De Beukelaer Frederic, De Beukelaer Sophie, Wuyts Laura L, Nikoubashman Omid, El Halal Mohammed, Kantzeli Iliana, Wiesmann Martin, Ridwan Hani, Weyland Charlotte S
Department of Neuroradiology, University hospital RWTH Aachen, Aachen, Germany.
Department of Neurology, Inselspital, University hospital Bern, Bern, Switzerland.
Eur Radiol Exp. 2025 Jan 29;9(1):10. doi: 10.1186/s41747-025-00550-9.
To define optimal parameters for the evaluation of vessel visibility in intracranial stents (ICS) and flow diverters (FD) using photon-counting detector computed tomography angiography (PCD-CTA) with spectral reconstructions.
We retrospectively analyzed consecutive patients with implanted ICS or FD, who received a PCD-CTA between April 2023 and March 2024. Polyenergetic, virtual monoenergetic, pure lumen, and iodine reconstructions with different keV levels (40, 60, and 80) and reconstruction kernels (body vascular [Bv]48, Bv56, Bv64, Bv72, and Bv76) were evaluated by two radiologists with regions of interests and Likert scales. Reconstructions were compared in descriptive analysis.
In total, twelve patients with nine FDs and six ICSs were analyzed. In terms of quantitative image quality, sharper kernels as Bv64 and Bv72 yielded increased image noise and decreased signal-to-noise and contrast-to-noise ratios compared to the smoothest kernel Bv48 (p = 0.001). Among the different keV levels and kernels, readers selected the 40 keV level (p = 0.001) and sharper kernels (in the majority of cases Bv72) as the best to visualize the in-stent vessel lumen. Assessing the different spectral reconstructions virtual monoenergetic and iodine reconstructions proved to be best to evaluate in-stent vessel lumen (p = 0.001).
PCD-CTA and spectral reconstructions with sharper reconstruction kernels and a low keV level of 40 seem to be beneficial to achieve optimal image quality for the evaluation of ICS and FD. Iodine and virtual monoenergetic reconstructions were superior to pure lumen and polyenergetic reconstructions to evaluate in-stent vessel lumen.
PCD-CTA offers the opportunity to reduce the need for invasive angiography serving as follow-up examination after intracranial stent (ICS) or flow diverter (FD) implantation.
Neuroimaging of intracranial vessels with implanted stents and flow diverters is limited by artifacts. Twelve patients with nine flow diverters and six intracranial stents underwent photon-counting detector computed tomography angiography (PCD-CTA). In-stent vessel lumen visibility improved using sharp reconstruction kernels and a low keV level. Virtual monoenergetic and iodine reconstructions were best to evaluate in-stent vessel lumen.
使用具有光谱重建功能的光子计数探测器计算机断层血管造影（PCD-CTA）来定义评估颅内支架（ICS）和血流导向装置（FD）中血管可视性的最佳参数。
我们回顾性分析了2023年4月至2024年3月期间接受PCD-CTA检查的连续植入ICS或FD的患者。由两名放射科医生使用感兴趣区域和李克特量表对不同keV水平（40、60和80）和重建核（体部血管[Bv]48、Bv56、Bv64、Bv72和Bv76）的多能、虚拟单能、纯管腔和碘重建进行评估。在描述性分析中对重建结果进行比较。
总共分析了12例患者，其中有9个FD和6个ICS。在定量图像质量方面，与最平滑的核Bv48相比，Bv64和Bv72等更锐利的核会增加图像噪声并降低信噪比和对比噪声比（p = 0.001）。在不同的keV水平和核中，读者选择40 keV水平（p = 0.001）和更锐利的核（大多数情况下为Bv72）作为观察支架内血管腔的最佳选择。评估不同的光谱重建时，虚拟单能和碘重建被证明最适合评估支架内血管腔（p = 0.001）。
PCD-CTA以及使用更锐利的重建核和40的低keV水平的光谱重建似乎有利于获得评估ICS和FD的最佳图像质量。碘和虚拟单能重建在评估支架内血管腔方面优于纯管腔和多能重建。
PCD-CTA提供了减少颅内支架（ICS）或血流导向装置（FD）植入后作为随访检查的侵入性血管造影需求的机会。
植入支架和血流导向装置的颅内血管神经成像受到伪影的限制。12例有9个血流导向装置和6个颅内支架的患者接受了光子计数探测器计算机断层血管造影（PCD-CTA）。使用锐利的重建核和低keV水平可改善支架内血管腔的可视性。虚拟单能和碘重建最适合评估支架内血管腔。
