Universität zu Köln

Bratke, Grischa, Hickethier, Tilman, Bar-Ness, Daniel, Bunck, Alexander Christian, Maintz, David, Pahn, Gregor, Coulon, Philippe, Si-Mohamed, Salim, Douek, Philippe and Sigovan, Monica (2020). Spectral Photon-Counting Computed Tomography for Coronary Stent Imaging Evaluation of the Potential Clinical Impact for the Delineation of In-Stent Restenosis. Invest. Radiol., 55 (2). S. 61 - 68. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1536-0210

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Abstract

Objectives In-stent restenosis (ISR) is one of the main long-term complications after coronary stent placement, and the ability to evaluate ISR noninvasively using coronary computed tomography (CT) angiography remains challenging. For this application, spectral photon-counting CT (SPCCT) has the potential to increase image quality and reduce artifacts due to its advanced detector technology. Our study aimed to verify the technical and clinical potential of a novel SPCCT prototype using an ISR phantom setup. Materials and Methods Soft plaque-like restenosis (45 HU; approximately 50% of the stent lumen) were inserted into 10 different coronary stents (3 mm diameter), which were placed in a vessel phantom and filled with a contrast agent (400 HU). A research prototype SPCCT and a clinical dual-layer CT (DLCT; IQon; Philips) with comparable acquisition and reconstruction parameters were used to scan the phantoms. Conventional polyenergetic (PolyE) and monoenergetic (MonoE) images with 4 different energy levels (40, 60, 90, 120 keV) were reconstructed. Qualitative (delineation of the stenosis and adjacent residual lumen using a 5-point Likert scale) and quantitative (image noise, visible lumen diameter, lumen diameter adjacent to the stenosis, contrast-to-noise ratio of the restenosis) parameters were evaluated for both systems. Results The qualitative results averaged over all reconstructions were significantly superior for SPCCT compared with DLCT (eg, subjective rating of the best reconstruction of each scanner: DLCT PolyE: 2.80 +/- 0.42 vs SPCCT MonoE 40 keV: 4.25 +/- 1.03). Stenosis could be clearly detected in 9 and suspected in 10 of the 10 stents with both SPCCT and DLCT. The residual lumen next to the stenosis was clearly delineable in 7 of 10 stents (0.64 +/- 0.11 mm or 34.97% of the measured stent lumen) with SPCCT, while it was not possible to delineate the residual lumen for all stents using DLCT. The measured diameter of the lumen within the stent was significantly higher for SPCCT compared with DLCT in all reconstructions with the best results for the MonoE 40 keV images (SPCCT: 1.80 +/- 0.17 mm; DLCT: 1.50 +/- 0.31 mm). The image noise and the contrast-to-noise ratio were better for DLCT than for SPCCT (contrast-to-noise ratio: DLCT MonoE 40: 31.58 +/- 12.54; SPCCT MonoE 40: 4.64 +/- 1.30). Conclusions Spectral photon-counting CT allowed for the noninvasive evaluation of ISR with reliable results regarding the residual lumen for most tested stents and the clear identification or suspicion of stenosis for all stents. In contrast, the residual lumen could not be detected for a single stent using DLCT.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bratke, Grischa UNSPECIFIED UNSPECIFIED UNSPECIFIED Hickethier, Tilman UNSPECIFIED UNSPECIFIED UNSPECIFIED Bar-Ness, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Bunck, Alexander Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Maintz, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Pahn, Gregor UNSPECIFIED UNSPECIFIED UNSPECIFIED Coulon, Philippe UNSPECIFIED UNSPECIFIED UNSPECIFIED Si-Mohamed, Salim UNSPECIFIED UNSPECIFIED UNSPECIFIED Douek, Philippe UNSPECIFIED UNSPECIFIED UNSPECIFIED Sigovan, Monica UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-347795
DOI:	10.1097/RLI.0000000000000610
Journal or Publication Title:	Invest. Radiol.
Volume:	55
Number:	2
Page Range:	S. 61 - 68
Date:	2020
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1536-0210
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CT ANGIOGRAPHY; REVASCULARIZATION; DIAGNOSIS; OUTCOMES; ENERGY Multiple languages Radiology, Nuclear Medicine & Medical Imaging Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/34779