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.
