Intra-individual comparison of coronary artery stenosis measurements between energy-integrating detector CT and photon-counting detector CT

Abstract

To compare intra-individual percentage diameter stenosis (PDS) measurements of coronary artery stenoses between energy-integrating detector computed tomography (EID-CT) and a clinical photon-counting detector computed tomography (PCD-CT) systems using similar acquisition and reconstruction settings.Patients (n = 23, mean age of 65 ± 12.1 years, out of these 16 (69.6%) male) were imaged on a conventional EID- and a clinical PCD-CT system with a median of 5.5 (3.0–12.5) days apart. Sequential CCTA scans were acquired and reconstructed using similar settings, including a vascular Bv36 kernel, a tube voltage of 110 kVp for EID-CT vs 120 kVp for PCD-CT, a slice thickness of 0.5 for EID-CT vs 0.6 for PCD-CT, and an iterative reconstruction strength of 3 on EID-CT vs a virtual monoenergetic reconstruction at 55 keV and quantum iterative reconstruction level of 3 on PCD-CT. Radiation dose, contrast volume, and injection parameters were matched as similarly as possible between the systems. PDS measurements were performed according to the coronary artery disease reporting and data system (CAD-RADS) by two trained readers and compared between the different modalities using the Wilcoxon rank sum test, Spearman correlation, and Bland-Altman analysis.PCD-CT measured significantly lower PDS values than EID-CT [PDSEID-CT: 45.1% (35.1%–64.0%) vs. PDSPCD-CT 44.2% (32.4%–61.0%), P < 0.0001]. This difference led to a mean bias of 1.8 (LoA −3.0/6.5) with an excellent ICC (0.99) value among EID- and PCD-CT. The mean intra-individual deviation between the examinations was 1.8% between the scanners. This led to CAD-RADS re-classification in 3/23 cases (13.0%, new-lower class) for the first reader, and in 4/23 cases (13.0%, new-lower and 4.4%, new-higher class) for the second reader. Inter-reader agreement between the two readers for each stenosis was very strong (ICC = 0.98).Coronary artery stenosis measurements from PCD-CT correlate strongly to EID-CT-based measurements, despite the tendency of the measurement from PCD-CT being lower. This difference led to a change in CAD-RADS classification in 17.4% of patients. The effects on clinical decision-making, downstream testing, and prognosis have to be evaluated in future studies.