冠状动脉疾病负担的半定量指标：超高分辨率光子计数探测器CT与能量积分探测器CT的个体内比较。

Semiquantitative metrics of coronary artery disease burden: Intra-individual comparison between ultrahigh-resolution photon-counting detector CT and energy-integrating detector CT.

作者信息

Tremamunno Giuseppe, Varga-Szemes Akos, Schoepf U Joseph, Kravchenko Dmitrij, Hagar Muhammad Taha, Gnasso Chiara, Zsarnóczay Emese, O'Doherty Jim, Caruso Damiano, Laghi Andrea, Szilveszter Bálint, Vattay Borbála, Maurovich-Horvat Pál, Kabakus Ismail Mikdat, Suranyi Pal Spruill, Emrich Tilman, Vecsey-Nagy Milan

机构信息

Department of Radiology and Radiological Science, Medical University of South Carolina, SC, USA; Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Italy.

Department of Radiology and Radiological Science, Medical University of South Carolina, SC, USA.

出版信息

J Cardiovasc Comput Tomogr. 2025 May 5. doi: 10.1016/j.jcct.2025.04.012.

DOI:10.1016/j.jcct.2025.04.012

PMID:40328542

Abstract

BACKGROUND

Quantitative coronary stenosis and plaque volumes have demonstrated intra-individual differences between ultrahigh-resolution (UHR) photon-counting detector (PCD)-CT and energy-integrating detector (EID)-CT. This study aimed to assess the impact of UHR PCD-CT on semiquantitative scores of coronary artery disease (CAD) burden compared with EID-CT.

METHODS

Patients undergoing coronary CT angiography (CCTA) on an EID-CT system for stable chest pain or pre-transcatheter aortic valve replacement evaluation were prospectively enrolled for UHR PCD-CT scan within 30 days. Both datasets were visually evaluated using five established semiquantitative scores: Segment Involvement Score (SIS), Segment Stenosis Score (SSS), Multivessel Aggregate Stenosis Score (MVAS), CCTA-adapted Leaman score (CT-LeSc), and Coronary Artery Disease Reporting and Data System (CAD-RADS). Additionally, the total number of detected plaques and high-risk features were reported (positive remodeling, spotty calcification, low-attenuation, and napkin-ring sign).

RESULTS

The cohort comprised 46 patients (37 men, 68.4 ± 6.9 years). When assessing stenosis severity, PCD-CT showed lower SSS (3.5 [1.3-5.0] vs 6.5 [3.0-9.8], p < 0.001), MVAS (5.5 [4.0-7.0] vs 7.0 [5.0-9.0], p < 0.001), and CT-LeSc (10.4 [8.5-13.9] vs 11.2 [8.8-15.4], p = 0.032). Furthermore, 52 % (24/46) of patients were reclassified to a lower CAD-RADS category compared to EID-CT. In terms of CAD extent, PCD-CT demonstrated higher SIS (8.0 [6.0-9.0] vs 7.0 [6.0-8.8], p = 0.018) and plaque count (9.0 [7.0-13.8] vs 7.0 [7.0-9.8] p < 0.001). Positive remodeling was less frequent in PCD-CT datasets (2.0 [1.0-4.3] vs 1.0 [0.0-3.0], p = 0.012), with no significant differences in other high-risk features.

CONCLUSION

The use of UHR PCD-CT detects less severe, but more extensive CAD compared to EID-CT. The effect of such CCTA-based differences on individual risk stratification needs further investigation.

摘要

背景

定量冠状动脉狭窄和斑块体积已显示出超高分辨率（UHR）光子计数探测器（PCD）CT与能量积分探测器（EID）CT之间的个体差异。本研究旨在评估与EID-CT相比，UHR PCD-CT对冠状动脉疾病（CAD）负担半定量评分的影响。

方法

因稳定型胸痛或经导管主动脉瓣置换术前评估而在EID-CT系统上接受冠状动脉CT血管造影（CCTA）的患者在30天内被前瞻性纳入接受UHR PCD-CT扫描。使用五个既定的半定量评分对两个数据集进行视觉评估：节段累及评分（SIS）、节段狭窄评分（SSS）、多支血管总狭窄评分（MVAS）、CCTA适应性利曼评分（CT-LeSc）和冠状动脉疾病报告与数据系统（CAD-RADS）。此外，报告检测到的斑块总数和高危特征（阳性重塑、斑点状钙化、低衰减和餐巾环征）。

结果

该队列包括46例患者（37例男性，68.4±6.9岁）。在评估狭窄严重程度时，PCD-CT显示较低的SSS（3.5[1.3 - 5.0]对6.5[3.0 - 9.8]，p<0.001）、MVAS（5.5[4.0 - 7.0]对7.0[5.0 - 9.0]，p<0.001）和CT-LeSc（10.4[8.5 - 13.9]对11.2[8.8 - 15.4]，p = 0.032）。此外，与EID-CT相比，52%（24/46）的患者被重新分类到较低的CAD-RADS类别。在CAD范围方面，PCD-CT显示较高的SIS（8.0[6.0 - 9.0]对7.0[6.0 - 8.8]，p = 0.018）和斑块计数（9.0[7.0 - 13.8]对7.0[7.0 - 9.8]，p<0.001）。PCD-CT数据集中阳性重塑的发生率较低（2.0[1.0 - 4.3]对1.0[0.0 - 3.0]，p = 0.012），其他高危特征无显著差异。