Sharma Simran P, Budde Ricardo P J, Groen Jan Willem, Dijkshoorn Marcel L, Manintveld Olivier C, Hirsch Alexander
Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Room Rg-419, Post Office Box: 2040, Rotterdam, 3000 CA, The Netherlands.
Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
Int J Cardiovasc Imaging. 2025 Jun 2. doi: 10.1007/s10554-025-03433-7.
This study aims to compare the image quality between photon-counting detector computed tomography (PCD-CT) and energy-integrating CT (EID-CT) for coronary artery visualization post-heart transplant (HTx) patients, using a paired comparison within one patient. Consecutive HTx patients who underwent both 3rd generation dual source EID-CT and ultra-high-resolution PCD-CT scans as part of routine clinical care, with a maximum interval of two years between scans were included. Image quality was assessed subjectively using a 5-point Likert scale and quantitatively with the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Coronary segments were scored for presence, stenosis degree, presence of artifacts, and plaque composition. Thirty patients were included (mean age 50 ± 17 years; 21 (70%) men). The median interval between scans was 17[12-24] months. The median calcium score was 9[0-51] on the EID-CT scan and 25[0-92] on the PCD-CT. On the PCD-CT, 90% of coronary segments were rated very good or excellent compared to 71% on EID-CT (p < 0.001). Fewer segments were absent or non-evaluable due to size with PCD-CT compared to EID-CT (30% vs. 34%; p < 0.001). PCD-CT identified more mixed plaques (11% vs. 3%, p < 0.001). SNR and CNR were significantly higher on PCD-CT (22.1 ± 6.1 and 27.8 ± 6.8, p < 0.001) than on EID-CT (14.3 ± 3.4 and 16.9 ± 3.6, p < 0.001). The CT dose index volume was 6 [5-10] mGy on EID-CT and 19 [14-21] mGy on PCD-CT (p < 0.001). Ultra-high-resolution PCD-CT improves image quality compared to EID-CT in HTx patients. With superior SNR and CNR, and fewer non-evaluable segments, PCD-CT offers enhanced coronary artery visualization, though at the cost of an increased radiation dose.
本研究旨在通过对同一患者进行配对比较，比较光子计数探测器计算机断层扫描（PCD-CT）和能量积分CT（EID-CT）对心脏移植（HTx）术后患者冠状动脉成像的图像质量。纳入作为常规临床护理一部分接受第三代双源EID-CT和超高分辨率PCD-CT扫描的连续HTx患者，两次扫描之间的最大间隔为两年。使用5分李克特量表主观评估图像质量，并通过信噪比（SNR）和对比噪声比（CNR）进行定量评估。对冠状动脉节段的存在情况、狭窄程度、伪影的存在情况和斑块成分进行评分。纳入30例患者（平均年龄50±17岁；21例（70%）为男性）。两次扫描之间的中位间隔为17[12-24]个月。EID-CT扫描的中位钙化评分为9[0-51]，PCD-CT扫描的中位钙化评分为25[0-92]。在PCD-CT上，90%的冠状动脉节段被评为非常好或优秀，而在EID-CT上这一比例为71%（p<0.001）。与EID-CT相比，PCD-CT因尺寸原因导致缺失或不可评估节段较少（30%对34%；p<0.001）。PCD-CT识别出更多混合斑块（11%对3%，p<0.001）。PCD-CT上的SNR和CNR显著高于EID-CT（分别为22.1±6.1和27.8±6.8，p<0.001）（EID-CT分别为14.3±3.4和16.9±3.6，p<0.001）。EID-CT的CT剂量指数体积为6[5-10]mGy，PCD-CT为19[14-21]mGy（p<0.001）。与EID-CT相比，超高分辨率PCD-CT可改善HTx患者的图像质量。PCD-CT具有更高的SNR和CNR，不可评估节段更少，能提供更好的冠状动脉成像，不过代价是辐射剂量增加。
