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Objective <p>To evaluate the patient-, vessel- and segment-based diagnostic performance of photon-counting detector CT (PCD-CT) compared to energy-integrating detector CT (EID-CT) for detecting ≥ 50% or ≥ 70% stenosis using invasive coronary angiography (ICA) as a reference standard.</p> Materials and methods <p>Patients with stable chest pain and ≥ 50% stenosis detected on dual source PCD-CT who subsequently underwent ICA were prospectively enroled. Diagnostic accuracy was calculated for PCD-CT vs ICA and additionally for a patient cohort scanned with EID-CT with similar risk profiles and disease prevalence. A Monte Carlo simulation based on diagnostic accuracy parameters was performed to estimate the potential reduction in ICA referrals.</p> Results <p>A total of 143 patients (66 ± 9 years, 27.3% female) with 572 vessels and 2431 segments were evaluated with PCD-CT and ICA. Regarding EID-CT, 109 patients (65 ± 9 years, 31.0% female), 436 vessels and 1853 segments were assessed, with every patient undergoing ICA. PCD-CT demonstrated significantly higher accuracy than EID-CT in detecting ≥ 50% stenosis: 88.1% vs 77.9% (patient level), 91.6% vs 77.8% (vessel level), and 97.7% vs 92.4% (segment level) (<i>p</i> &lt; 0.01 for all). For detecting ≥ 70% stenosis, PCD-CT also showed higher accuracy than EID-CT: 90.9% vs 70.6% (patient level), 94.6% vs 80.9% (vessel level), and 98.6% vs 94.1% (segment level) (<i>p</i> &lt; 0.01 for all). We demonstrated a potential mean reduction of 14.8% in ICA referrals when utilising PCD-CT compared to EID-CT.</p> Conclusions <p>PCD-CT provides improved per-patient, per-vessel and per-segment diagnostic performance in detecting obstructive CAD in symptomatic patients when compared to patients scanned on EID-CT. PCD-CT may lead to a significant decrease in ICA utilisation.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>Accurate coronary CT angiography guides treatment, but its diagnostic accuracy is limited by various factors</i>.</p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>Photon counting detector (PCD)-CT improved diagnostic performance in detecting ≥ 50% or ≥ 70% stenosis, potentially reducing unnecessary ICA referrals by 14.8%</i>.</p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>PCD-CT improves diagnostic accuracy over EID-CT and may reduce unnecessary ICA</i>.</p> Graphical Abstract <p></p>

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Comparative analysis of photon-counting and energy-integrating detector CT to identify obstructive coronary artery disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月14日

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  • Melinda Boussoussou,
  • Milán Vecsey-Nagy,
  • Zsófia Jokkel,
  • Borbála Vattay,
  • Anikó Kubovje,
  • Barbara Sipos,
  • Márton Kolossváry,
  • Anikó Ilona Nagy,
  • Lili Száraz,
  • Sámuel Beke,
  • Bernard Schmidt,
  • Máté Kiss,
  • Béla Merkely,
  • Josua A. Decker,
  • Tilman Emrich,
  • Akos Varga-Szemes,
  • Pál Maurovich-Horvat,
  • Bálint Szilveszter

摘要

Objective

To evaluate the patient-, vessel- and segment-based diagnostic performance of photon-counting detector CT (PCD-CT) compared to energy-integrating detector CT (EID-CT) for detecting ≥ 50% or ≥ 70% stenosis using invasive coronary angiography (ICA) as a reference standard.

Materials and methods

Patients with stable chest pain and ≥ 50% stenosis detected on dual source PCD-CT who subsequently underwent ICA were prospectively enroled. Diagnostic accuracy was calculated for PCD-CT vs ICA and additionally for a patient cohort scanned with EID-CT with similar risk profiles and disease prevalence. A Monte Carlo simulation based on diagnostic accuracy parameters was performed to estimate the potential reduction in ICA referrals.

Results

A total of 143 patients (66 ± 9 years, 27.3% female) with 572 vessels and 2431 segments were evaluated with PCD-CT and ICA. Regarding EID-CT, 109 patients (65 ± 9 years, 31.0% female), 436 vessels and 1853 segments were assessed, with every patient undergoing ICA. PCD-CT demonstrated significantly higher accuracy than EID-CT in detecting ≥ 50% stenosis: 88.1% vs 77.9% (patient level), 91.6% vs 77.8% (vessel level), and 97.7% vs 92.4% (segment level) (p < 0.01 for all). For detecting ≥ 70% stenosis, PCD-CT also showed higher accuracy than EID-CT: 90.9% vs 70.6% (patient level), 94.6% vs 80.9% (vessel level), and 98.6% vs 94.1% (segment level) (p < 0.01 for all). We demonstrated a potential mean reduction of 14.8% in ICA referrals when utilising PCD-CT compared to EID-CT.

Conclusions

PCD-CT provides improved per-patient, per-vessel and per-segment diagnostic performance in detecting obstructive CAD in symptomatic patients when compared to patients scanned on EID-CT. PCD-CT may lead to a significant decrease in ICA utilisation.

Key Points

Question Accurate coronary CT angiography guides treatment, but its diagnostic accuracy is limited by various factors.

Findings Photon counting detector (PCD)-CT improved diagnostic performance in detecting ≥ 50% or ≥ 70% stenosis, potentially reducing unnecessary ICA referrals by 14.8%.

Clinical relevance PCD-CT improves diagnostic accuracy over EID-CT and may reduce unnecessary ICA.

Graphical Abstract