keV compared with CACSTNC at 70 keV in some cases (in vitro: 625.8 ± 24.4; in vivo: 225.4 [35.1/959.7]). In vitro CACS increased with rising QIR at low keV. In vivo scores were significantly higher at QIR 1 compared with QIR 4 only at 60 and 80 keV (60 keV: 220.3 [29.6-1060] vs 219.5 [23.7/1048]; 80 keV: 152.0 [12.0/735.6] vs 142.5 [7.4/737.7]; P < 0.001). CACSVNI was closest to CACSTNC at 60 keV, QIR 2 (+0.1%) in the small; 55 keV, QIR 1 (±0%) in the medium; 55 keV, QIR 4 (-0.1%) in the large phantom; and at 60 keV, QIR 1 (-2.3%) in patients. CONCLUSIONS Virtual monoenergetic imaging reconstructions have a significant impact on CACSVNI. The effects of different QIR levels are less consistent and seem to depend on several individual conditions, which should be further investigated.
Collapse
|
21
|
Sartoretti T, Wildberger JE, Flohr T, Alkadhi H. Photon-counting detector CT: early clinical experience review. Br J Radiol 2023:20220544. [PMID: 36744809 DOI: 10.1259/bjr.20220544] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Since its development in the 1970s, X-ray CT has emerged as a landmark diagnostic imaging modality of modern medicine. Technological advances have been crucial to the success of CT imaging, as they have increasingly enabled improvements in image quality and diagnostic value at increasing radiation dose efficiency. With recent advances in engineering and physics, a novel technology has emerged with the potential to surpass several shortcomings and limitations of current CT systems. Photon-counting detector (PCD)-CT might substantially improve and expand the applicability of CT imaging by offering intrinsic spectral capabilities, increased spatial resolution, reduced electronic noise and improved image contrast. In this review we sought to summarize the first clinical experience of PCD-CT. We focused on most recent prototype and first clinically approved PCD-CT systems thereby reviewing initial publications and presenting corresponding clinical cases.
Collapse
Affiliation(s)
- Thomas Sartoretti
- Diagnostic and Interventional Radiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Thomas Flohr
- Siemens Healthcare GmbH, Computed Tomography, Forchheim, Germany
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| |
Collapse
|
22
|
Photon-Counting Computed Tomography (PCCT): Technical Background and Cardio-Vascular Applications. Diagnostics (Basel) 2023; 13:diagnostics13040645. [PMID: 36832139 PMCID: PMC9955798 DOI: 10.3390/diagnostics13040645] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/28/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Photon-counting computed tomography (PCCT) is a new advanced imaging technique that is going to transform the standard clinical use of computed tomography (CT) imaging. Photon-counting detectors resolve the number of photons and the incident X-ray energy spectrum into multiple energy bins. Compared with conventional CT technology, PCCT offers the advantages of improved spatial and contrast resolution, reduction of image noise and artifacts, reduced radiation exposure, and multi-energy/multi-parametric imaging based on the atomic properties of tissues, with the consequent possibility to use different contrast agents and improve quantitative imaging. This narrative review first briefly describes the technical principles and the benefits of photon-counting CT and then provides a synthetic outline of the current literature on its use for vascular imaging.
Collapse
|
23
|
Schwartz FR, Daubert MA, Molvin L, Ramirez-Giraldo JC, Samei E, Marin D, Tailor TD. Coronary Artery Calcium Evaluation Using New Generation Photon-counting Computed Tomography Yields Lower Radiation Dose Compared With Standard Computed Tomography. J Thorac Imaging 2023; 38:44-45. [PMID: 36490311 PMCID: PMC10812840 DOI: 10.1097/rti.0000000000000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT Prospective head-to-head comparison of coronary calcium scores between standard computed tomography (CT) and photon-counting CT show no significant differences, while photon-counting CT administers substantially lower radiation dose.
Collapse
|
24
|
Schwartz FR, Vinson EN, Spritzer CE, Colglazier R, Samei E, French RJ, Said N, Waldman L, McCrum E. Prospective Multireader Evaluation of Photon-counting CT for Multiple Myeloma Screening. Radiol Imaging Cancer 2022; 4:e220073. [PMID: 36399038 PMCID: PMC9713593 DOI: 10.1148/rycan.220073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/31/2022] [Accepted: 10/26/2022] [Indexed: 05/27/2023]
Abstract
Purpose To determine whether photon-counting CT (PCCT) acquisition of whole-body CT images provides similar quantitative image quality and reader satisfaction for multiple myeloma screening at lower radiation doses than does standard energy-integrating detector (EID) CT. Materials and Methods Patients with monoclonal gammopathy of undetermined significance prospectively underwent clinical noncontrast whole-body CT with EID and same-day PCCT (August-December 2021). Five axial scan locations were evaluated by seven radiologists, with 11% (eight of 70) of images including osteolytic lesions. Images were shown in randomized order, and each reader rated the following: discernibility of the osseous cortex and osseous trabeculae, perceived image noise level, and diagnostic confidence. Presence of lytic osseous lesions was indicated. Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were calculated. Comparisons were made using paired t tests and mixed linear effects models. Results Seven participants (four women) were included (mean age, 66 years ± 9 [SD]; body mass index, 30.1 kg/m2 ± 5.2). Mean cortical definition, trabecular definition, image noise, and image quality scores were 83, 67, 75, and 78 versus 84, 66, 74, and 76 for EID and PCCT, respectively (P = .65, .11, .26, and .11, respectively). PCCT helped identify more lesions (79% [22 of 28]) than did EID (64% [18 of 28]). CNRs and SNRs were similar between modalities. PCCT had lower radiation doses than EID (volume CT dose index: EID, 11.37 ± 2.8 vs PCCT, 1.8 ± 0.6 [P = .06]; dose-length product: EID, 1654.1 ± 409.6 vs PCCT, 253.4 ± 89.6 [P = .05]). Conclusion This pilot investigation suggests that PCCT affords similar quantitative and qualitative scores as EID at significantly lower radiation doses. Keywords: CT, CT-Spectral, Skeletal-Axial, Spine, Hematologic Diseases, Whole-Body Imaging, Comparative Studies Supplemental material is available for this article. © RSNA, 2022.
Collapse
|
25
|
van der Werf NR, Booij R, Greuter MJW, Bos D, van der Lugt A, Budde RPJ, van Straten M. Reproducibility of coronary artery calcium quantification on dual-source CT and dual-source photon-counting CT: a dynamic phantom study. Int J Cardiovasc Imaging 2022; 38:1613-1619. [PMID: 35113282 PMCID: PMC11142942 DOI: 10.1007/s10554-022-02540-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/24/2022] [Indexed: 12/19/2022]
Abstract
To systematically compare coronary artery calcium (CAC) quantification between conventional computed tomography (CT) and photon-counting CT (PCCT) at different virtual monoenergetic (monoE) levels for different heart rates. A dynamic (heart rates of 0, < 60, 60-75, and > 75 bpm) anthropomorphic phantom with three calcification densities was scanned using routine clinical CAC protocols with CT and PCCT. In addition to the standard clinical protocol of 70 keV, PCCT images were reconstructed at monoE levels of 72, 74, and 76 keV. CAC was quantified using Agatston, volume, and mass scores. Agatston scores 95% confidence intervals (CI) were calculated and compared between PCCT and CT. Volume and mass scores were compared with physical quantities. For all CAC densities, routine clinical protocol Agatston scores of static CAC were higher for PCCT compared to CT. At < 60 bpm, Agatston scores at 74 and 76 keV reconstructions were reproducible (overlapping CI) for PCCT and CT. Increased heart rates yielded different Agatston scores for PCCT in comparison with CT, for all monoE levels. Low density CAC volume scores showed the largest deviation from physical volume, with mean deviations of 59% and 77% for CT and PCCT, respectively. Overall, mass scores underestimated physical mass by 10%, 38%, and 59% for low, medium, and high density CAC, respectively. PCCT allows for reproducible Agatston scores for dynamic CAC (< 60 bpm) when reconstructed at monoE levels of 74 or 76 keV, regardless of CAC density. Deviations from physical volume and mass were, in general, large for both CT and PCCT.
Collapse
Affiliation(s)
- Niels R van der Werf
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Ronald Booij
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marcel J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Daniel Bos
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A van der Lugt
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - R P J Budde
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marcel van Straten
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
26
|
van der Werf NR, Rodesch PA, Si-Mohamed S, van Hamersvelt RW, Greuter MJW, Leiner T, Boussel L, Willemink MJ, Douek P. Improved coronary calcium detection and quantification with low-dose full field-of-view photon-counting CT: a phantom study. Eur Radiol 2022; 32:3447-3457. [PMID: 34997284 DOI: 10.1007/s00330-021-08421-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 08/31/2021] [Accepted: 10/17/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of the current study was to systematically assess coronary artery calcium (CAC) detection and quantification for spectral photon-counting CT (SPCCT) in comparison to conventional CT and, in addition, to evaluate the possibility of radiation dose reduction. METHODS Routine clinical CAC CT protocols were used for data acquisition and reconstruction of two CAC containing cylindrical inserts which were positioned within an anthropomorphic thorax phantom. In addition, data was acquired at 50% lower radiation dose by reducing tube current, and slice thickness was decreased. Calcifications were considered detectable when three adjacent voxels exceeded the CAC scoring threshold of 130 Hounsfield units (HU). Quantification of CAC (as volume and mass score) was assessed by comparison with known physical quantities. RESULTS In comparison with CT, SPCCT detected 33% and 7% more calcifications for the small and large phantoms, respectively. At reduced radiation dose and reduced slice thickness, small phantom CAC detection increased by 108% and 150% for CT and SPCCT, respectively. For the large phantom size, noise levels interfered with CAC detection. Although comparable between CT and SPCCT, routine protocols CAC quantification showed large deviations (up to 134%) from physical CAC volume. At reduced radiation dose and slice thickness, physical volume overestimations decreased to 96% and 72% for CT and SPCCT, respectively. In comparison with volume scores, mass score deviations from physical quantities were smaller. CONCLUSION CAC detection on SPCCT is superior to CT, and was even preserved at a reduced radiation dose. Furthermore, SPCCT allows for improved physical volume estimation. KEY POINTS • In comparison with conventional CT, increased coronary artery calcium detection (up to 156%) for spectral photon-counting CT was found, even at 50% radiation dose reduction. • Spectral photon-counting CT can more accurately measure physical volumes than conventional CT, especially at reduced slice thickness and for high-density coronary artery calcium. • For both conventional and spectral photon-counting CT, reduced slice thickness reconstructions result in more accurate physical mass approximation.
Collapse
Affiliation(s)
- N R van der Werf
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - P A Rodesch
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| | - S Si-Mohamed
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| | - R W van Hamersvelt
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Boussel
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| | - M J Willemink
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - P Douek
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| |
Collapse
|
27
|
Skoog S, Henriksson L, Gustafsson H, Sandstedt M, Elvelind S, Persson A. Comparison of the Agatston score acquired with photon-counting detector CT and energy-integrating detector CT: ex vivo study of cadaveric hearts. Int J Cardiovasc Imaging 2022; 38:1145-1155. [PMID: 34988781 PMCID: PMC11142966 DOI: 10.1007/s10554-021-02494-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/10/2021] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to compare the correlation and agreement between AS derived from either an energy-integrating detector CT (EID-CT) or a photon-counting detector CT (PCD-CT). Reproducibility was also compared. In total, 26 calcified coronary lesions (from five cadaveric hearts) were identified for inclusion. The hearts were positioned in a chest phantom and scanned in both an EID-CT and a prototype PCD-CT. The EID-CT and PCD-CT acquisition and reconstruction parameters were matched. To evaluate the reproducibility, the phantom was manually repositioned, and an additional scan was performed using both methods. The EID-CT reconstructions were performed using the dedicated calcium score kernel Sa36. The PCD-CT reconstructions were performed with a vendor-recommended kernel (Qr36). Several monoenergetic energy levels (50-150 keV) were evaluated to find the closest match with the EID-CT scans. A semi-automatic evaluation of calcium score was performed on a post-processing multimodality workplace. The best match with Sa36 was PCD-CT Qr36 images, at a monoenergetic level of 72 keV. Statistical analyses showed excellent correlation and agreement. The correlation and agreement with regards to the Agatston score (AS) between the two methods, for each position as well as between the two positions for each method, were assessed with the Spearman´s rank correlation. The correlation coefficient, rho, was 0.98 and 0.97 respectively 0.99 and 0.98. The corresponding agreements were investigated by means of Bland-Altman plots. High correlation and agreement was observed between the AS derived from the EID-CT and a PCD-CT. Both methods also demonstrated excellent reproducibility.
Collapse
Affiliation(s)
- Susann Skoog
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, 581 85, Linköping, Sweden.
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Lilian Henriksson
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, 581 85, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Håkan Gustafsson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Medical Radiation Physics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mårten Sandstedt
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, 581 85, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Sebastian Elvelind
- Department of Clinical Pathology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anders Persson
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, 581 85, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| |
Collapse
|
28
|
Tortora M, Gemini L, D’Iglio I, Ugga L, Spadarella G, Cuocolo R. Spectral Photon-Counting Computed Tomography: A Review on Technical Principles and Clinical Applications. J Imaging 2022; 8:jimaging8040112. [PMID: 35448239 PMCID: PMC9029331 DOI: 10.3390/jimaging8040112] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 01/01/2023] Open
Abstract
Photon-counting computed tomography (CT) is a technology that has attracted increasing interest in recent years since, thanks to new-generation detectors, it holds the promise to radically change the clinical use of CT imaging. Photon-counting detectors overcome the major limitations of conventional CT detectors by providing very high spatial resolution without electronic noise, providing a higher contrast-to-noise ratio, and optimizing spectral images. Additionally, photon-counting CT can lead to reduced radiation exposure, reconstruction of higher spatial resolution images, reduction of image artifacts, optimization of the use of contrast agents, and create new opportunities for quantitative imaging. The aim of this review is to briefly explain the technical principles of photon-counting CT and, more extensively, the potential clinical applications of this technology.
Collapse
Affiliation(s)
- Mario Tortora
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (M.T.); (L.G.); (I.D.); (L.U.); (G.S.)
| | - Laura Gemini
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (M.T.); (L.G.); (I.D.); (L.U.); (G.S.)
| | - Imma D’Iglio
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (M.T.); (L.G.); (I.D.); (L.U.); (G.S.)
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (M.T.); (L.G.); (I.D.); (L.U.); (G.S.)
| | - Gaia Spadarella
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (M.T.); (L.G.); (I.D.); (L.U.); (G.S.)
| | - Renato Cuocolo
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende 43, 84081 Baronissi, Italy
- Correspondence:
| |
Collapse
|
29
|
Mergen V, Higashigaito K, Allmendinger T, Manka R, Euler A, Alkadhi H, Eberhard M. Tube voltage-independent coronary calcium scoring on a first-generation dual-source photon-counting CT-a proof-of-principle phantom study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:905-912. [PMID: 34780012 DOI: 10.1007/s10554-021-02466-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
To evaluate the accuracy of coronary artery calcium (CAC) scoring at various tube voltages and different monoenergetic image reconstructions on a first-generation dual-source photon-counting detector CT (PCD-CT). A commercially available anthropomorphic chest phantom with calcium inserts was scanned at different tube voltages (90 kV, Sn100kV, 120 kV, and Sn140kV) on a first-generation dual-source PCD-CT system with quantum technology using automatic exposure control with an image quality (IQ) level of 20. The same phantom was also scanned on a conventional energy-integrating detector CT (120 kV; weighted filtered back projection) for reference. Extension rings were used to emulate different patient sizes. Virtual monoenergetic images at 65 keV and 70 keV applying different levels of quantum iterative reconstruction (QIR) were reconstructed from the PCD-CT data sets. CAC scores were determined and compared to the reference. Radiation doses were noted. At an IQ level of 20, radiation doses ranged between 1.18 mGy and 4.64 mGy, depending on the tube voltage and phantom size. Imaging at 90 kV or Sn100kV was associated with a size-dependent radiation dose reduction between 23% and 48% compared to 120 kV. Tube voltage adapted image reconstructions with 65 keV and QIR 3 at 90 kV and with 70 keV and QIR 1 at Sn100kV allowed to calculate CAC scores comparable to conventional EID-CT scans with a percentage deviation of ≤ 5% for all phantom sizes. Our phantom study indicates that CAC scoring with dual-source PCD-CT is accurate at various tube voltages, offering the possibility of substantial radiation dose reduction.
Collapse
Affiliation(s)
- V Mergen
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - K Higashigaito
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | | | - R Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A Euler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - H Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - M Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| |
Collapse
|
30
|
Yaros K, Eksi B, Chandra A, Agusala K, Lehmann LH, Zaha Vlad G. Cardio-oncology imaging tools at the translational interface. J Mol Cell Cardiol 2022; 168:24-32. [DOI: 10.1016/j.yjmcc.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/03/2022] [Accepted: 03/27/2022] [Indexed: 10/18/2022]
|
31
|
Coronary Computed Tomography Angiography-Based Calcium Scoring: In Vitro and In Vivo Validation of a Novel Virtual Noniodine Reconstruction Algorithm on a Clinical, First-Generation Dual-Source Photon Counting-Detector System. Invest Radiol 2022; 57:536-543. [PMID: 35318969 DOI: 10.1097/rli.0000000000000868] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate coronary computed tomography angiography (CCTA)-based in vitro and in vivo coronary artery calcium scoring (CACS) using a novel virtual noniodine reconstruction (PureCalcium) on a clinical first-generation photon-counting detector-computed tomography system compared with virtual noncontrast (VNC) reconstructions and true noncontrast (TNC) acquisitions. MATERIALS AND METHODS Although CACS and CCTA are well-established techniques for the assessment of coronary artery disease, they are complementary acquisitions, translating into increased scan time and patient radiation dose. Hence, accurate CACS derived from a single CCTA acquisition would be highly desirable. In this study, CACS based on PureCalcium, VNC, and TNC, reconstructions was evaluated in a CACS phantom and in 67 patients (70 [59/80] years, 58.2% male) undergoing CCTA on a first-generation photon counting detector-computed tomography system. Coronary artery calcium scores were quantified for the 3 reconstructions and compared using Wilcoxon test. Agreement was evaluated by Pearson and Spearman correlation and Bland-Altman analysis. Classification of coronary artery calcium score categories (0, 1-10, 11-100, 101-400, and >400) was compared using Cohen κ. RESULTS Phantom studies demonstrated strong agreement between CACSPureCalcium and CACSTNC (60.7 ± 90.6 vs 67.3 ± 88.3, P = 0.01, r = 0.98, intraclass correlation [ICC] = 0.98; mean bias, 6.6; limits of agreement [LoA], -39.8/26.6), whereas CACSVNC showed a significant underestimation (42.4 ± 75.3 vs 67.3 ± 88.3, P < 0.001, r = 0.94, ICC = 0.89; mean bias, 24.9; LoA, -87.1/37.2). In vivo comparison confirmed a high correlation but revealed an underestimation of CACSPureCalcium (169.3 [0.7/969.4] vs 232.2 [26.5/1112.2], P < 0.001, r = 0.97, ICC = 0.98; mean bias, -113.5; LoA, -470.2/243.2). In comparison, CACSVNC showed a similarly high correlation, but a substantially larger underestimation (24.3 [0/272.3] vs 232.2 [26.5/1112.2], P < 0.001, r = 0.97, ICC = 0.54; mean bias, -551.6; LoA, -2037.5/934.4). CACSPureCalcium showed superior agreement of CACS classification (κ = 0.88) than CACSVNC (κ = 0.60). CONCLUSIONS The accuracy of CACS quantification and classification based on PureCalcium reconstructions of CCTA outperforms CACS derived from VNC reconstructions.
Collapse
|
32
|
Si-Mohamed SA, Boccalini S, Lacombe H, Diaw A, Varasteh M, Rodesch PA, Dessouky R, Villien M, Tatard-Leitman V, Bochaton T, Coulon P, Yagil Y, Lahoud E, Erhard K, Riche B, Bonnefoy E, Rioufol G, Finet G, Bergerot C, Boussel L, Greffier J, Douek PC. Coronary CT Angiography with Photon-counting CT: First-In-Human Results. Radiology 2022; 303:303-313. [PMID: 35166583 DOI: 10.1148/radiol.211780] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Spatial resolution, soft-tissue contrast, and dose-efficient capabilities of photon-counting CT (PCCT) potentially allow a better quality and diagnostic confidence of coronary CT angiography (CCTA) in comparison to conventional CT. Purpose To compare the quality of CCTA scans obtained with a clinical prototype PCCT system and an energy-integrating detector (EID) dual-layer CT (DLCT) system. Materials and Methods In this prospective board-approved study with informed consent, participants with coronary artery disease underwent retrospective electrocardiographically gated CCTA with both systems after injection of 65-75 mL of 400 mg/mL iodinated contrast agent at 5 mL/sec. A prior phantom task-based quality assessment of the detectability index of coronary lesions was performed. Ultra-high-resolution parameters were used for PCCT (1024 matrix, 0.25-mm section thickness) and EID DLCT (512 matrix, 0.67-mm section thickness). Three cardiac radiologists independently performed a blinded analysis using a five-point quality score (1 = insufficient, 5 = excellent) for overall image quality, diagnostic confidence, and diagnostic quality of calcifications, stents, and noncalcified plaques. A logistic regression model, adjusted for radiologists, was used to evaluate the proportion of improvement in scores with the best method. Results Fourteen consecutive participants (12 men; mean age, 61 years ± 17) were enrolled. Scores of overall quality and diagnostic confidence were higher with PCCT images with a median of 5 (interquartile range [IQR], 2) and 5 (IQR, 1) versus 4 (IQR, 1) and 4 (IQR, 3) with EID DLCT images, using a mean tube current of 255 mAs ± 0 versus 349 mAs ± 111 for EID DLCT images (P < .01). Proportions of improvement with PCCT images for quality of calcification, stent, and noncalcified plaque were 100%, 92% (95% CI: 71, 98), and 45% (95% CI: 28, 63), respectively. In the phantom study, detectability indexes were 2.3-fold higher for lumen and 2.9-fold higher for noncalcified plaques with PCCT images. Conclusion Coronary CT angiography with a photon-counting CT system demonstrated in humans an improved image quality and diagnostic confidence compared with an energy-integrating dual-layer CT. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Sandfort and Bluemke in this issue.
Collapse
Affiliation(s)
- Salim A Si-Mohamed
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Sara Boccalini
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Hugo Lacombe
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Adja Diaw
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Mohammad Varasteh
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Pierre-Antoine Rodesch
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Riham Dessouky
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Marjorie Villien
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Valérie Tatard-Leitman
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Thomas Bochaton
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Philippe Coulon
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Yoad Yagil
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Elias Lahoud
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Klaus Erhard
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Benjamin Riche
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Eric Bonnefoy
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Gilles Rioufol
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Gerard Finet
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Cyrille Bergerot
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Loic Boussel
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Joel Greffier
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| | - Philippe C Douek
- From the University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France (S.A.S.M., S.B., H.L., A.D., M. Varasteh, P.A.R., V.T.L., L.B., P.C.D.); Departments of Radiology (S.A.S.M., S.B., L.B., P.C.D.) and Cardiology (T.B., E.B., G.R., G.F., C.B.), Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); Philips Healthcare, Suresnes, France (M Villien, P.C.); Philips Healthcare, Haifa, Israel (Y.Y., E.L.); Philips Healthcare, Hamburg, Germany (K.E.); Public Health Center, Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France (B.R.); Department of Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, CNRS, UMR 5558, Villeurbanne, France (B.R.); and Department of Medical Imaging, CHU Nimes, University Montpellier, Nimes Medical Imaging Group, EA 2992, Montpellier, France (J.G.)
| |
Collapse
|
33
|
Koopman MY, Willemsen RTA, van der Harst P, van Bruggen R, Gratama JWC, Braam R, van Ooijen PMA, Doggen CJM, Dinant GJ, Kietselaer B, Vliegenthart R. The Diagnostic and Prognostic Value of Coronary Calcium Scoring in Stable Chest Pain Patients: A Narrative Review. ROFO-FORTSCHR RONTG 2022; 194:257-265. [PMID: 35081649 PMCID: PMC8837467 DOI: 10.1055/a-1662-5711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background
Non-contrast computed tomography (CT) scanning allows for reliable coronary calcium score (CCS) calculation at a low radiation dose and has been well established as marker to assess the future risk of coronary artery disease (CAD) events in asymptomatic individuals. However, the diagnostic and prognostic value in symptomatic patients remains a matter of debate. This narrative review focuses on the available evidence for CCS in patients with stable chest pain complaints.
Method
PubMed, Embase, and Web of Science were searched for literature using search terms related to three overarching categories: CT, symptomatic chest pain patients, and coronary calcium. The search resulted in 42 articles fulfilling the inclusion and exclusion criteria: 27 articles (n = 38 137 patients) focused on diagnostic value and 23 articles (n = 44 683 patients) on prognostic value of CCS. Of these, 10 articles (n = 21 208 patients) focused on both the diagnostic and prognostic value of CCS.
Results
Between 22 and 10 037 patients were included in the studies on the diagnostic and prognostic value of CCS, including 43 % and 51 % patients with CCS 0. The most evidence is available for patients with a low and intermediate pre-test probability (PTP) of CAD. Overall, the prevalence of obstructive CAD (OCAD, defined as a luminal stenosis of ≥ 50 % in any of the coronary arteries) as determined with CT coronary angiography in CCS 0 patients, was 4.4 % (n = 703/16 074) with a range of 0–26 % in individual studies. The event rate for major adverse cardiac events (MACE) ranged from 0 % to 2.1 % during a follow-up of 1.6 to 6.8 years, resulting in a high negative predictive value for MACE between 98 % and 100 % in CCS 0 patients. At increasing CCS, the OCAD probability and MACE risk increased. OCAD was present in 58.3 % (n = 617/1058) of CCS > 400 patients with percentages ranging from 20 % to 94 % and MACE occurred in 16.7 % (n = 175/1048) of these patients with percentages ranging from 6.9 % to 50 %.
Conclusion
Accumulating evidence shows that OCAD is unlikely and the MACE risk is very low in symptomatic patients with CCS 0, especially in those with low and intermediate PTPs. This suggests a role of CCS as a gatekeeper for additional diagnostic testing. Increasing CCS is related to an increasing probability of OCAD and risk of cardiac events. Additional research is needed to assess the value of CCS in women and patient management in a primary healthcare setting.
Key Points:
Citation Format
Collapse
Affiliation(s)
| | | | - Pim van der Harst
- Cardiology, University Medical Centre Utrecht Department of Cardiology, Utrecht, Netherlands.,Division Heart and Lungs, University Medical Centre Groningen, Netherlands
| | - Rykel van Bruggen
- Primary Health Care, Multicenter General Practitioners Organisation "HuisartsenOrganisatie Oost-Gelderland", Apeldoorn, Netherlands
| | | | | | - Peter M A van Ooijen
- Data Science Center in Health, University Medical Centre Groningen, Netherlands.,Radiation Oncology, University Medical Centre Groningen, Netherlands
| | - Carine J M Doggen
- Health Technology & Services Research, Techmed Centre, University of Twente, Enschede, Netherlands
| | | | - Bas Kietselaer
- Cardiology, Zuyderland Medical Centre Sittard-Geleen, Netherlands
| | | |
Collapse
|
34
|
Inkinen SI, Juntunen MAK, Ketola J, Korhonen K, Sepponen P, Kotiaho A, Pohjanen VM, Nieminen M. Virtual monochromatic imaging reduces beam hardening artefacts in cardiac interior photon counting computed tomography: a phantom study with cadaveric specimens. Biomed Phys Eng Express 2021; 8. [PMID: 34911047 DOI: 10.1088/2057-1976/ac4397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/15/2021] [Indexed: 11/11/2022]
Abstract
In interior cardiac computed tomography (CT) imaging, the x-ray beam is collimated to a limited field-of-view covering the heart volume, which decreases the radiation exposure to surrounding tissues. Spectral CT enables the creation of virtual monochromatic images (VMIs) through a computational material decomposition process. This study investigates the utility of VMIs for beam hardening (BH) reduction in interior cardiac CT, and further, the suitability of VMIs for coronary artery calcium (CAC) scoring and volume assessment is studied using spectral photon counting detector CT (PCD-CT).Ex vivocoronary artery samples (N = 18) were inserted in an epoxy rod phantom. The rod was scanned in the conventional CT geometry, and subsequently, the rod was positioned in a torso phantom and re-measured in the interior PCD-CT geometry. The total energy (TE) 10-100 keV reconstructions from PCD-CT were used as a reference. The low energy 10-60 keV and high energy 60-100 keV data were used to perform projection domain material decomposition to polymethyl methacrylate and calcium hydroxylapatite basis. The truncated basis-material sinograms were extended using the adaptive detruncation method. VMIs from 30-180 keV range were computed from the detruncated virtual monochromatic sinograms using filtered back projection. Detrending was applied as a post-processing method prior to CAC scoring. The results showed that BH artefacts from the exterior structures can be suppressed with high (≥100 keV) VMIs. With appropriate selection of the monoenergy (46 keV), the underestimation trend of CAC scores and volumes shown in Bland-Altman (BA) plots for TE interior PCD-CT was mitigated, as the BA slope values were -0.02 for the 46 keV VMI compared to -0.21 the conventional TE image. To conclude, spectral PCD-CT imaging using VMIs could be applied to reduce BH artefacts interior CT geometry, and further, optimal selection of VMI may improve the accuracy of CAC scoring assessment in interior PCD-CT.
Collapse
Affiliation(s)
- Satu I Inkinen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Mikael A K Juntunen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Oulu University Hospital, Department of Diagnostic Radiology, Oulu, Finland
| | - Juuso Ketola
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,The South Savo Social and Health Care Authority, Mikkeli Central Hospital, Mikkeli, Finland
| | - Kristiina Korhonen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Pasi Sepponen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Antti Kotiaho
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Oulu University Hospital, Department of Diagnostic Radiology, Oulu, Finland
| | - Vesa-Matti Pohjanen
- Cancer and Translational Medicine Research Unit, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Miika Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Oulu University Hospital, Department of Diagnostic Radiology, Oulu, Finland
| |
Collapse
|
35
|
Petritsch B, Petri N, Weng AM, Petersilka M, Allmendinger T, Bley TA, Gassenmaier T. Photon-Counting Computed Tomography for Coronary Stent Imaging: In Vitro Evaluation of 28 Coronary Stents. Invest Radiol 2021; 56:653-660. [PMID: 33867450 DOI: 10.1097/rli.0000000000000787] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to assess in-stent lumen visibility and quantitative image characteristics of different coronary stents using a novel photon-counting detector (PCD) computed tomography (CT) system in comparison to a state-of-the-art energy-integrating detector (EID) CT scanner. MATERIALS AND METHODS In this in vitro phantom study, 28 different coronary stents ranging from 2.25 to 4.5 mm lumen diameter were expanded into plastic tubes filled with contrast agent. Stent-containing plastic tubes were positioned in a custom-made emulsion-filled phantom, which was inserted into an anthropomorphic phantom simulating a medium-sized patient. Computed tomography scans were acquired parallel to the scanners' z axis using a novel cadmium telluride-based PCD CT system (SOMATOM CountPlus; Siemens Healthcare GmbH, Forchheim Germany), operating in 2 different modes (standard-resolution mode [SR] and ultra-high-resolution [UHR] mode), and a latest generation dual-source EID CT system (SOMATOM Force; Siemens Healthcare GmbH, Forchheim). CTDIvol-matched images were reconstructed with comparable convolution kernels and using the same reconstruction parameters. In-stent lumen visibility (in %), increase in in-stent attenuation (expressed as Δ in-stent CT attenuation), and image noise (in Hounsfield unit) were manually measured. Parts of the image analysis (in-stent lumen visibility) were additionally performed in an automated way. Differences were tested using Wilcoxon signed rank test. RESULTS The best in-stent lumen visibility was achieved with the PCD-UHR mode and the lowest noise levels with the PCD-SR mode. The median in-stent lumen visibility was significantly higher (P < 0.001) with PCD (SR, 66.7%; interquartile range [IQR], 63.3-72.3; UHR, 68.9%; IQR, 64.4-74.4) compared with EID (65.4%; IQR, 62.2-70.4). The Δ in-stent CT attenuation was significantly lower for PCD in both SR (78 HU; IQR, 46-108; P = 0.024) and UHR (85 HU; IQR, 59-113; P = 0.006) compared with EID (108 HU; IQR, 85-126). Image noise was significantly lower (P < 0.001) for PCD-SR (21 HU; IQR, 21-21) compared with EID images (25 HU; IQR, 24-25.0). CONCLUSIONS The PCD provides superior in-stent lumen visibility and quantitative image characteristics when compared with conventional EID.
Collapse
Affiliation(s)
| | - Nils Petri
- Internal Medicine I, University Hospital Würzburg, Würzburg
| | - Andreas M Weng
- From the Departments of Diagnostic and Interventional Radiology
| | | | | | - Thorsten A Bley
- From the Departments of Diagnostic and Interventional Radiology
| | | |
Collapse
|
36
|
Coronary Calcium Scoring with First Generation Dual-Source Photon-Counting CT-First Evidence from Phantom and In-Vivo Scans. Diagnostics (Basel) 2021; 11:diagnostics11091708. [PMID: 34574049 PMCID: PMC8466604 DOI: 10.3390/diagnostics11091708] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 01/09/2023] Open
Abstract
We evaluated the accuracy of coronary artery calcium (CAC) scoring on a dual-source photon-counting detector CT (PCD-CT). An anthropomorphic chest phantom underwent ECG-gated sequential scanning on a PCD-CT at 120 kV with four radiation dose levels (CTDIvol, 2.0–8.6 mGy). Polychromatic images at 120 kV (T3D) and virtual monoenergetic images (VMI), from 60 to 75 keV without quantum iterative reconstruction (no QIR) and QIR strength levels 1–4, were reconstructed. For reference, the same phantom was scanned on a conventional energy-integrating detector CT (120 kV; filtered back projection) at identical radiation doses. CAC scoring in 20 patients with PCD-CT (120 kV; no QIR and QIR 1–4) were included. In the phantom, there were no differences between CAC scores of different radiation doses (all, p > 0.05). Images with 70 keV, no QIR (CAC score, 649); 65 keV, QIR 3 (656); 65 keV; QIR4 (648) and T3D, QIR4 (656) showed a <1% deviation to the reference (653). CAC scores significantly decreased at increasing QIR levels (all, p < 0.001) and for each 5 keV-increase (all, p < 0.001). Patient data (median CAC score: 86 [inter-quartile range: 38–978] at 70 keV) confirmed relationships and differences between reconstructions from the phantom. First phantom and in-vivo experience with a clinical dual-source PCD-CT system shows accurate CAC scoring with VMI reconstructions at different radiation dose levels.
Collapse
|
37
|
Juntunen MAK, Kotiaho AO, Nieminen MT, Inkinen SI. Optimizing iterative reconstruction for quantification of calcium hydroxyapatite with photon counting flat-detector computed tomography: a cardiac phantom study. J Med Imaging (Bellingham) 2021; 8:052102. [PMID: 33718518 PMCID: PMC7946398 DOI: 10.1117/1.jmi.8.5.052102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 01/28/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose: Coronary artery calcium (CAC) scoring with computed tomography (CT) has been proposed as a screening tool for coronary artery disease, but concerns remain regarding the radiation dose of CT CAC scoring. Photon counting detectors and iterative reconstruction (IR) are promising approaches for patient dose reduction, yet the preservation of CAC scores with IR has been questioned. The purpose of this study was to investigate the applicability of IR for quantification of CAC using a photon counting flat-detector. Approach: We imaged a cardiac rod phantom with calcium hydroxyapatite (CaHA) inserts with different noise levels using an experimental photon counting flat-detector CT setup to simulate the clinical CAC scoring protocol. We applied filtered back projection (FBP) and two IR algorithms with different regularization strengths. We compared the air kerma values, image quality parameters [noise magnitude, noise power spectrum, modulation transfer function (MTF), and contrast-to-noise ratio], and CaHA quantification accuracy between FBP and IR. Results: IR regularization strength influenced CAC scores significantly ( p < 0.05 ). The CAC volumes and scores between FBP and IRs were the most similar when the IR regularization strength was chosen to match the MTF of the FBP reconstruction. Conclusion: When the regularization strength is selected to produce comparable spatial resolution with FBP, IR can yield comparable CAC scores and volumes with FBP. Nonetheless, at the lowest radiation dose setting, FBP produced more accurate CAC volumes and scores compared to IR, and no improved CAC scoring accuracy at low dose was demonstrated with the utilized IR methods.
Collapse
Affiliation(s)
- Mikael A. K. Juntunen
- University of Oulu, Research Unit of Medical Imaging, Physics, and Technology, Oulu, Finland
- Oulu University Hospital, Department of Diagnostic Radiology, Oulu, Finland
| | - Antti O. Kotiaho
- Oulu University Hospital, Department of Diagnostic Radiology, Oulu, Finland
| | - Miika T. Nieminen
- University of Oulu, Research Unit of Medical Imaging, Physics, and Technology, Oulu, Finland
- Oulu University Hospital, Department of Diagnostic Radiology, Oulu, Finland
- Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Satu I. Inkinen
- University of Oulu, Research Unit of Medical Imaging, Physics, and Technology, Oulu, Finland
| |
Collapse
|
38
|
Sartoretti T, Eberhard M, Nowak T, Gutjahr R, Jost G, Pietsch H, Schmidt B, Flohr T, Alkadhi H, Euler A. Photon-Counting Multienergy Computed Tomography With Spectrally Optimized Contrast Media for Plaque Removal and Stenosis Assessment. Invest Radiol 2021; 56:563-570. [PMID: 33660630 DOI: 10.1097/rli.0000000000000773] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to systematically evaluate the potential to combine investigational contrast media with spectrally optimized energy-thresholding of photon-counting detector computed tomography (PCCT) for subtraction of calcified plaques in a coronary artery stenosis phantom. METHODS A small vessel phantom containing 3 fillable tubes (diameter, 3 mm each) with calcified plaques was placed into an anthropomorphic chest phantom. The plaques had incremental thicknesses ranging from 0.3 to 2.7 mm, simulating vessel stenoses ranging from 10% to 90% of the lumen diameter. The phantom was filled with 5 different investigational contrast media (iodine, bismuth, hafnium, holmium, and tungsten) at equal mass concentrations (15 mg/mL) and was imaged on a prototype PCCT at 140 kVp using optimized, contrast media-dependent energy thresholds. Contrast maps (CMs) were reconstructed for each contrast medium by applying a linear 2-material decomposition algorithm. Image noise magnitude and noise texture of CM were compared among the contrast media using the noise power spectrum. Two blinded readers independently rated the vessel lumen visualization on short-axis and the overall subjective image quality on long-axis CM relative to iodine as the reference standard. Four readers determined the highest degree of stenosis that could be assessed with high diagnostic confidence on long-axis CM. RESULTS Average image noise on CM was lower for tungsten (49 HU) and hafnium (62 HU) and higher for bismuth (81 HU) and holmium (165 HU) compared with iodine (78 HU). Noise texture of CM was similar among the contrast media. Interreader agreement for vessel lumen visualization on short-axis CM ranged from moderate to excellent (k = 0.567-0.814). Compared with iodine, lumen visualization of each reader was improved using tungsten (P < 0.001 for both readers), similar to improved using hafnium (P = 0.008, P = 0.29), similar using bismuth (P = 0.38, P = 0.69), and decreased using holmium (both, P < 0.001). Overall subjective image quality was similar for holmium and superior for tungsten, hafnium, and bismuth as compared with iodine. Higher-degree stenoses were evaluable with high confidence using tungsten (mean, 70%; interquartile range, 70%-70%), bismuth (70%; 60%-70%), and hafnium (75%; 70%-80%) compared with iodine (50%; 50%-60%) and holmium (50%; 50%-60%). CONCLUSIONS Spectral optimization in PCCT combined with investigational contrast media can improve calcium subtraction and stenosis assessment in small vessels. Contrast maps of tungsten and, to a lesser extent, hafnium as contrast media yielded superior image noise properties and improved vessel lumen visualization, along with a higher subjective image quality compared with the reference standard iodine.
Collapse
Affiliation(s)
- Thomas Sartoretti
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Eberhard
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | - Hatem Alkadhi
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - André Euler
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
39
|
van der Werf NR, Si-Mohamed S, Rodesch PA, van Hamersvelt RW, Greuter MJW, Boccalini S, Greffier J, Leiner T, Boussel L, Willemink MJ, Douek P. Coronary calcium scoring potential of large field-of-view spectral photon-counting CT: a phantom study. Eur Radiol 2021; 32:152-162. [PMID: 34255159 PMCID: PMC8660747 DOI: 10.1007/s00330-021-08152-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/05/2021] [Accepted: 06/14/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of the current study was, first, to assess the coronary artery calcium (CAC) scoring potential of spectral photon-counting CT (SPCCT) in comparison with computed tomography (CT) for routine clinical protocols. Second, improved CAC detection and quantification at reduced slice thickness were assessed. METHODS Raw data was acquired and reconstructed with several combinations of reduced slice thickness and increasing strengths of iterative reconstruction (IR) for both CT systems with routine clinical CAC protocols for CT. Two CAC-containing cylindrical inserts, consisting of CAC of different densities and sizes, were placed in an anthropomorphic phantom. A specific CAC was detectable when 3 or more connected voxels exceeded the CAC scoring threshold of 130 Hounsfield units (HU). For all reconstructions, total CAC detectability was compared between both CT systems. Significant differences in CAC quantification (Agatston and volume scores) were assessed with Mann-Whitney U tests. Furthermore, volume scores were compared with the known CAC physical. RESULTS CAC scores for routine clinical protocols were comparable between SPCCT and CT. SPCCT showed 34% and 4% higher detectability of CAC for the small and large phantom, respectively. At reduced slice thickness, CAC detection increased by 142% and 169% for CT and SPCCT, respectively. In comparison with CT, volume scores from SPCCT were more comparable with the physical volume of the CAC. CONCLUSION CAC scores using routine clinical protocols are comparable between conventional CT and SPCCT. The increased spatial resolution of SPCCT allows for increased detectability and more accurate CAC volume estimation. KEY POINTS • Coronary artery calcium scores using routine clinical protocols are comparable between conventional CT and spectral photon-counting CT. • In comparison with conventional CT, increased coronary artery calcium detectability was shown for spectral photon-counting CT due to increased spatial resolution. • Volumes scores were more accurately determined with spectral photon-counting CT.
Collapse
Affiliation(s)
- Niels R van der Werf
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - S Si-Mohamed
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| | - P A Rodesch
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| | - R W van Hamersvelt
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - S Boccalini
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| | - J Greffier
- Department of medical imaging, Medical Imaging Group, Univ Montpellier, CHU Nimes, 2415, Nimes, EA, France
| | - T Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Boussel
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| | - M J Willemink
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - P Douek
- Louis Pradel Cardiology Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, France
| |
Collapse
|
40
|
Si-Mohamed SA, Sigovan M, Hsu JC, Tatard-Leitman V, Chalabreysse L, Naha PC, Garrivier T, Dessouky R, Carnaru M, Boussel L, Cormode DP, Douek PC. In Vivo Molecular K-Edge Imaging of Atherosclerotic Plaque Using Photon-counting CT. Radiology 2021; 300:98-107. [PMID: 33944628 PMCID: PMC8217298 DOI: 10.1148/radiol.2021203968] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background Macrophage burden is a major factor in the risk of atherosclerotic plaque rupture, and its evaluation remains challenging with molecular noninvasive imaging approaches. Photon-counting CT (PCCT) with k-edge imaging aims to allow for the specific detection of macrophages using gold nanoparticles. Purpose To perform k-edge imaging in combination with gold nanoparticles to detect and quantify the macrophage burden within the atherosclerotic aortas of rabbits. Materials and Methods Atherosclerotic and control New Zealand white rabbits were imaged before and at several time points up to 2 days after intravenous injection of gold nanoparticles (3.5 mL/kg, 65 mg gold per milliliter). Aortic CT angiography was performed at the end of the follow-up using an intravenous injection of an iodinated contrast material. Gold k-edge and conventional CT images were reconstructed for qualitative and quantitative assessment of the macrophage burden. PCCT imaging results were compared with findings at histologic examination, quantitative histomorphometry, transmission electron microscopy, and quantitative inductively coupled plasma optical emission spectrometry. Pearson correlations between the macrophage area measured in immunostained sections and the concentration of gold and attenuation measured in the corresponding PCCT sections were calculated. Results Seven rabbits with atherosclerosis and four control rabbits without atherosclerosis were analyzed. In atherosclerotic rabbits, calcifications were observed along the aortic wall before injection. At 2 days after injection of gold nanoparticles, only gold k-edge images allowed for the distinction of plaque enhancement within calcifications and for lumen enhancement during angiography. A good correlation was observed between the gold concentration measured within the wall and the macrophage area in 35 plaques (five per rabbit) (r = 0.82; 95% CI: 0.67, 0.91; P < .001), which was higher than that observed on conventional CT images (r = 0.41; 95% CI: 0.09, 0.65; P = .01). Transmission electron microscopy and inductively coupled plasma optical emission spectrometry analyses confirmed the gold k-edge imaging findings. Conclusion Photon-counting CT with gold nanoparticles allowed for the noninvasive evaluation of both molecular and anatomic information in vivo in rabbits with atherosclerotic plaques. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Leiner in this issue.
Collapse
Affiliation(s)
- Salim A Si-Mohamed
- From the University of Lyon, National Institute of Applied Sciences of Lyon, University Claude Bernard Lyon 1, Jean Monnet University-Saint Etienne, French National Centre for Scientific Research, Institut national de la santé et de la recherche médicale, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé Unité mixte de recherche 5220, U1206, F-69621, Lyon, France (S.A.S.M., M.S., V.T.L., R.D., L.B., P.C.D.); Departments of Radiology (S.A.S.M., T.G., L.B., P.C.D.) and Pathology (L.C.), Hospices Civils de Lyon, Lyon, France; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.C.H., P.C.N., D.P.C.); Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); and Department of Rheumatology, Allergy, and Immunology, Yale University, New Haven, Conn (M.C.)
| | - Monica Sigovan
- From the University of Lyon, National Institute of Applied Sciences of Lyon, University Claude Bernard Lyon 1, Jean Monnet University-Saint Etienne, French National Centre for Scientific Research, Institut national de la santé et de la recherche médicale, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé Unité mixte de recherche 5220, U1206, F-69621, Lyon, France (S.A.S.M., M.S., V.T.L., R.D., L.B., P.C.D.); Departments of Radiology (S.A.S.M., T.G., L.B., P.C.D.) and Pathology (L.C.), Hospices Civils de Lyon, Lyon, France; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.C.H., P.C.N., D.P.C.); Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); and Department of Rheumatology, Allergy, and Immunology, Yale University, New Haven, Conn (M.C.)
| | - Jessica C Hsu
- From the University of Lyon, National Institute of Applied Sciences of Lyon, University Claude Bernard Lyon 1, Jean Monnet University-Saint Etienne, French National Centre for Scientific Research, Institut national de la santé et de la recherche médicale, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé Unité mixte de recherche 5220, U1206, F-69621, Lyon, France (S.A.S.M., M.S., V.T.L., R.D., L.B., P.C.D.); Departments of Radiology (S.A.S.M., T.G., L.B., P.C.D.) and Pathology (L.C.), Hospices Civils de Lyon, Lyon, France; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.C.H., P.C.N., D.P.C.); Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); and Department of Rheumatology, Allergy, and Immunology, Yale University, New Haven, Conn (M.C.)
| | - Valérie Tatard-Leitman
- From the University of Lyon, National Institute of Applied Sciences of Lyon, University Claude Bernard Lyon 1, Jean Monnet University-Saint Etienne, French National Centre for Scientific Research, Institut national de la santé et de la recherche médicale, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé Unité mixte de recherche 5220, U1206, F-69621, Lyon, France (S.A.S.M., M.S., V.T.L., R.D., L.B., P.C.D.); Departments of Radiology (S.A.S.M., T.G., L.B., P.C.D.) and Pathology (L.C.), Hospices Civils de Lyon, Lyon, France; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.C.H., P.C.N., D.P.C.); Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); and Department of Rheumatology, Allergy, and Immunology, Yale University, New Haven, Conn (M.C.)
| | - Lara Chalabreysse
- From the University of Lyon, National Institute of Applied Sciences of Lyon, University Claude Bernard Lyon 1, Jean Monnet University-Saint Etienne, French National Centre for Scientific Research, Institut national de la santé et de la recherche médicale, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé Unité mixte de recherche 5220, U1206, F-69621, Lyon, France (S.A.S.M., M.S., V.T.L., R.D., L.B., P.C.D.); Departments of Radiology (S.A.S.M., T.G., L.B., P.C.D.) and Pathology (L.C.), Hospices Civils de Lyon, Lyon, France; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.C.H., P.C.N., D.P.C.); Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); and Department of Rheumatology, Allergy, and Immunology, Yale University, New Haven, Conn (M.C.)
| | - Pratap C Naha
- From the University of Lyon, National Institute of Applied Sciences of Lyon, University Claude Bernard Lyon 1, Jean Monnet University-Saint Etienne, French National Centre for Scientific Research, Institut national de la santé et de la recherche médicale, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé Unité mixte de recherche 5220, U1206, F-69621, Lyon, France (S.A.S.M., M.S., V.T.L., R.D., L.B., P.C.D.); Departments of Radiology (S.A.S.M., T.G., L.B., P.C.D.) and Pathology (L.C.), Hospices Civils de Lyon, Lyon, France; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.C.H., P.C.N., D.P.C.); Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); and Department of Rheumatology, Allergy, and Immunology, Yale University, New Haven, Conn (M.C.)
| | - Thibaut Garrivier
- From the University of Lyon, National Institute of Applied Sciences of Lyon, University Claude Bernard Lyon 1, Jean Monnet University-Saint Etienne, French National Centre for Scientific Research, Institut national de la santé et de la recherche médicale, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé Unité mixte de recherche 5220, U1206, F-69621, Lyon, France (S.A.S.M., M.S., V.T.L., R.D., L.B., P.C.D.); Departments of Radiology (S.A.S.M., T.G., L.B., P.C.D.) and Pathology (L.C.), Hospices Civils de Lyon, Lyon, France; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.C.H., P.C.N., D.P.C.); Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); and Department of Rheumatology, Allergy, and Immunology, Yale University, New Haven, Conn (M.C.)
| | - Riham Dessouky
- From the University of Lyon, National Institute of Applied Sciences of Lyon, University Claude Bernard Lyon 1, Jean Monnet University-Saint Etienne, French National Centre for Scientific Research, Institut national de la santé et de la recherche médicale, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé Unité mixte de recherche 5220, U1206, F-69621, Lyon, France (S.A.S.M., M.S., V.T.L., R.D., L.B., P.C.D.); Departments of Radiology (S.A.S.M., T.G., L.B., P.C.D.) and Pathology (L.C.), Hospices Civils de Lyon, Lyon, France; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.C.H., P.C.N., D.P.C.); Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); and Department of Rheumatology, Allergy, and Immunology, Yale University, New Haven, Conn (M.C.)
| | - Miruna Carnaru
- From the University of Lyon, National Institute of Applied Sciences of Lyon, University Claude Bernard Lyon 1, Jean Monnet University-Saint Etienne, French National Centre for Scientific Research, Institut national de la santé et de la recherche médicale, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé Unité mixte de recherche 5220, U1206, F-69621, Lyon, France (S.A.S.M., M.S., V.T.L., R.D., L.B., P.C.D.); Departments of Radiology (S.A.S.M., T.G., L.B., P.C.D.) and Pathology (L.C.), Hospices Civils de Lyon, Lyon, France; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.C.H., P.C.N., D.P.C.); Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); and Department of Rheumatology, Allergy, and Immunology, Yale University, New Haven, Conn (M.C.)
| | - Loic Boussel
- From the University of Lyon, National Institute of Applied Sciences of Lyon, University Claude Bernard Lyon 1, Jean Monnet University-Saint Etienne, French National Centre for Scientific Research, Institut national de la santé et de la recherche médicale, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé Unité mixte de recherche 5220, U1206, F-69621, Lyon, France (S.A.S.M., M.S., V.T.L., R.D., L.B., P.C.D.); Departments of Radiology (S.A.S.M., T.G., L.B., P.C.D.) and Pathology (L.C.), Hospices Civils de Lyon, Lyon, France; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.C.H., P.C.N., D.P.C.); Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); and Department of Rheumatology, Allergy, and Immunology, Yale University, New Haven, Conn (M.C.)
| | - David P Cormode
- From the University of Lyon, National Institute of Applied Sciences of Lyon, University Claude Bernard Lyon 1, Jean Monnet University-Saint Etienne, French National Centre for Scientific Research, Institut national de la santé et de la recherche médicale, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé Unité mixte de recherche 5220, U1206, F-69621, Lyon, France (S.A.S.M., M.S., V.T.L., R.D., L.B., P.C.D.); Departments of Radiology (S.A.S.M., T.G., L.B., P.C.D.) and Pathology (L.C.), Hospices Civils de Lyon, Lyon, France; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.C.H., P.C.N., D.P.C.); Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); and Department of Rheumatology, Allergy, and Immunology, Yale University, New Haven, Conn (M.C.)
| | - Philippe C Douek
- From the University of Lyon, National Institute of Applied Sciences of Lyon, University Claude Bernard Lyon 1, Jean Monnet University-Saint Etienne, French National Centre for Scientific Research, Institut national de la santé et de la recherche médicale, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé Unité mixte de recherche 5220, U1206, F-69621, Lyon, France (S.A.S.M., M.S., V.T.L., R.D., L.B., P.C.D.); Departments of Radiology (S.A.S.M., T.G., L.B., P.C.D.) and Pathology (L.C.), Hospices Civils de Lyon, Lyon, France; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.C.H., P.C.N., D.P.C.); Department of Radiology, Faculty of Medicine, Zagazig University, Egypt (R.D.); and Department of Rheumatology, Allergy, and Immunology, Yale University, New Haven, Conn (M.C.)
| |
Collapse
|
41
|
Willemink MJ, Varga-Szemes A, Schoepf UJ, Codari M, Nieman K, Fleischmann D, Mastrodicasa D. Emerging methods for the characterization of ischemic heart disease: ultrafast Doppler angiography, micro-CT, photon-counting CT, novel MRI and PET techniques, and artificial intelligence. Eur Radiol Exp 2021; 5:12. [PMID: 33763754 PMCID: PMC7991013 DOI: 10.1186/s41747-021-00207-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/22/2021] [Indexed: 12/24/2022] Open
Abstract
After an ischemic event, disruptive changes in the healthy myocardium may gradually develop and may ultimately turn into fibrotic scar. While these structural changes have been described by conventional imaging modalities mostly on a macroscopic scale-i.e., late gadolinium enhancement at magnetic resonance imaging (MRI)-in recent years, novel imaging methods have shown the potential to unveil an even more detailed picture of the postischemic myocardial phenomena. These new methods may bring advances in the understanding of ischemic heart disease with potential major changes in the current clinical practice. In this review article, we provide an overview of the emerging methods for the non-invasive characterization of ischemic heart disease, including coronary ultrafast Doppler angiography, photon-counting computed tomography (CT), micro-CT (for preclinical studies), low-field and ultrahigh-field MRI, and 11C-methionine positron emission tomography. In addition, we discuss new opportunities brought by artificial intelligence, while addressing promising future scenarios and the challenges for the application of artificial intelligence in the field of cardiac imaging.
Collapse
Affiliation(s)
- Martin J. Willemink
- grid.168010.e0000000419368956Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94035 USA
| | - Akos Varga-Szemes
- grid.259828.c0000 0001 2189 3475Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC USA
| | - U. Joseph Schoepf
- grid.259828.c0000 0001 2189 3475Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC USA
| | - Marina Codari
- grid.168010.e0000000419368956Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94035 USA
| | - Koen Nieman
- grid.168010.e0000000419368956Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA USA ,Stanford Cardiovascular Institute, Stanford, CA 94305 USA
| | - Dominik Fleischmann
- grid.168010.e0000000419368956Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94035 USA ,Stanford Cardiovascular Institute, Stanford, CA 94305 USA
| | - Domenico Mastrodicasa
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94035, USA. .,Stanford Cardiovascular Institute, Stanford, CA, 94305, USA.
| |
Collapse
|
42
|
Sandstedt M, Marsh J, Rajendran K, Gong H, Tao S, Persson A, Leng S, McCollough C. Improved coronary calcification quantification using photon-counting-detector CT: an ex vivo study in cadaveric specimens. Eur Radiol 2021; 31:6621-6630. [PMID: 33713174 DOI: 10.1007/s00330-021-07780-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/19/2021] [Accepted: 02/12/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To compare the accuracy of coronary calcium quantification of cadaveric specimens imaged from a photon-counting detector (PCD)-CT and an energy-integrating detector (EID)-CT. METHODS Excised coronary specimens were scanned on a PCD-CT scanner, using both the PCD and EID subsystems. The scanning and reconstruction parameters for EID-CT and PCD-CT were matched: 120 kV, 9.3-9.4 mGy CTDIvol, and a quantitative kernel (D50). PCD-CT images were also reconstructed using a sharper kernel (D60). Scanning the same specimens using micro-CT served as a reference standard for calcified volumes. Calcifications were segmented with a half-maximum thresholding technique. Segmented calcified volume differences were analyzed using the Friedman test and post hoc pairwise Wilcoxon signed rank test with the Bonferroni correction. Image noise measurements were compared between EID-CT and PCD-CT with a repeated-measures ANOVA test and post hoc pairwise comparison with the Bonferroni correction. A p < 0.05 was considered statistically significant. RESULTS The volume measurements in 12/13 calcifications followed a similar trend: EID-D50 > PCD-D50 > PCD-D60 > micro-CT. The median calcified volumes in EID-D50, PCD-D50, PCD-D60, and micro-CT were 22.1 (IQR 10.2-64.8), 21.0 (IQR 9.0-56.5), 18.2 (IQR 8.3-49.3), and 14.6 (IQR 5.1-42.4) mm3, respectively (p < 0.05 for all pairwise comparisons). The average image noise in EID-D50, PCD-D50, and PCD-D60 was 60.4 (± 3.5), 56.0 (± 4.2), and 113.6 (± 8.5) HU, respectively (p < 0.01 for all pairwise comparisons). CONCLUSION The PCT-CT system quantified coronary calcifications more accurately than EID-CT, and a sharp PCD-CT kernel further improved the accuracy. The PCD-CT images exhibited lower noise than the EID-CT images. KEY POINTS • High spatial resolution offered by PCD-CT reduces partial volume averaging and consequently leads to better morphological depiction of coronary calcifications. • Improved quantitative accuracy for coronary calcification volumes could be achieved using high-resolution PCD-CT compared to conventional EID-CT. • PCD-CT images exhibit lower image noise than conventional EID-CT at matched radiation dose and reconstruction kernel.
Collapse
Affiliation(s)
- Mårten Sandstedt
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jeffrey Marsh
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Hao Gong
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Shengzhen Tao
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Anders Persson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
43
|
Panetta D, Gabelloni M, Faggioni L, Pelosi G, Aringhieri G, Caramella D, Salvadori PA. Cardiac Computed Tomography Perfusion: Contrast Agents, Challenges and Emerging Methodologies from Preclinical Research to the Clinics. Acad Radiol 2021; 28:e1-e13. [PMID: 32220550 DOI: 10.1016/j.acra.2019.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 12/19/2022]
Abstract
Computed Tomography (CT) has long been regarded as a purely anatomical imaging modality. Recent advances on CT technology and Contrast Agents (CA) in both clinical and preclinical cardiac imaging offer opportunities for the use of CT in functional imaging. Combined with modern ECG-gating techniques, functional CT has now become a reality allowing a comprehensive evaluation of myocardial global and regional function, perfusion and coronary angiography. This article aims at reviewing the current status of cardiac CT perfusion and micro-CT perfusion with established and experimental scanners and contrast agents, from clinical practice to the experimental domain of investigations based on animal models of heart diseases.
Collapse
|
44
|
Sandfort V, Persson M, Pourmorteza A, Noël PB, Fleischmann D, Willemink MJ. Spectral photon-counting CT in cardiovascular imaging. J Cardiovasc Comput Tomogr 2020; 15:218-225. [PMID: 33358186 DOI: 10.1016/j.jcct.2020.12.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/13/2020] [Accepted: 12/17/2020] [Indexed: 12/18/2022]
Abstract
Photon-counting computed tomography (PCCT) is an emerging technology promising to substantially improve cardiovascular imaging. Recent engineering and manufacturing advances by several vendors are expected to imminently launch this new technology into clinical reality. Photon-counting detectors (PCDs) have multiple potential advantages over conventional energy integrating detectors (EIDs) such as the absence of electronic noise, multi-energy capability, and increased spatial resolution. These developments will have different timescales for implementation and will affect different clinical scopes. We describe the technical aspects of PCCT, explain the current developments, and finally discuss potential advantages of PCCT in cardiovascular imaging.
Collapse
Affiliation(s)
- Veit Sandfort
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mats Persson
- Department of Physics, Royal Institute of Technology, Stockholm, Sweden
| | - Amir Pourmorteza
- Department of Radiology and Imaging Sciences, Winship Cancer Institute, Emory University, Atlanta, GA, USA; Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Peter B Noël
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Martin J Willemink
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| |
Collapse
|
45
|
Kwan AC, Pourmorteza A, Stutman D, Bluemke DA, Lima JAC. Next-Generation Hardware Advances in CT: Cardiac Applications. Radiology 2020; 298:3-17. [PMID: 33201793 DOI: 10.1148/radiol.2020192791] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Impending major hardware advances in cardiac CT include three areas: ultra-high-resolution (UHR) CT, photon-counting CT, and phase-contrast CT. Cardiac CT is a particularly demanding CT application that requires a high degree of temporal resolution, spatial resolution, and soft-tissue contrast in a moving structure. In this review, cardiac CT is used to highlight the strengths of these technical advances. UHR CT improves visualization of calcified and stented vessels but may result in increased noise and radiation exposure. Photon-counting CT uses multiple photon energies to reduce artifacts, improve contrast resolution, and perform material decomposition. Finally, phase-contrast CT uses x-ray refraction properties to improve spatial and soft-tissue contrast. This review describes these hardware advances in CT and their relevance to cardiovascular imaging.
Collapse
Affiliation(s)
- Alan C Kwan
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP, Suite A3600, Los Angeles, CA 90048-0750 (A.C.K.); Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Winship Cancer Institute, Emory University, Atlanta, Ga (A.P.); Department of Biomedical Engineering, Georgia Institute of Technology-Emory University, Atlanta, Ga (A.P.); Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Md (D.S.); Extreme Light Infrastructure-Nuclear Physics, Bucharest-Magurele, Romania (D.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); and Department of Cardiology, The Johns Hopkins Hospital, Baltimore, Md (J.A.C.L.)
| | - Amir Pourmorteza
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP, Suite A3600, Los Angeles, CA 90048-0750 (A.C.K.); Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Winship Cancer Institute, Emory University, Atlanta, Ga (A.P.); Department of Biomedical Engineering, Georgia Institute of Technology-Emory University, Atlanta, Ga (A.P.); Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Md (D.S.); Extreme Light Infrastructure-Nuclear Physics, Bucharest-Magurele, Romania (D.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); and Department of Cardiology, The Johns Hopkins Hospital, Baltimore, Md (J.A.C.L.)
| | - Dan Stutman
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP, Suite A3600, Los Angeles, CA 90048-0750 (A.C.K.); Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Winship Cancer Institute, Emory University, Atlanta, Ga (A.P.); Department of Biomedical Engineering, Georgia Institute of Technology-Emory University, Atlanta, Ga (A.P.); Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Md (D.S.); Extreme Light Infrastructure-Nuclear Physics, Bucharest-Magurele, Romania (D.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); and Department of Cardiology, The Johns Hopkins Hospital, Baltimore, Md (J.A.C.L.)
| | - David A Bluemke
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP, Suite A3600, Los Angeles, CA 90048-0750 (A.C.K.); Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Winship Cancer Institute, Emory University, Atlanta, Ga (A.P.); Department of Biomedical Engineering, Georgia Institute of Technology-Emory University, Atlanta, Ga (A.P.); Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Md (D.S.); Extreme Light Infrastructure-Nuclear Physics, Bucharest-Magurele, Romania (D.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); and Department of Cardiology, The Johns Hopkins Hospital, Baltimore, Md (J.A.C.L.)
| | - João A C Lima
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP, Suite A3600, Los Angeles, CA 90048-0750 (A.C.K.); Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Winship Cancer Institute, Emory University, Atlanta, Ga (A.P.); Department of Biomedical Engineering, Georgia Institute of Technology-Emory University, Atlanta, Ga (A.P.); Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Md (D.S.); Extreme Light Infrastructure-Nuclear Physics, Bucharest-Magurele, Romania (D.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); and Department of Cardiology, The Johns Hopkins Hospital, Baltimore, Md (J.A.C.L.)
| |
Collapse
|
46
|
Flohr T, Petersilka M, Henning A, Ulzheimer S, Ferda J, Schmidt B. Photon-counting CT review. Phys Med 2020; 79:126-136. [DOI: 10.1016/j.ejmp.2020.10.030] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 01/30/2023] Open
|
47
|
Sartoretti T, Eberhard M, Rüschoff JH, Pietsch H, Jost G, Nowak T, Schmidt B, Flohr T, Euler A, Alkadhi H. Photon-counting CT with tungsten as contrast medium: Experimental evidence of vessel lumen and plaque visualization. Atherosclerosis 2020; 310:11-16. [PMID: 32861961 DOI: 10.1016/j.atherosclerosis.2020.07.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/30/2020] [Accepted: 07/23/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS We aimed to investigate the potential of a preclinical photon-counting detector CT (PCT) scanner with an experimental tungsten-based contrast medium for carotid artery imaging. METHODS A carotid artery specimen was imaged on a PCT system using the multi-energy bin option (pixel size 0.5 × 0.5 mm2; tube voltage 140 kVp, contrast media-dependent energy thresholds: iodine 20, 75 keV; tungsten 20, 68 keV) at two radiation doses (CTDIvol of 100 mGy and 10 mGy) with iodine and tungsten as contrast media at equal mass-concentrations. Standard CT, virtual non-calcium (VNCa) and calcium-only images were reconstructed. Subjective image quality (4-point Likert scale) was rated using histology as reference. Noise and attenuation measurements were performed. Simulations were conducted to assess the material-decomposition efficiency for different object diameters. RESULTS Image quality on VNCa images was significantly higher for tungsten at lower dose (reader 1/reader 2: 2, [2,2]/2, [2,2] vs 1.5, [2,1]/1, [1,1.75], p < 0.05). Noise was significantly lower at both dose levels for tungsten VNCa images as compared to iodine images (higher dose: tungsten 24 vs iodine 31; lower dose: tungsten 60 vs iodine 82; both p < 0.01). Simulations indicated improved material-decomposition efficiency for tungsten than for iodine pronounced at smaller object diameters. CONCLUSIONS PCT employing the multi-energy bin option in combination with tungsten as contrast media enables improved carotid artery imaging with respect to lumen and plaque visualization and image noise.
Collapse
Affiliation(s)
- Thomas Sartoretti
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Matthias Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Jan Hendrik Rüschoff
- Department of Pathology, University Hospital Zurich, University of Zurich, Switzerland
| | | | | | | | | | | | - André Euler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland.
| |
Collapse
|
48
|
Cardiovascular imaging 2019 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2020; 36:769-787. [PMID: 32281010 DOI: 10.1007/s10554-020-01845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
49
|
|
50
|
Flohr T, Ulzheimer S, Petersilka M, Schmidt B. Basic principles and clinical potential of photon-counting detector CT. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s42058-020-00029-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|