Ghibes Patrick, Hagen Florian, Weissinger Matthias, Wrazidlo Robin, Nikolaou Konstantin, Levitin Abraham, Kirksey Levester, Artzner Christoph, Grözinger Gerd, Partovi Sasan
Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany.
Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany.
Eur J Radiol. 2025 Jan;182:111834. doi: 10.1016/j.ejrad.2024.111834. Epub 2024 Nov 13.
Photon-counting (PC) CT has the potential to improve diagnostic confidence and image quality of CT angiography (CTA) in patients with peripheral artery disease (PAD).
To retrospectively evaluate the diagnostic performance of Photon-counting CT angiography for the assessment of stenotic disease in patients with PAD compared to digital subtraction angiography (DSA) as gold standard.
All patients undergoing PC CTA followed by DSA between November 2021 and November 2023 were included in this institutional review board approved HIPAA compliant retrospective analysis. The arterial vasculature of the lower extremity was divided into 10 segments from the iliac vasculature to the calf arterial vasculature. The images were evaluated independently by two experienced readers. Inter-reader agreement was determined using Cohen's kappa coefficient (κ). Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) as well as accuracy were calculated for PC CTA and PC pure lumen reconstruction compared to DSA as gold standard.
109 patients (mean age 74.68 ± 11.10 years; 77 males, 32 females) were included in the retrospective analysis. PC pure lumen reconstructions was available for 91 patients (83 %). A total of 933 vascular segments for PC CTA and 780 vascular segments for PC pure lumen reconstruction were evaluated. Good to perfect inter-reader agreement was found for PC CTA (κ = 0.791) and for PC pure lumen reconstruction (κ = 0.829). Sensitivity, Specificity and accuracy for PC CTA were 91 %; 95 % and 93 %, respectively. Sensitivity, Specificity and accuracy for PC pure lumen reconstruction were 85 %, 89 % and 88 %, respectively.
Photon-counting CTA demonstrates high sensitivity and specificity for the detection and diagnosis of stenotic lesions in PAD. PC non-calcium reconstruction does not further increase the accuracy compared to PC CTA.
光子计数（PC）CT有潜力提高外周动脉疾病（PAD）患者CT血管造影（CTA）的诊断置信度和图像质量。
与作为金标准的数字减影血管造影（DSA）相比，回顾性评估光子计数CT血管造影对PAD患者狭窄性疾病的诊断性能。
纳入2021年11月至2023年11月期间接受PC CTA检查后又进行DSA检查的所有患者，进行本机构审查委员会批准的符合健康保险流通与责任法案（HIPAA）的回顾性分析。下肢动脉血管系统从髂血管到小腿动脉血管系统分为10个节段。图像由两名经验丰富的阅片者独立评估。阅片者间一致性采用Cohen卡方系数（κ）确定。将PC CTA和PC纯管腔重建与作为金标准的DSA相比，计算其敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）以及准确性。
109例患者（平均年龄74.68±11.10岁；男性77例，女性32例）纳入回顾性分析。91例患者（83%）有PC纯管腔重建图像。共评估了PC CTA的933个血管节段和PC纯管腔重建的780个血管节段。PC CTA（κ=0.791）和PC纯管腔重建（κ=0.829）的阅片者间一致性良好至极佳。PC CTA的敏感性、特异性和准确性分别为91%、95%和93%。PC纯管腔重建的敏感性、特异性和准确性分别为85%、89%和88%。
光子计数CTA对PAD狭窄性病变的检测和诊断具有高敏感性和特异性。与PC CTA相比，PC非钙化重建并未进一步提高准确性。
