Gadolinium-based coronary CT angiography on a clinical photon-counting-detector system: a dynamic circulating phantom study.

IF 3.7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING European Radiology Experimental Pub Date : 2024-10-18 DOI:10.1186/s41747-024-00501-w
Dmitrij Kravchenko, Chiara Gnasso, U Joseph Schoepf, Milan Vecsey-Nagy, Giuseppe Tremamunno, Jim O'Doherty, Andrew Zhang, Julian A Luetkens, Daniel Kuetting, Ulrike Attenberger, Bernhard Schmidt, Akos Varga-Szemes, Tilman Emrich
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Abstract

Background: Coronary computed tomography angiography (CCTA) offers non-invasive diagnostics of the coronary arteries. Vessel evaluation requires the administration of intravenous contrast. The purpose of this study was to evaluate the utility of gadolinium-based contrast agent (GBCA) as an alternative to iodinated contrast for CCTA on a first-generation clinical dual-source photon-counting-detector (PCD)-CT system.

Methods: A dynamic circulating phantom containing a three-dimensional-printed model of the thoracic aorta and the coronary arteries were used to evaluate injection protocols using gadopentetate dimeglumine at 50%, 100%, 150%, and 200% of the maximum approved clinical dose (0.3 mmol/kg). Virtual monoenergetic image (VMI) reconstructions ranging from 40 keV to 100 keV with 5 keV increments were generated on a PCD-CT. Contrast-to-noise ratio (CNR) was calculated from attenuations measured in the aorta and coronary arteries and noise measured in the background tissue. Attenuation of at least 350 HU was deemed as diagnostic.

Results: The highest coronary attenuation (441 ± 23 HU, mean ± standard deviation) and CNR (29.5 ± 1.5) was achieved at 40 keV and at the highest GBCA dose (200%). There was a systematic decline of attenuation and CNR with higher keV reconstructions and lower GBCA doses. Only reconstructions at 40 and 45 keV at 200% and 40 keV at 150% GBCA dose demonstrated sufficient attenuation above 350 HU.

Conclusion: Current PCD-CT protocols and settings are unsuitable for the use of GBCA for CCTA at clinically approved doses. Future advances to the PCD-CT system including a 4-threshold mode, as well as multi-material decomposition may add new opportunities for k-edge imaging of GBCA.

Relevance statement: Patients allergic to iodine-based contrast media and the future of multicontrast CT examinations would benefit greatly from alternative contrast media, but the utility of GBCA for coronary photon-counting-dector-CT angiography remains limited without further optimization of protocols and scanner settings.

Key points: GBCA-enhanced coronary PCD-CT angiography is not feasible at clinically approved doses. GBCAs have potential applications for the visualization of larger vessels, such as the aorta, on PCD-CT angiography. Higher GBCA doses and lower keV reconstructions achieved higher attenuation values and CNR.

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临床光子计数探测器系统上的钆基冠状动脉 CT 血管造影:动态循环模型研究。
背景:冠状动脉计算机断层扫描血管造影术(CCTA)可对冠状动脉进行无创诊断。血管评估需要静脉注射造影剂。本研究的目的是评估在第一代临床双源光子计数探测器(PCD)-CT 系统上使用钆基造影剂(GBCA)替代碘化造影剂进行 CCTA 的实用性:方法:使用一个包含胸主动脉和冠状动脉三维打印模型的动态循环模型来评估使用钆喷酸二葡胺的注射方案,注射剂量为批准的最大临床剂量(0.3 毫摩尔/千克)的 50%、100%、150% 和 200%。在 PCD-CT 上生成的虚拟单能量图像 (VMI) 重建范围从 40 keV 到 100 keV,增量为 5 keV。根据主动脉和冠状动脉测得的衰减和背景组织测得的噪声计算出对比-噪声比(CNR)。至少 350 HU 的衰减被视为具有诊断意义:结果:在 40 keV 和最高 GBCA 剂量(200%)下,冠状动脉衰减(441 ± 23 HU,平均值 ± 标准偏差)和 CNR(29.5 ± 1.5)最高。衰减和 CNR 随较高的 KeV 重建和较低的 GBCA 剂量而系统性下降。只有 GBCA 剂量为 200% 的 40 和 45 keV 重建以及 GBCA 剂量为 150% 的 40 keV 重建显示出 350 HU 以上的足够衰减:结论:目前的 PCD-CT 方案和设置不适合将 GBCA 用于临床认可剂量的 CCTA。PCD-CT 系统未来的进步包括 4 阈值模式和多材料分解,这可能会为 GBCA 的 k 边成像增加新的机会:对碘基造影剂过敏的患者以及未来的多对比 CT 检查将从替代造影剂中获益匪浅,但如果不进一步优化方案和扫描仪设置,GBCA 在冠状动脉光子计数矢量 CT 血管造影中的应用仍然有限:要点:GBCA 增强冠状动脉 PCD-CT 血管造影在临床认可的剂量下是不可行的。GBCA 有可能应用于 PCD-CT 血管造影对主动脉等较大血管的成像。较高的 GBCA 剂量和较低的 keV 重建可获得较高的衰减值和 CNR。
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来源期刊
European Radiology Experimental
European Radiology Experimental Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
6.70
自引率
2.60%
发文量
56
审稿时长
18 weeks
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