Nakashima Mitsutaka, Miyoshi Toru, Hara Shohei, Miyagi Ryosuke, Nishihara Takahiro, Miki Takashi, Osawa Kazuhiro, Yuasa Shinsuke
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
Department of General Internal Medicine 3, Kawasaki Medical School General Medicine Centre, Okayama 700-8505, Japan.
J Clin Med. 2025 Aug 26;14(17):6049. doi: 10.3390/jcm14176049.
Coronary CT angiography (CCTA) is a cornerstone in evaluating stable coronary artery disease (CAD), but conventional energy-integrating detector CT (EID-CT) has limitations, including calcium blooming and limited spatial resolution. Photon-counting detector CT (PCD-CT) may overcome these drawbacks through enhanced spatial resolution and improved tissue characterization. : In this retrospective, propensity score-matched study, we compared CCTA findings from 820 patients (410 per group) who underwent either EID-CT or PCD-CT for suspected stable CAD. Primary outcomes included stenosis severity, high-risk plaque features, and downstream invasive coronary angiography (ICA) referral and yield. : The matched cohorts were balanced in demographics and cardiovascular risk factors (mean age 67 years, 63% male). PCD-CT showed a favorable shift in stenosis severity distribution ( = 0.03). High-risk plaques were detected less frequently with PCD-CT (22.7% vs. 30.5%, = 0.01). Median coronary calcium scores did not differ ( = 0.60). Among patients referred for ICA, those initially evaluated with PCD-CT were more likely to undergo revascularization (62.5% vs. 44.1%), and fewer underwent potentially unnecessary ICA without revascularization (3.7% vs. 8.0%, = 0.001). The specificity in diagnosing significant stenosis requiring revascularization was 0.74 with EID-CT and 0.81 with PCD-CT ( = 0.04). : PCD-CT improved diagnostic specificity for CAD, reducing unnecessary ICA referrals while maintaining detection of clinically significant disease. This advanced CT technology holds promise for more accurate, efficient, and patient-centered CAD evaluation.
冠状动脉CT血管造影（CCTA）是评估稳定型冠状动脉疾病（CAD）的基石，但传统的能量积分探测器CT（EID-CT）存在局限性，包括钙化伪影和空间分辨率有限。光子计数探测器CT（PCD-CT）可能通过提高空间分辨率和改善组织特征来克服这些缺点。在这项回顾性、倾向评分匹配研究中，我们比较了820例因疑似稳定型CAD而接受EID-CT或PCD-CT检查的患者（每组410例）的CCTA结果。主要结局包括狭窄严重程度、高危斑块特征以及下游侵入性冠状动脉造影（ICA）转诊和阳性率。匹配队列在人口统计学和心血管危险因素方面均衡（平均年龄67岁，63%为男性）。PCD-CT显示狭窄严重程度分布有有利变化（P=0.03）。PCD-CT检测到的高危斑块较少（22.7%对30.5%，P=0.01）。冠状动脉钙化评分中位数无差异（P=0.60）。在转诊接受ICA检查的患者中，最初接受PCD-CT评估的患者更有可能接受血运重建（62.5%对44.1%），而接受无血运重建的潜在不必要ICA检查的患者较少（3.7%对8.0%，P=0.001）。EID-CT诊断需要血运重建的显著狭窄的特异性为0.74，PCD-CT为0.81（P=0.04）。PCD-CT提高了CAD的诊断特异性，减少了不必要的ICA转诊，同时保持了对临床显著疾病的检测。这种先进的CT技术有望实现更准确、高效和以患者为中心的CAD评估。
