(2022) Soschynski | High temporal resolution dual-source PCCT for coronary artery disease

Daniel Stromer

Dual-source PCD-CCTA delivered very good image quality, high contrast-to-noise ratio, and 95% assessability of coronary segments in a real-world multicenter setting.

Coronary segment assessability remained high with low to moderate calcium burden, but declined with very high Agatston scores above 600 and with higher heart rates when high-pitch mode was used.

In the small ICA subgroup, PCD-CCTA showed high per-segment diagnostic performance, supporting its promise for reliable CAD assessment, while larger validation studies are still needed.

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Figure 2. CCTA scan of a 75-year-old male patient with atypical angina pectoris. Risk factors: smoking and hypertension. Normal LV-function, normal resting electrocardiogram (ECG). Unspecific T-wave changes on exercise ECG. Total Agatston score was 589, which corresponded to the 68. percentile (multi-ethnic study of atherosclerosis) [15]. Sequential scan with diastolic acquisition window was performed at heart rate 68/min. All segments were diagnostic, IQ was 1–2. Despite a high plaque burden, all calcified plaques were assessable and could be rated as <50% diameter stenosis, so that significant CAD could be excluded with high certainty.

Protocol

Detail	Value
Scanner	NAEOTOM Alpha
Software	VA40
Scan area	HEART
Scan mode	QuantumPlus ECG-synchronized PCD-CCTA, mode depending on heart rate
Tube voltage [kV]	120
Effective mAs [mAs]	52.5 ± 29.6
IQ level	n.a.
Dose modulation	CARE Dose4D
CTDIvol [mGy]	16.4 ± 25.3
DLP [mGy*cm]	234.1 ± 347.6
Effective dose [mSv]	3.51 ± 5.21 mean; median 1.4
Rotation time [s]	0.25
Pitch	3.2 in high-pitch mode
Matrix	512 × 512
Slice collimation [mm]	144 × 0.4
Z-coverage [mm]	57.6
Slice width [mm]	0.4
Reconstruction increment [mm]	0.3
Reconstruction kernel	Bv40
keV level [keV]	60
Iterative reconstruction	QIR 3
Field of view	Restricted to the heart
Temporal resolution	66 ms
Calcium scoring	Non-contrast high-pitch scan, 120 kV
Scan mode selection	High-pitch if stable HR <65/min; sequential if HR 65–70/min; sequential with wider window if HR >70/min or HR variation >10/min; retrospective low-pitch for tachyarrhythmia >90/min
Contrast agent	Ultravist 370 or iomeprol 400
Contrast volume	60–80 mL
Flow rate	5–6 mL/s
Saline flush	60–80 mL at 5–6 mL/s
Patient preparation	Sublingual nitrates 5 mg; IV metoprolol 5–15 mg if needed

Soschynski M, Hagen F, Baumann S, et al. High Temporal Resolution Dual-Source Photon-Counting CT for Coronary Artery Disease: Initial Multicenter Clinical Experience. J Clin Med. 2022;11(20):6003.