(2025) Hartung | Ultra-high vs Standard Resolution PCCT Angiography for Imaging of Femoral Stents

Daniel Stromer

Ultra-high-resolution (UHR) PCCT provided better subjective image quality than standard-resolution (SR) PCCT for femoral stent CTA, while stent-lumen visibility itself remained comparable between modes.

The study used a perfused human cadaveric upper-leg model with 7 superficial femoral artery stents. SR and UHR acquisitions were dose-matched at 120 kVp and CTDIvol 3, 5, and 10 mGy, with four vascular reconstruction kernels evaluated.

The advantage of UHR became particularly apparent with sharp/ultra-sharp reconstruction: CNR was significantly higher with UHR for BV60 and BV76, and readers preferred UHR image quality across all evaluated kernels, with BV76 ranked highest.

Importantly, the UHR benefit was largest at low radiation dose. With BV76, the relative CNR improvement was 48% at low dose vs 36% at high dose. A 3-mGy UHR acquisition achieved CNR comparable to a 10-mGy SR acquisition (8.0 ± 0.6 vs 9.1 ± 1.1; p > .760).

Clinical implication:

UHR PCCT may be particularly valuable for peripheral stent imaging, where very high spatial resolution and sharp kernels can improve visualization without requiring higher radiation exposure. The findings suggest potential for substantial dose reduction while maintaining high stent image quality, although this remains a cadaveric feasibility study rather than clinical outcome evidence.

Source: Hartung V, Hendel R, Huflage H, et al. Ultra-high Versus Standard Resolution Photon-Counting Detector CT Angiography for Imaging of Femoral Stents in a Cadaveric Perfusion Model. Academic Radiology. 2025;32(1):556–564. doi:10.1016/j.acra.2024.07.038.