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. 2021 Oct 1;56(10):653-660.
doi: 10.1097/RLI.0000000000000787.

Photon-Counting Computed Tomography for Coronary Stent Imaging: In Vitro Evaluation of 28 Coronary Stents

Bernhard Petritsch  1 , Nils Petri  2 , Andreas M Weng  1 , Martin Petersilka  3 , Thomas Allmendinger  3 , Thorsten A Bley  1 , Tobias Gassenmaier  1
Affiliations

Photon-Counting Computed Tomography for Coronary Stent Imaging: In Vitro Evaluation of 28 Coronary Stents

Bernhard Petritsch et al. Invest Radiol. .

Abstract

Objectives: The aim of this study was to assess in-stent lumen visibility and quantitative image characteristics of different coronary stents using a novel photon-counting detector (PCD) computed tomography (CT) system in comparison to a state-of-the-art energy-integrating detector (EID) CT scanner.

Materials and methods: In this in vitro phantom study, 28 different coronary stents ranging from 2.25 to 4.5 mm lumen diameter were expanded into plastic tubes filled with contrast agent. Stent-containing plastic tubes were positioned in a custom-made emulsion-filled phantom, which was inserted into an anthropomorphic phantom simulating a medium-sized patient. Computed tomography scans were acquired parallel to the scanners' z axis using a novel cadmium telluride-based PCD CT system (SOMATOM CountPlus; Siemens Healthcare GmbH, Forchheim Germany), operating in 2 different modes (standard-resolution mode [SR] and ultra-high-resolution [UHR] mode), and a latest generation dual-source EID CT system (SOMATOM Force; Siemens Healthcare GmbH, Forchheim). CTDIvol-matched images were reconstructed with comparable convolution kernels and using the same reconstruction parameters. In-stent lumen visibility (in %), increase in in-stent attenuation (expressed as Δ in-stent CT attenuation), and image noise (in Hounsfield unit) were manually measured. Parts of the image analysis (in-stent lumen visibility) were additionally performed in an automated way. Differences were tested using Wilcoxon signed rank test.

Results: The best in-stent lumen visibility was achieved with the PCD-UHR mode and the lowest noise levels with the PCD-SR mode. The median in-stent lumen visibility was significantly higher (P < 0.001) with PCD (SR, 66.7%; interquartile range [IQR], 63.3-72.3; UHR, 68.9%; IQR, 64.4-74.4) compared with EID (65.4%; IQR, 62.2-70.4). The Δ in-stent CT attenuation was significantly lower for PCD in both SR (78 HU; IQR, 46-108; P = 0.024) and UHR (85 HU; IQR, 59-113; P = 0.006) compared with EID (108 HU; IQR, 85-126). Image noise was significantly lower (P < 0.001) for PCD-SR (21 HU; IQR, 21-21) compared with EID images (25 HU; IQR, 24-25.0).

Conclusions: The PCD provides superior in-stent lumen visibility and quantitative image characteristics when compared with conventional EID.

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Conflict of interest statement

Conflicts of interest and sources of funding: B.P. received speaker honoraria from Siemens Healthcare GmbH. Two authors (M.P. and T.A.) are employees of Siemens Healthcare GmbH. Authors who are not employees of or consultants for Siemens had control of inclusion of any data and information that might present a conflict of interest for the authors who are employees of that company. For the remaining authors, none were declared.

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