PCCT significantly improved specificity, PPV, and overall diagnostic accuracy for obstructive CAD compared to EID-CT, while maintaining equally high sensitivity and NPV.
Fewer patients were referred to invasive coronary angiography after PCCT, but those referred were more likely to undergo revascularization, indicating better clinical decision-making.
PCCT reduced indeterminate findings and unnecessary diagnostic ICA, especially in patients with higher coronary calcium burden.
Central Illustration. Side-by-side coronary CTA images demonstrate clearer lumen visualization and reduced blooming artifacts with PCCT, particularly in heavily calcified vessels. Clinically, this translated into fewer ICA referrals (9.9% vs 13.1%), but higher yield of revascularization when referred (43.4% vs 35.5%), highlighting improved diagnostic confidence and patient selection.
Source: Sakai et al., JACC, 2024
Protocol
Detail | Value |
|---|
Scanner (PCCT) | NAEOTOM Alpha |
Scan area | Coronary CTA |
Scan mode | QuantumPlus (98.9%) QuantumHD (minor subset) The acquisition window was set to 60% to 80% of the cardiac cycle for heart rates <65 beats/min; for higher heart rates, an automated decision tree was used to determine the optimal window. |
Total radiation [mSv] | 11.7 ± 8.4 |
Tube voltage [kV] | 140 |
Slice thickness [mm] | 0.4 SR | 0.2 UHR |
Slice collimation [mm] | 144 × 0.4 SR | 120 × 0.2 UHR |
Reconstruction | QIR 3 |
Contrast volume | 60–90 mL |
Flow rate | 4–6 mL/s |
Heart rate control | Beta-blockers (target <65 bpm) + nitroglycerin |
Sakai K, Shin D, Singh M, et al. Diagnostic Performance and Clinical Impact of Photon-Counting Detector Computed Tomography in Coronary Artery Disease. J Am Coll Cardiol. 2024;85(4).
