Si-Mohamed Salim A, Boccalini Sara, Lacombe Hugo, Diaw Adja, Varasteh Mohammad, Rodesch Pierre-Antoine, Dessouky Riham, Villien Marjorie, Tatard-Leitman Valérie, Bochaton Thomas, Coulon Philippe, Yagil Yoad, Lahoud Elias, Erhard Klaus, Riche Benjamin, Bonnefoy Eric, Rioufol Gilles, Finet Gerard, Bergerot Cyrille, Boussel Loic, Greffier Joel, Douek Philippe C
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.).
Radiology. 2022 May;303(2):303-313. doi: 10.1148/radiol.211780. Epub 2022 Feb 15.
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 ( < .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 See also the editorial by Sandfort and Bluemke in this issue.
背景 与传统CT相比，光子计数CT（PCCT）的空间分辨率、软组织对比度和剂量效率特性可能使冠状动脉CT血管造影（CCTA）具有更高的质量和诊断可信度。目的 比较使用临床原型PCCT系统和能量积分探测器（EID）双层CT（DLCT）系统获得的CCTA扫描质量。材料与方法 在这项经机构批准的前瞻性研究中，研究对象均签署了知情同意书，患有冠状动脉疾病的参与者在以5 mL/秒的速度注射65 - 75 mL的400 mg/mL碘化造影剂后，使用这两种系统进行回顾性心电门控CCTA检查。事先基于模体任务对冠状动脉病变的可检测性指数进行了质量评估。PCCT使用超高分辨率参数（1024矩阵，0.25毫米层厚），EID DLCT使用（512矩阵，0.67毫米层厚）。三名心脏放射科医生独立进行盲法分析，使用五点质量评分（1 = 不足，5 = 优秀）对整体图像质量、诊断可信度以及钙化、支架和非钙化斑块的诊断质量进行评分。使用针对放射科医生进行校正的逻辑回归模型来评估采用最佳方法时评分提高的比例。结果 连续纳入了14名参与者（12名男性；平均年龄61岁±17岁）。PCCT图像的整体质量和诊断可信度评分更高，中位数分别为5（四分位间距[IQR]，2）和5（IQR，1），而EID DLCT图像的评分为4（IQR，1）和4（IQR，3），EID DLCT图像的平均管电流为349 mAs±111，而PCCT图像为255 mAs±0（P <.01）。PCCT图像在钙化、支架和非钙化斑块质量方面的改善比例分别为100%、92%（95%CI：71，98）和45%（95%CI：28，63）。在模体研究中，PCCT图像的管腔可检测性指数高2.3倍，非钙化斑块高2.9倍。结论 与能量积分双层CT相比，使用光子计数CT系统进行冠状动脉CT血管造影在人体中显示出更高的图像质量和诊断可信度。©RSNA，2022 另见本期Sandfort和Bluemke撰写的社论。
