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Comparative Study
. 2024 Jul;31(7):2973-2986.
doi: 10.1016/j.acra.2024.02.008. Epub 2024 Feb 24.

Photon-Counting Detector CT Angiography Versus Digital Subtraction Angiography in Patients with Peripheral Arterial Disease

Anne Marie Augustin  1 , Viktor Hartung  2 , Jan-Peter Grunz  2 , Jan-Lucca Hennes  2 , Henner Huflage  2 , Thorsten Alexander Bley  2 , Bernhard Petritsch  2 , Philipp Gruschwitz  2
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Free article
Comparative Study

Photon-Counting Detector CT Angiography Versus Digital Subtraction Angiography in Patients with Peripheral Arterial Disease

Anne Marie Augustin et al. Acad Radiol. 2024 Jul.
Free article

Abstract

Rationale and objectives: This study aims to compare the diagnostic confidence of photon-counting detector CT angiography (PCD-CTA) depending on the used vascular reformatting kernels with digital subtraction angiography (DSA) as diagnostic reference standard in peripheral arterial occlusive disease (PAOD).

Material and methods: In 39 patients, 45 lower extremity PCD-CTA with subsequent DSA were analyzed. Advanced PAOD (Fontaine stage 4) was ascertained in 77.8% of patients. CTA post-processing comprised three vascular kernels (Bv36/48/56). Objective image quality assessment included vessel attenuation, image noise, contrast-to-noise (CNR) and signal-to-noise ratios (SNR). Subjective evaluation of calcium blooming, vessel sharpness, luminal attenuation and image noise was performed by three radiologists. Diagnostic performance and concordance to DSA were assessed.

Results: The luminal attenuation remained kernel-independent constant. With sharper kernels, image noise increased substantially, while SNR and CNR decreased. Subjective reduction of calcium blooming and increased vessel sharpness were noted for the sharp Bv56 kernel. While sensitivity in stenosis quantification was comparable between kernels (81.6% vs. 81.5% vs. 81.0%, p = 0.797), specificity increased slightly higher sharpness (71.1% vs. 76.9% vs. 79.6%, p = 0.067). Diagnostic concordance of stenosis ratings compared to DSA increased likewise (Bv36 vs. Bv56, p = 0.002). Severe crural vessel calcifications had no influence on sensitivity, regardless of kernel selection. Contrarily, specificity was substantially worse in severely calcified tibial vessels but could be improved by using the sharp Bv56 kernel (Bv36 vs. Bv56 p = 0.024). Diagnostic confidence was highest for Bv56.

Conclusion: In lower leg PCD-CTA, sharp convolution kernels increase diagnostic confidence compared to DSA by improved vessel delineation and reduced calcium blooming with acceptable image noise.

Keywords: Digital subtraction angiography; Peripheral arterial disease; Photon-counting detector CT; Run-off CTA.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Philipp Gruschwitz reports financial support was provided by Interdisciplinary Center of Clinical Research Würzburg. Jan-Peter Grunz reports financial support was provided by Interdisciplinary Center of Clinical Research Würzburg. Thorsten Alexander Bley reports a relationship with Siemens Healthineers that includes: consulting or advisory and speaking and lecture fees. Bernhard Petritsch reports a relationship with Siemens Healthineers that includes: consulting or advisory and speaking and lecture fees. Jan-Peter Grunz reports a relationship with Siemens Healthineers that includes: consulting or advisory and speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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