Coronary stent imaging remains limited with conventional CT. In this patient study we evaluated the quality of coronary stent imaging and determined the optimal reconstruction settings for ultra-high-resolution (UHR) coronary CT angiography (cCTA) with clinical photon-counting-detector CT (PCD-CT).
In this retrospective dual-center study, 22 patients with 36 coronary stents who underwent UHR cCTA with PCD-CT were included. Images with a slice thickness of 0.6mm and Bv40 kernel and UHR images at a slice thickness of 0.2mm with kernels of eight sharpness levels (Bv40, Bv44, Bv56, Bv60, Bv64, Bv72, Bv80, and Bv89) and adapted matrix-sizes and field-of-views were reconstructed. Image noise, contrast-to-noise-ratio (CNR), in-stent diameters, and differences of in-stent attenuation compared with adjacent segments were measured. Stent strut sharpness was quantified using data derived from line profiles. Subjective in-stent lumen visualization was rated by two blinded, independent readers. In-vitro stent diameters were taken as reference standard.
At increasing kernel sharpness, CNR decreased, in-stent diameter increased (1.8 ± 0.5mm for 0.6mm/Bv40 to 2.5 ± 0.5mm for 0.2mm/Bv89), and stent strut sharpness increased. Differences of in-stent attenuation decreased from 0.6mm/Bv40 to 0.2 mm/Bv60-Bv80 kernels, being not different from zero for the latter kernels (p > 0.05). Percentage (absolute) differences of measured to in-vitro diameters decreased from 40.1 ± 11.1% (1.2 ± 0.4mm) for 0.6mm/Bv40 to 16.6 ± 8% (0.5 ± 0.3mm) for 0.2mm/Bv89. There were no associations between stent angulation and in-stent diameter or attenuation differences (p > 0.05). Qualitative scores increased from suboptimal/good for 0.6mm/Bv40 to very good/excellent for 0.2mm/Bv64 and 0.2mm/Bv72.
UHR cCTA with clinical PCD-CT enables excellent in-vivo coronary stent lumen visualization.
Abbreviations:CNR (Contrast-to-noise ratio), CT (Computed tomography), cCTA (Coronary computed tomography angiography), ECG (Electrocardiography), FoV (Field-of-View), HU (Hounsfield Unit), ISL (In-stent-lumen), PCD (Photon-counting detector), UHR (Ultra high resolution)
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Published online: March 08, 2023
Accepted: February 28, 2023
Received in revised form: February 26, 2023
Received: January 27, 2023
Publication stageIn Press Journal Pre-Proof
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