1
|
Li M, Wu M, Pack J, Wu P, Yan P, De Man B, Wang A, Nieman K, Wang G. Coronary atherosclerotic plaque characterization with silicon-based photon-counting computed tomography (CT): A simulation-based feasibility study. Med Phys 2024. [PMID: 39321385 DOI: 10.1002/mp.17422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 08/23/2024] [Accepted: 08/30/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND Recent photon-counting computed tomography (PCCT) development brings great opportunities for plaque characterization with much-improved spatial resolution and spectral imaging capability. While existing coronary plaque PCCT imaging results are based on CZT- or CdTe-materials detectors, deep-silicon photon-counting detectors offer unique performance characteristics and promise distinct imaging capabilities. PURPOSE This study aims to numerically investigate the feasibility of characterizing plaques with a deep-silicon PCCT scanner and to demonstrate its potential performance advantages over traditional CT scanners using energy-integrating detectors (EID). METHODS We conducted a systematic simulation study of a deep-silicon PCCT scanner using a newly developed digital plaque phantom with clinically relevant geometrical and chemical properties. Through qualitative and quantitative evaluations, this study investigates the effects of spatial resolution, noise, and motion artifacts on plaque imaging. RESULTS Noise-free simulations indicated that PCCT imaging could delineate the boundary of necrotic cores with a much finer resolution than EID-CT imaging, achieving a structural similarity index metric (SSIM) score of 0.970 and reducing the root mean squared error (RMSE) by two-thirds. Measuring necrotic core area errors were reduced from 91.5% to 24%, and fibrous cap thickness errors were reduced from 349.8% to 33.3%. In the presence of noise, the optimal reconstruction was achieved using 0.25 mm voxels and a soft reconstruction kernel, yielding the highest contrast-to-noise ratio (CNR) of 3.48 for necrotic core detection and the best image quality metrics among all choices. However, the ultrahigh resolution of PCCT increased sensitivity to motion artifacts, which could be mitigated by keeping residual motion amplitude below 0.4 mm. CONCLUSIONS The findings suggest that deep-silicon PCCT scanner can offer sufficient spatial resolution and tissue contrast for effective plaque characterization, potentially improving diagnostic accuracy in cardiovascular imaging, provided image noise and motion blur can be mitigated using advanced algorithms. This simulation study involves several simplifications, which may result in some idealized outcomes that do not directly translate to clinical practice. Further validation studies with physical scans are necessary and will be considered for future work.
Collapse
Affiliation(s)
- Mengzhou Li
- Biomedical Imaging Center, Center for Biotechnology and Interdisciplinary Research, Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Mingye Wu
- GE HealthCare Technology & Innovation Center, Niskayuna, New York, USA
| | - Jed Pack
- GE HealthCare Technology & Innovation Center, Niskayuna, New York, USA
| | - Pengwei Wu
- GE HealthCare Technology & Innovation Center, Niskayuna, New York, USA
| | - Pingkun Yan
- Biomedical Imaging Center, Center for Biotechnology and Interdisciplinary Research, Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Bruno De Man
- GE HealthCare Technology & Innovation Center, Niskayuna, New York, USA
| | - Adam Wang
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Koen Nieman
- Department of Radiology, Stanford University, Stanford, California, USA
- Department of Medicine (Cardiovascular Medicine), Stanford University, Stanford, California, USA
| | - Ge Wang
- Biomedical Imaging Center, Center for Biotechnology and Interdisciplinary Research, Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
| |
Collapse
|
2
|
Black D, Singh T, Molloi S. Coronary artery calcium quantification technique using dual energy material decomposition: a simulation study. Int J Cardiovasc Imaging 2024; 40:1465-1474. [PMID: 38904849 PMCID: PMC11258084 DOI: 10.1007/s10554-024-03124-9] [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: 01/29/2024] [Accepted: 04/28/2024] [Indexed: 06/22/2024]
Abstract
Coronary artery calcification is a significant predictor of cardiovascular disease, with current detection methods like Agatston scoring having limitations in sensitivity. This study aimed to evaluate the effectiveness of a novel CAC quantification method using dual-energy material decomposition, particularly its ability to detect low-density calcium and microcalcifications. A simulation study was conducted comparing the dual-energy material decomposition technique against the established Agatston scoring method and the newer volume fraction calcium mass technique. Detection accuracy and calcium mass measurement were the primary evaluation metrics. The dual-energy material decomposition technique demonstrated fewer false negatives than both Agatston scoring and volume fraction calcium mass, indicating higher sensitivity. In low-density phantom measurements, material decomposition resulted in only 7.41% false-negative (CAC = 0) measurements compared to 83.95% for Agatston scoring. For high-density phantoms, false negatives were removed (0.0%) compared to 20.99% in Agatston scoring. The dual-energy material decomposition technique presents a more sensitive and reliable method for CAC quantification.
Collapse
Affiliation(s)
- Dale Black
- Department of Radiological Sciences, University of California, Medical Sciences I, B-140, Irvine, CA, 92697, USA
| | - Tejus Singh
- Department of Radiological Sciences, University of California, Medical Sciences I, B-140, Irvine, CA, 92697, USA
| | - Sabee Molloi
- Department of Radiological Sciences, University of California, Medical Sciences I, B-140, Irvine, CA, 92697, USA.
| |
Collapse
|
3
|
Matthaiou N, Klontzas ME, Kakkos GA, Tsetis K, Maris TG, Ioannou CV, Tsetis D, Kehagias E. Utility of Dual-Energy Computed Tomography in lesion characterization and treatment planning for peripheral Chronic Total Occlusions: A comprehensive analysis of crossing difficulty. Eur J Radiol 2024; 176:111539. [PMID: 38833769 DOI: 10.1016/j.ejrad.2024.111539] [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: 04/13/2024] [Revised: 05/18/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE To investigate whether Dual-Energy Computed Tomography (DECT) could be useful in the lesion characterization and endovascular treatment planning of symptomatic patients with peripheral arterial disease (PAD) due to Chronic Total Occlusions (CTO). MATERIALS AND METHODS Between 2018 and 2022, 60 symptomatic patients (52 male, age 71 years) with peripheral arterial CTO underwent DECT angiography before percutaneous endovascular treatment. Patients were classified, according to guidewire crossing difficulty into four categories, which were subsequently correlated with DECT values, including Dual Energy Index (DEI) and Effective Z (Zeff). DECT values were also corelated with crossing time. The crossing difficulty was further correlated with the Trans-Atlantic Inter-Society Consensus Document (TASC II) classification. RESULTS Technical success, defined as perceived antegrade true lumen or subintimal crossing, was achieved in 76.7 %. Among the cases, 20 were deemed easy, 14 moderate, 12 hard and 14 were failed attempts. Statistical analysis revealed a significant correlation between DEI, Zeff values, and the crossing difficulty categories (p < 0.001). Additionally, there was also a correlation between crossing time and DECT values. However, no significant correlation was recorded between difficulty categories and TASC II classification. CONCLUSION Pre-procedural DECT angiography provides valuable information for patient selection and planning of the revascularization strategy. Moreover, it is helpful in the selection of the appropriate PTA materials, based on the lesion characteristics. Further research should be invested in this important field, to determine the optimal treatment approach in patients suffering from PAD due to CTOs.
Collapse
Affiliation(s)
- Nikolas Matthaiou
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece.
| | - Michail E Klontzas
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece.
| | - George A Kakkos
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
| | - Konstantinos Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
| | - Thomas G Maris
- Department of Medical Physics, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Voutes, 71110 Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
| |
Collapse
|
4
|
Gao Y, Pan Y, Jia C. Influencing factors and improvement methods of coronary artery plaque evaluation in CT. Front Cardiovasc Med 2024; 11:1395350. [PMID: 38984352 PMCID: PMC11232181 DOI: 10.3389/fcvm.2024.1395350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/14/2024] [Indexed: 07/11/2024] Open
Abstract
Accurate evaluation of the nature and composition of coronary plaque involves clinical follow-up and prognosis. Coronary CT angiography is the most commonly non-invasive method for plaque evaluation, however, the qualitative and quantitative evaluation of plaque based on CT value is inaccurate, due to the influence of luminal attenuation, tube voltage, parameter setting and the subjectivity.
Collapse
Affiliation(s)
- Yaqi Gao
- Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yao Pan
- Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chongfu Jia
- Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| |
Collapse
|
5
|
Böttcher B, Zsarnoczay E, Varga-Szemes A, Schoepf UJ, Meinel FG, van Assen M, De Cecco CN. Dual-Energy Computed Tomography in Cardiac Imaging. Radiol Clin North Am 2023; 61:995-1009. [PMID: 37758366 DOI: 10.1016/j.rcl.2023.05.004] [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] [Indexed: 10/03/2023]
Abstract
Dual-energy computed tomography (DECT) acquires images using two energy spectra and offers a variation of reconstruction techniques for improved cardiac imaging. Virtual monoenergetic images decrease artifacts improving coronary plaque and stent visualization. Further, contrast attenuation is increased allowing significant reduction of contrast dose. Virtual non-contrast reconstructions enable coronary artery calcium scoring from contrast-enhanced scans. DECT provides advanced plaque imaging with detailed analysis of plaque components, indicating plaque stability. Extracellular volume assessment using DECT offers noninvasive detection of myocardial fibrosis. This review aims to outline the current cardiac applications of DECT, summarize recent literature, and discuss their findings.
Collapse
Affiliation(s)
- Benjamin Böttcher
- Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, USA; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Clinical Science Building, 96 Jonathan Lucas Street, Suite 210, MSC 323 Charleston, SC 29425, USA; MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Center, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Clinical Science Building, 96 Jonathan Lucas Street, Suite 210, MSC 323 Charleston, SC 29425, USA
| | - Uwe Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Clinical Science Building, 96 Jonathan Lucas Street, Suite 210, MSC 323 Charleston, SC 29425, USA
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany
| | - Marly van Assen
- Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road NE, Suite D112, Atlanta, GA 30322, USA
| | - Carlo N De Cecco
- Division of Cardiothoracic Imaging and Imaging Informatics, Department of Radiology and Imaging Sciences, Emory University Hospital, Emory Healthcare, Inc. 1365 Clifton Road NE, Suite - AT503, Atlanta, GA 30322, USA.
| |
Collapse
|
6
|
Black D, Xiao X, Molloi S. Coronary artery calcium mass measurement based on integrated intensity and volume fraction techniques. J Med Imaging (Bellingham) 2023; 10:043502. [PMID: 37434664 PMCID: PMC10332802 DOI: 10.1117/1.jmi.10.4.043502] [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: 01/16/2023] [Revised: 05/11/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
Purpose Agatston scoring does not detect all the calcium present in computed tomography scans of the heart. A technique that removes the need for thresholding and quantifies calcium mass more accurately and reproducibly is needed. Approach Integrated intensity and volume fraction techniques were evaluated for accurate quantification of calcium mass. Integrated intensity calcium mass, volume fraction calcium mass, Agatston scoring, and spatially weighted calcium scoring were compared with known calcium mass in simulated and physical phantoms. The simulation was created to match a 320-slice CT scanner. Fat rings were added to the simulated phantoms, which resulted in small (30 × 20 cm 2 ), medium (35 × 25 cm 2 ), and large (40 × 30 cm 2 ) phantoms. Three calcification inserts of different diameters and hydroxyapatite densities were placed within the phantoms. All the calcium mass measurements were repeated across different beam energies, patient sizes, insert sizes, and densities. Physical phantom images from a previously reported study were then used to evaluate the accuracy and reproducibility of the techniques. Results Both integrated intensity calcium mass and volume fraction calcium mass yielded lower root mean squared error (RMSE) and deviation (RMSD) values than Agatston scoring in all the measurements in the simulated phantoms. Specifically, integrated calcium mass (RMSE: 0.49 mg, RMSD: 0.49 mg) and volume fraction calcium mass (RMSE: 0.58 mg, RMSD: 0.57 mg) were more accurate for the low-density stationary calcium measurements than Agatston scoring (RMSE: 3.70 mg, RMSD: 2.30 mg). Similarly, integrated calcium mass (15.74%) and volume fraction calcium mass (20.37%) had fewer false-negative (CAC = 0) measurements than Agatston scoring (75.00%) and spatially weighted calcium scoring (26.85%), on the low-density stationary calcium measurements. Conclusion The integrated calcium mass and volume fraction calcium mass techniques can potentially improve risk stratification for patients undergoing calcium scoring and further improve risk assessment compared with Agatston scoring.
Collapse
Affiliation(s)
- Dale Black
- University of California, Irvine, Department of Radiological Sciences, Irvine, California, United States
| | - Xingshuo Xiao
- University of California, Irvine, Department of Radiological Sciences, Irvine, California, United States
| | - Sabee Molloi
- University of California, Irvine, Department of Radiological Sciences, Irvine, California, United States
| |
Collapse
|
7
|
Vulasala SSR, Wynn GC, Hernandez M, Kadambi I, Gopireddy DR, Bhosale P, Virarkar MK. Dual-Energy Imaging of the Chest. Semin Ultrasound CT MR 2022; 43:311-319. [PMID: 35738816 DOI: 10.1053/j.sult.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dual-energy computed tomography (DECT) is a contemporary development by which the tissue can be characterized beyond conventional computed tomography. It improves tissue differentiation by exploiting the X-ray absorptive property of the tissues. Although still in its early stages, DECT utilization in pulmonary and cardiovascular pathologies is emerging. It includes applications such as pulmonary embolism, pulmonary hypertension, myocardial perfusion, and coronary artery assessment. This article discusses DECT principles and their current and emerging applications in thoracic imaging.
Collapse
Affiliation(s)
- Sai Swarupa R Vulasala
- Research Assistant, Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| | - Gregory Carl Wynn
- Associate Professor, Division of Cardiovascular and Thoracic Imaging, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| | - Mauricio Hernandez
- Radiology Research Manager II, Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States.
| | - Isiri Kadambi
- Observer, Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| | - Dheeraj Reddy Gopireddy
- Associate Professor & Associate Chair, Clinical Operations, and Quality Assurance., Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| | - Priya Bhosale
- Professor, Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, United States
| | - Mayur K Virarkar
- Assistant Professor, Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| |
Collapse
|