Juul Bierens, Jelske Kuijpers, Florentina M E Pinckaers, Luca Saba, Luc J M Smits, Robert J van Oostenbrugge, Thomas Flohr, M Eline Kooi, Alida A Postma
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引用次数: 0
Abstract
Background: Conventional energy-integrating detector (EID) CT is limited in differentiating soft-plaque components due to overlapping attenuation values and is frequently affected by calcification-related blooming artifacts that obscure the vessel lumen and may overestimate stenosis. Photon-counting detector CT (PCD-CT) can provide enhanced spatial resolution and spectral discrimination compared with conventional EID-CT, potentially improving carotid plaque characterization and mitigating artifact-related limitations. This study systematically evaluated image quality, plaque component attenuation, and stenosis visualization across spectral PCD-CT reconstructions.
Methods: We retrospectively included patients who underwent PCD-CT for carotid stenosis assessment. Four monoenergetic (ME 40, 55, 70, and 85 keV), PureLumen (PL), and virtual noncontrast (VNC) reconstructions were analyzed. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), edge sharpness, plaque area, degree of NASCET stenosis, and attenuation of plaque components (intraplaque hemorrhage, lipid-rich necrotic core, fibrotic tissue, calcification) were compared using repeated-measures ANOVA with Bonferroni correction.
Results: Our study included 27 patients (16 men, age: 74.5±9.1 y) with 50 plaques. CNR, SNR, and noise decreased with increasing ME levels ( P <0.001). PL yielded CNR and sharpness comparable to ME55, whereas VNC exhibited a near-zero lumen signal. Stenosis remained consistent across ME reconstructions (44% to 45%, P =1.00), but significantly reduced for PL (38%, P <0.001). Lower-energy reconstructions (ME40/ME55) improved the separation of attenuation values between the lumen and the various plaque components.
Conclusion: Low-energy PCD-CT reconstructions enhance CNR and sharpness while maintaining consistent plaque and stenosis measurements. The PL algorithm may improve the assessment of calcified plaques, where conventional reconstructions may overestimate stenosis. PCD-CT shows promise for advanced plaque composition evaluation, but further validation against MRI and histology is warranted.
期刊介绍：
Investigative Radiology publishes original, peer-reviewed reports on clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, and related modalities. Emphasis is on early and timely publication. Primarily research-oriented, the journal also includes a wide variety of features of interest to clinical radiologists.
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