Xu Cheng, Sun Yue, Wang Liang, Zou Limiao, Wang Ming, Lin Lu, Wang Yun, Sun Xiaonan, Liu Xiaoying, Yu Xianbo, Leidecker Christianne, Wang Lun, Liu Yifan, Qian Hao, Tian Ran, Vliegenthart Rozemarijn, Liu Zhenyu, Wang Yining
Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
AJR Am J Roentgenol. 2025 Sep 10. doi: 10.2214/AJR.25.33493.
Patients with inflammation-associated coronary artery disease (CAD) may exhibit rapid progression and require regular coronary imaging. To evaluate the diagnostic performance of spectral photon-counting detector (PCD) coronary CTA with reduced radiation and contrast media doses for detecting coronary stenosis and in-stent restenosis in patients with inflammation-associated CAD. This prospective study enrolled patients with inflammation-associated CAD from January 2023 to March 2024. Participants underwent spectral PCD coronary CTA using prospectively ECG-triggered sequential acquisition and an individualized low-dose contrast media protocol. Virtual monoenergetic images (VMI) at 55 keV and polychromatic (T3D) images were reconstructed with matching parameters, including 0.4-mm slice thickness. Two readers independently assessed subjective (5-point Likert scales) and objective image quality measures; readers also assessed images for obstructive stenosis and in-stent restenosis (both ≥50%) in patients with invasive coronary angiography (ICA) available as reference. The analysis included 63 patients (mean age, 50.4±11.5 years; 45 women, 18 men). Median contrast media volume was 28.0 mL. Median DLP was 165.0 mG·cm. The 55-keV VMI, compared with T3D, showed better (p<.05) overall image quality, diagnostic confidence, SNR, and CNR in all three assessed vessels (e.g., right circumflex artery for reader 1: overall image quality of 4.5 vs 4.1, CNR of 12.1 vs 9.9). Diagnostic performance using ICA as reference was evaluated in 40 patients with 132 lesions and 75 stents. The 55-keV VMI, compared to T3D, demonstrated higher (p<.05) per-lesion accuracy for obstructive stenosis (reader 1: 96.2% vs 84.1%; reader 2: 97.0% vs 86.4%); these differences in accuracy were also observed for both readers for noncalcified and partly calcified plaques, lesions in mid and distal segments, and patients with BMI ≥24. The 55-keV VMI and T3D showed no significant difference (p>.05) in accuracy for in-stent restenosis (reader 1: 97.3% vs 96.0%; reader 2: 96.0% vs 94.7%). Spectral PCD coronary CTA, obtained using low radiation and contrast media doses and reconstructed using 55-keV VMI, demonstrated excellent diagnostic accuracy in detecting obstructive stenosis and in-stent restenosis in patients with inflammation-associated CAD. The proposed protocol could be used to guide clinical decision-making in inflammation-associated CAD.
炎症相关性冠状动脉疾病（CAD）患者可能病情进展迅速，需要定期进行冠状动脉成像检查。为了评估光谱光子计数探测器（PCD）冠状动脉CTA在降低辐射和造影剂剂量的情况下，对炎症相关性CAD患者冠状动脉狭窄和支架内再狭窄的诊断性能。这项前瞻性研究纳入了2023年1月至2024年3月期间的炎症相关性CAD患者。参与者采用前瞻性心电图触发序列采集和个体化低剂量造影剂方案进行光谱PCD冠状动脉CTA检查。重建了55 keV的虚拟单能量图像（VMI）和多色（T3D）图像，匹配参数包括0.4毫米层厚。两名阅片者独立评估主观（5级李克特量表）和客观图像质量指标；阅片者还根据可作为参考的有创冠状动脉造影（ICA），对患者的阻塞性狭窄和支架内再狭窄（均≥50%）进行图像评估。分析纳入了63例患者（平均年龄50.4±11.5岁；45例女性，18例男性）。造影剂体积中位数为28.0 mL。剂量长度乘积（DLP）中位数为165.0 mGy·cm。与T3D相比，55 keV的VMI在所有三根评估血管中显示出更好（p<0.05）的整体图像质量、诊断信心、信噪比（SNR）和对比噪声比（CNR）（例如，阅片者1对左旋支动脉：整体图像质量4.5 vs 4.1，CNR 12.1 vs 9.9）。以ICA为参考，对40例患者的132处病变和75个支架评估了诊断性能。与T3D相比，55 keV的VMI在阻塞性狭窄的每处病变准确性方面更高（p<0.05）（阅片者1：96.2% vs 84.1%；阅片者2：97.0% vs 86.4%）；在非钙化和部分钙化斑块、中远端节段病变以及体重指数（BMI）≥24的患者中，两位阅片者也观察到了这些准确性差异。55 keV的VMI和T3D在支架内再狭窄的准确性方面无显著差异（p>0.05）（阅片者1：97.3% vs 96.0%；阅片者2：96.0% vs 94.7%）。采用低辐射和造影剂剂量并使用55 keV的VMI重建的光谱PCD冠状动脉CTA，在检测炎症相关性CAD患者的阻塞性狭窄和支架内再狭窄方面显示出优异的诊断准确性。所提出的方案可用于指导炎症相关性CAD的临床决策。
