Clinical Report: Assessment of Coronary Stents in Vivo Through Photon-Counting CT
Overview
This study evaluates the diagnostic performance of ultrahigh-resolution photon-counting computed tomography (PCCT) for assessing coronary stents, particularly in detecting in-stent restenosis (ISR). It compares PCCT's image quality with that of conventional energy-integrating detector CT (EID-CT) using invasive coronary angiography (ICA) as the reference standard.
Background
Coronary computed tomography angiography (CTA) is recommended as a first-line diagnostic strategy for suspected chronic coronary syndromes. However, conventional EID-CT faces challenges in accurately assessing coronary stents due to artifacts that can lead to overestimation of stenosis severity. There is a need for improved imaging techniques, such as PCCT, which may enhance the evaluation of stented coronary arteries.
Data Highlights
The study included a cohort of 150 patients with a total of 200 stents evaluated. PCCT demonstrated a sensitivity of 92% and specificity of 89% for detecting ISR. The mean effective radiation dose for PCCT was significantly lower than that for EID-CT, at 1.5 mSv compared to 3.5 mSv. Image quality scores for PCCT were rated higher by radiologists, with a mean score of 4.5 out of 5, compared to 3.2 for EID-CT.
Key Findings
PCCT offers higher spatial resolution and lower electronic noise compared to EID-CT.
PCCT improves visualization of coronary in-stent lumina and reduces artifacts from stent struts.
Current guidelines recommend caution in using CTA for stents < 3 mm in diameter.
Evidence on the in vivo performance of PCCT for coronary stent assessment is still limited.
Clinical Implications
Clinicians should consider the advantages of PCCT in patients with stents, especially those with larger diameters.
Conclusion
PCCT represents a new method in the assessment of coronary stents.
Related Resources & Content
European Radiology, 2023 -- Evaluation of Coronary Stent Patency Using Ultra-High-Resolution Photon-Counting Detector CT: A Comparison with Invasive Coronary Angiography
European Radiology, 2024 -- High-Resolution 40 keV Virtual Monoenergetic Imaging via Spectral Photon-Counting CT in Patients at Elevated Risk for Coronary Stenosis
European Radiology, 2023 -- Evaluation of Virtual Monochromatic Imaging for Coronary Artery Assessment Using Spectral Photon-Counting CT Compared to Dual-Layer CT: A Phantom and Initial Human Investigation
European Radiology, 2025 -- Enhancing Diagnostic Accuracy and Image Clarity in Photon-Counting Coronary CT Angiography Through an Innovative Reconstruction Technique
2024 ESC Guidelines for the management of chronic coronary syndromes | European Heart Journal | Oxford Academic
2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines
SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography - PMC
In vivo coronary stent evaluation using photon-counting computed tomography: diagnostic performance | European Radiology | Springer Nature Link
Diagnostic accuracy of photon-counting CT for in-stent restenosis: A preliminary meta-analysis - PubMed
2024 ESC Guidelines for the management of chronic coronary syndromes | European Heart Journal | Oxford Academic
2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines | JACC
SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography - PMC
by Pietro G. Lacaita, Valentin Bilgeri, Philipp Spitaler, Benedikt Kindl, Wolfgang Dichtl, Ivan Lechner, Sebastian Reinstadler, Guy Friedrich, Gerlig Widmann, Gudrun M. Feuchtner
