Fahrni Guillaume, Boccalini Sara, Mahmoudi Allal, Lacombe Hugo, Houmeau Angèle, Elbaz Meyer, Rotzinger David, Villien Marjorie, Bochaton Thomas, Douek Philippe, Si-Mohamed Salim A
From the Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (G.F., D.R.); University of Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Villeurbanne, France (G.F., S.B., H.L., A.H., P.D., S.A.S.-M.); Department of Radiology, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France (G.F., S.B., P.D., S.A.S.-M.); Cardiology Department, HFR Fribourg Hôpital Cantonal, Villars-Sur-Glâne, Fribourg, Switzerland (A.M.); Cardiology Department, Institute CARDIOMET, CHU-Toulouse, Toulouse, France (M.E.); Philips Healthcare, Suresnes, France (H.L., M.V.); and Department of Cardiology, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France (T.B.).
Invest Radiol. 2025 Feb 1;60(2):114-122. doi: 10.1097/RLI.0000000000001109. Epub 2024 Aug 21.
Development of spectral photon-counting computed tomography (SPCCT) for ultra-high-resolution coronary CT angiography (CCTA) has the potential to accurately evaluate the coronary arteries of very-high-risk patients. The aim of this study was to compare the diagnostic performances of SPCCT against conventional CT for quantifying coronary stenosis in very-high-risk patients, with invasive coronary angiography (ICA) as the reference method.
In this prospective institutional review board-approved study, very-high-risk patients addressed for ICA following an acute coronary syndrome were consecutively included. CCTA was performed for each patient with both SPCCT and conventional CT before ICA within 3 days. Stenoses were assessed using the minimal diameter over proximal and distal diameters method for CCTA and the quantitative coronary angiography method for ICA. Intraclass correlation coefficients and mean errors were assessed. Sensitivity and specificity were calculated for a >50% diameter stenosis threshold. Reclassification rates for conventional CT and SPCCT were assessed according to CAD-RADS 2.0, using ICA as the gold standard.
Twenty-six coronary stenoses were identified in 26 patients (4 women [15%]; age 64 ± 8 years) with 19 (73%) above 50% and 9 (35%) equal or above 70%. The median stenosis value was 64% (interquartile range, 48%-73%). SPCCT showed a lower mean error (6% [5%, 8%]) than conventional CT (12% [9%, 16%]). SPCCT demonstrated greater sensitivity (100%) and specificity (90%) than conventional CT (75% and 50%, respectively). Ten (38%) stenoses were reclassified with SPCCT and one (4%) with conventional CT.
In very-high-risk patients, ultra-high-resolution SPCCT coronary angiography showed greater accuracy, sensitivity, and specificity, and led to more stenosis reclassifications than conventional CT.
开发用于超高分辨率冠状动脉CT血管造影（CCTA）的光谱光子计数计算机断层扫描（SPCCT）有潜力准确评估极高风险患者的冠状动脉。本研究的目的是以有创冠状动脉造影（ICA）作为参考方法，比较SPCCT与传统CT在量化极高风险患者冠状动脉狭窄方面的诊断性能。
在这项经机构审查委员会批准的前瞻性研究中，连续纳入急性冠状动脉综合征后接受ICA检查的极高风险患者。在ICA前3天内，对每位患者分别使用SPCCT和传统CT进行CCTA检查。采用CCTA的近端和远端直径最小直径法以及ICA的定量冠状动脉造影法评估狭窄情况。评估组内相关系数和平均误差。计算直径狭窄阈值>50%时的敏感性和特异性。以ICA作为金标准，根据CAD-RADS 2.0评估传统CT和SPCCT的重新分类率。
26例患者（4例女性[15%]；年龄64±8岁）共发现26处冠状动脉狭窄，其中19处（73%）狭窄超过50%，9处（35%）狭窄等于或超过70%。狭窄值中位数为64%（四分位间距，48%-73%）。SPCCT的平均误差（6%[5%，8%]）低于传统CT（12%[9%，16%]）。SPCCT的敏感性（100%）和特异性（90%）高于传统CT（分别为75%和50%）。SPCCT使10处（38%）狭窄重新分类，传统CT使1处（4%）狭窄重新分类。
在极高风险患者中，超高分辨率SPCCT冠状动脉造影比传统CT显示出更高的准确性、敏感性和特异性，且导致更多狭窄重新分类。
