Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston (M.V.-N., G.T., U.J.S., C.G., E.Z., N.F., D.K., J.O.D., I.M.K., P.S.S., A.V.-S., T.E.).
Heart and Vascular Center, Semmelweis University, Budapest, Hungary (M.V.-N., B.S.).
Circ Cardiovasc Imaging. 2024 Oct;17(10):e017112. doi: 10.1161/CIRCIMAGING.124.017112. Epub 2024 Sep 27.
A recent simulation study proposed that stenosis measurements on coronary computed tomography (CT) angiography are influenced by the improved spatial resolution of photon-counting detector (PCD)-CT. The aim of the current study was to evaluate the impact of ultrahigh-spatial-resolution (UHR) on coronary stenosis measurements and Coronary Artery Disease Reporting and Data System (CAD-RADS) reclassification rates in patients undergoing coronary CT angiography on both PCD-CT and energy-integrating detector (EID)-CT and to compare measurements against quantitative coronary angiography.
Patients with coronary calcification on EID-CT (collimation, 192×0.6 mm) were prospectively enrolled for a research coronary CT angiography with UHR PCD-CT (collimation, 120×0.2 mm) within 30 days (between April 1, 2023 and January 31, 2024). PCD-CT was acquired with the same or lower CT dose index and equivalent contrast media volume as EID-CT. Percentage diameter stenosis (PDS) for calcified, partially calcified, and noncalcified lesions were compared between scanners. Patient-level reclassification rates for CAD-RADS were evaluated. The accuracy of PDS measurements was validated against quantitative coronary angiography in patients who underwent invasive coronary angiography.
In total, PDS of 278 plaques were quantified in 49 patients (calcified, 202; partially calcified, 51; noncalcified, 25). PCD-CT-based PDS values were lower than EID-CT measurements for calcified (45.1±20.7 versus 54.6±19.2%; <0.001) and partially calcified plaques (44.3±19.6 versus 54.9±20.0%; <0.001), without significant differences for noncalcified lesions (39.1±15.2 versus 39.0±16.0%; =0.98). The reduction in stenosis degrees led to a 49.0% (24/49) reclassification rate to a lower CAD-RADS with PCD-CT. In a subset of 12 patients with 56 lesions, UHR-based PDS values showed higher agreement with quantitative coronary angiography (mean difference, 7.3%; limits of agreement, -10.7%/25.2%) than EID-CT measurements (mean difference, 17.4%; limits of agreement, -6.9%/41.7%).
Compared with conventional EID-CT, UHR PCD-CT results in lower PDS values and more accurate stenosis measurements in coronary plaques with calcified components and leads to a substantial Coronary Artery Disease Reporting and Data System reclassification rate in 49.0% of patients.
最近的一项模拟研究表明，冠状动脉计算机断层扫描（CT）血管造影中的狭窄测量受到光子计数探测器（PCD）-CT 空间分辨率提高的影响。本研究旨在评估超高空间分辨率（UHR）对接受冠状动脉 CT 血管造影检查的患者的冠状动脉狭窄测量和冠状动脉疾病报告和数据系统（CAD-RADS）重新分类率的影响，并将测量结果与定量冠状动脉造影进行比较。
前瞻性纳入了 EID-CT（准直器，192×0.6mm）上有冠状动脉钙化的患者，在 30 天内（2023 年 4 月 1 日至 2024 年 1 月 31 日）进行 UHR PCD-CT（准直器，120×0.2mm）研究性冠状动脉 CT 血管造影。PCD-CT 的采集采用与 EID-CT 相同或更低的 CT 剂量指数和等效对比剂体积。比较两种扫描仪上钙化、部分钙化和非钙化病变的百分比直径狭窄（PDS）。评估 CAD-RADS 的患者水平重新分类率。在接受介入冠状动脉造影的患者中，验证 PDS 测量的准确性与定量冠状动脉造影。
共对 49 例患者的 278 个斑块进行了 PDS 定量分析（钙化斑块 202 个，部分钙化斑块 51 个，非钙化斑块 25 个）。与 EID-CT 测量值相比，PCD-CT 基于 PDS 的测量值在钙化（45.1±20.7 比 54.6±19.2%；<0.001）和部分钙化斑块（44.3±19.6 比 54.9±20.0%；<0.001）中较低，而非钙化病变无显著差异（39.1±15.2 比 39.0±16.0%；=0.98）。狭窄程度的降低导致 49.0%（24/49）的患者采用 PCD-CT 重新分类为更低的 CAD-RADS。在 12 例患者的 56 个病变的亚组中，基于 UHR 的 PDS 值与定量冠状动脉造影相比显示出更高的一致性（平均差异，7.3%；一致性界限，-10.7%/25.2%），优于 EID-CT 测量值（平均差异，17.4%；一致性界限，-6.9%/41.7%）。
与传统的 EID-CT 相比，UHR PCD-CT 导致冠状动脉斑块中的钙化成分的 PDS 值降低，狭窄测量更准确，并导致 49.0%的患者的冠状动脉疾病报告和数据系统重新分类率显著提高。
