Ultra-high spatial resolution photon counting detector CT (PCCT) can improve the assessment of coronary artery disease (CAD), reclassifying the disease to a lower category in 54% of patients, researchers have found.

The technology has the potential to improve patient management and reduce unnecessary interventions, according to the team, including corresponding author Tillman Emrich, MD, of the Medical University of South Carolina in Charleston. The findings were published on February 20th. Radiology.

“Our study provides a glimpse into the potential impact of performing coronary CT angiography. [CCTA] “We use ultra-high spatial resolution techniques to reclassify risks and recommend downstream testing,” he said in a statement released by RSNA.

Coronary CT angiography (CCTA) is the go-to imaging test for evaluating CAD, but its diagnostic value is limited in patients with calcium buildup in coronary artery plaques, the researchers explained. Ultra-high spatial resolution PCCT offers better image quality and spatial resolution than conventional CT and is therefore promising for this specific indication.

Tilman’s group used ultra-high spatial resolution PCCT to evaluate coronary artery stenosis in a vascular phantom containing two different stenosis grades (25% and 50%) and PCCT findings in 114 people undergoing evaluation for CAD. Did. The research team compared the phantom results to the manufacturer’s specifications and used the Coronary Artery Disease Reporting and Data System (CAD-RADS) to interpret the patient results.

The researchers found that the PCCT phantom results not only showed a reduction in stenosis overestimation by mitigating the negative effects of calcification on images, but also in patients with suspected or diagnosed CAD. We also found that PCCT results showed a lower median degree of stenosis. Percentage of calcified plaques compared to conventional his CT images – 29% vs. 42%. In fact, of the 114 patients, the researchers reported that 54% were given a lower CAD-RADS classification than originally assigned.

Coronary CT angiography in case of suspected progression of known coronary artery disease in a 56-year-old female patient. Curved multiplanar reconstructions with cross-sectional thicknesses of 0.6 mm (yellow outline), 0.4 mm (blue outline), and 0.2 mm (green outline) show calcified plaque (arrow) and coronary artery stenosis (inset image), respectively. is shown. As the section thickness decreases, there will be less calcium bloom and therefore the assessment of the percentage of coronary artery stenosis in this patient will be less demanding. Images and captions courtesy of RSNA.