利用光子计数CT对颅内血流分流器进行超高分辨率成像:与平板CT的对比体模研究

Ultra-high-resolution imaging of intracranial flow diverters with photon counting CT: A comparative phantom study with flat-panel CT.

作者信息

Maurer Christoph Johannes, Berlis Ansgar, Pinekenstein Dmitrij, Wolf Michael, Östreicher Gebhard, Behrens Lars, Stangl Franz Josef

机构信息

Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.

Faculty of Medicine, Martin Luther University Halle-Wittenberg, Dorothea- Erxleben-Lernzentrum, Halle, Germany.

出版信息

Sci Rep. 2025 Jul 21;15(1):26498. doi: 10.1038/s41598-025-12713-0.

Abstract

Flow diverters are a crucial element in the treatment of intracranial aneurysms. However, the optimal non-invasive follow-up imaging modality, particularly for the detection of in-stent stenosis, remains uncertain. This study aims to compare the performance of photon-counting detector CT (PCD-CT) in ultra-high-resolution (UHR) mode with flat-panel CT (FP-CT) for the evaluation of intracranial flow diverters. A phantom model for intracranial vessels was used to evaluate 15 flow diverters of various sizes and designs. Imaging was performed using both PCD-CT and FP-CT. Qualitative assessment of the stent lumen was conducted by three experienced neuroradiologists using a 5-point Likert scale. Quantitative analysis included measurements of lumen area, contrast to noise ratio and signal to noise ratio. FP-CT provided a significantly larger assessable stent lumen than PCD-CT at all dose levels (p < 0.05), with no significant differences between PCD-CT dose levels (p = 0.999). Increasing PCD-CT dose did not improve lumen visualization. SNR and CNR increased with PCD-CT dose (p < 0.001), peaking at CTDI 20, but showed diminishing returns beyond CTDI 10. Flow diverter diameter correlated positively with SNR and CNR (p < 0.05). Subjective image quality improved with PCD-CT dose (p < 0.001) but showed no significant difference beyond 10 mGy (p > 0.05). FRED devices had the lowest ratings, independent of imaging modality (p = 0.80). Our study demonstrated that while FP-CT provided superior visualization of the flow diverter lumen in a head phantom vessel model, subjective assessability ratings were comparable between FP-CT and PCD-CT when evaluated by experienced readers. PCD-CT at a CTDIvol of 10 mGy offered the best balance between image quality and radiation dose, making it a viable alternative for post-interventional assessment of flow diverters.

摘要

血流导向装置是颅内动脉瘤治疗中的关键要素。然而,最佳的非侵入性随访成像方式,尤其是用于检测支架内狭窄的方式,仍不明确。本研究旨在比较光子计数探测器CT(PCD-CT)在超高分辨率(UHR)模式下与平板CT(FP-CT)评估颅内血流导向装置的性能。使用颅内血管的体模模型评估15个不同尺寸和设计的血流导向装置。使用PCD-CT和FP-CT进行成像。由三位经验丰富的神经放射科医生使用5级李克特量表对支架管腔进行定性评估。定量分析包括管腔面积、对比噪声比和信噪比的测量。在所有剂量水平下,FP-CT提供的可评估支架管腔明显大于PCD-CT(p<0.05),PCD-CT剂量水平之间无显著差异(p=0.999)。增加PCD-CT剂量并不能改善管腔可视化。信噪比和对比噪声比随PCD-CT剂量增加(p<0.001),在CTDI 20时达到峰值,但在CTDI 10以上显示出收益递减。血流导向装置直径与信噪比和对比噪声比呈正相关(p<0.05)。主观图像质量随PCD-CT剂量提高(p<0.001),但在超过10 mGy时无显著差异(p>0.05)。FRED装置的评分最低,与成像方式无关(p=0.80)。我们的研究表明,虽然在头部体模血管模型中FP-CT对血流导向装置管腔的可视化效果更佳,但由经验丰富的阅片者评估时,FP-CT和PCD-CT的主观可评估性评分相当。CTDIvol为10 mGy的PCD-CT在图像质量和辐射剂量之间提供了最佳平衡,使其成为血流导向装置介入后评估的可行替代方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/67ac/12280025/b627c3b3e11c/41598_2025_12713_Fig1_HTML.jpg

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