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European Radiology

27-04-2024 | CT Angiography | Cardiac

Improvement of coronary stent visualization using ultra-high-resolution photon-counting detector CT

Authors: Le Qin, Shanshui Zhou, Haipeng Dong, Jiqiang Li, Ruiyan Zhang, Chendie Yang, Peng Liu, Zhihan Xu, Fuhua Yan, Wenjie Yang

Published in: European Radiology

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Abstract

Objectives

This study aimed to compare the image quality and diagnostic performance of standard-resolution (SR) and ultra-high-resolution (UHR) coronary CT angiography (CCTA) based on photon-counting detector CT (PCD-CT) of coronary stents and explore the best reconstruction kernel for stent imaging.

Methods

From July 2023 to September 2023, patients were enrolled to undergo CCTA using a dual-source PCD-CT system after coronary angioplasty with stent placement. SR images with a slice thickness/increment of 0.6/0.4 mm were reconstructed using a vascular kernel (Bv48), while UHR images with a slice thickness/increment of 0.2/0.2 mm were reconstructed using vascular kernels of six sharpness levels (Bv48, Bv56, Bv60, Bv64, Bv72, and Bv76). The in-stent lumen diameters were evaluated. Subjective image quality was also evaluated by a 5-point Likert scale. Invasive coronary angiography was conducted in 12 patients (25 stents).

Results

Sixty-nine patients (68.0 [61.0, 73.0] years, 46 males) with 131 stents were included. All UHR images had significantly larger in-stent lumen diameter than SR images (p < 0.001). Specifically, UHR-Bv72 and UHR-Bv76 for in-stent lumen diameter (2.17 [1.93, 2.63] mm versus 2.20 [1.93, 2.59] mm) ranked the two best kernels. The subjective analysis demonstrated that UHR-Bv72 images had the most pronounced effect on reducing blooming artifacts, showcasing in-stent lumen and stent demonstration, and diagnostic confidence (p < 0.001). Furthermore, SR and UHR-Bv72 images showed a diagnostic accuracy of 78.3% (95% confidence interval [CI]: 56.3%–92.5%) and 88.0% (95%CI: 68.8%–97.5%), respectively.

Conclusion

UHR CCTA by PCD-CT leads to significantly improved visualization and diagnostic performance of coronary stents, and Bv72 is the optimal reconstruction kernel showing the stent struts and in-stent lumen.

Clinical relevance statement

The significantly improved visualization of coronary stents using ultra-high resolution CCTA could increase the diagnostic accuracy for in-stent restenosis and avoid unnecessary invasive quantitative coronary angiography, thus changing the clinical management for patients after percutaneous coronary intervention.

Key Points

  • Coronary stent imaging is challenging with energy-integrating detector CT due to “blooming artifacts.”
  • UHR images using a PCD-CT enhanced coronary stent visualization.
  • UHR coronary stent imaging demonstrated improved diagnostic accuracy in clinical settings.
Appendix
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Metadata
Title
Improvement of coronary stent visualization using ultra-high-resolution photon-counting detector CT
Authors
Le Qin
Shanshui Zhou
Haipeng Dong
Jiqiang Li
Ruiyan Zhang
Chendie Yang
Peng Liu
Zhihan Xu
Fuhua Yan
Wenjie Yang
Publication date
27-04-2024
Publisher
Springer Berlin Heidelberg
Keyword
CT Angiography
Published in
European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-024-10760-1