Protocols

@Bálint Szilveszter, Borbála Vattay, Péter Csongor, @Milan Vecsey-Nagy Városmajor Heart and Vascular Centre, Cardiac CT Working Group, Budapest, Hungary September 29, 2026 History Why did the patient come for a CT exam? A 63-year-old female patient, presenting with typical chest pain, was referred for coronary imaging to…

Ferenc Imre Suhai, Barbara Sipos, Milán Vecsey-Nagy, Bálint Szilveszter Városmajor Heart and Vascular Centre, Cardiac CT Working Group, Budapest, Hungary September 29, 2026 History Why did the patient come for a CT exam? A 29-year-old male patient, with a history of hypertension and bronchial asthma, was referred to the…

In 71 post-TAVI PCCT examinations from 63 patients, time-resolved cardiac PCCT enabled calculation of prosthetic-valve hemodynamics from left-ventricular volumetry and direct valve-orifice planimetry. CT-derived mean and maximum transvalvular gradients correlated strongly with echocardiography (ρ = 0.85 for both), while…

In 12 patients after mechanical thrombectomy, 54 ASPECTS regions ultimately developed infarction; 40/54 (74.1%) showed hyperattenuation on PCCT iodine maps, but only 15/40 (37.5%) were visually hyperattenuating on conventional brain-window images. Thus, iodine accumulation was frequently measurable before becoming visually…

In 25 consecutive patients with Cushing disease undergoing transsphenoidal surgery, dynamic pituitary PCCT localized corticotroph adenomas substantially more accurately than preoperative MRI: 92% vs 56%, respectively (p = .01). PCCT identified a lesion in 24/25 patients, with only one misleading localization. The gain was…

In this feasibility study, an ultra-low-dose pediatric chest PCCT protocol was optimized to Sn100 kVp, 2 mAs, pitch 1.5, achieving a phantom effective dose of 14 µSv. In clinical use, the median total effective dose was 11.6 µSv, close to the 8.2 µSv median dose of a single chest radiograph. The protocol was applied in 24…

In 27 adults with suspected respiratory infection, an ultra-low-dose PCCT chest protocol achieved a mean effective dose of 0.11 ± 0.04 mSv, essentially matching the German reference dose for a two-view chest radiograph. Despite this very low exposure, PCCT provided substantially more diagnostic information than…

This early case series illustrates how UHR PCCT can improve structural heart imaging before and after TAVR, particularly through sharper depiction of the aortic valve, annulus, coronary arteries, prosthetic valve frames, and vascular access routes. UHR acquisition allows 0.2-mm sections, compared with 0.4 mm in the regular…

In 110 patients undergoing EVAR surveillance, including 41 endoleaks, the authors compared conventional triphasic PCCT (true noncontrast + arterial + venous) with a biphasic strategy in which virtual noniodine (VNI) images reconstructed from the venous phase replaced the true noncontrast acquisition. Endoleak detection was…

In 124 patients with CCTA and invasive coronary angiography (ICA) within 30 days, diagnostic performance of PCCT CCTA was similar with and without sublingual nitroglycerin. Per-patient sensitivity was 90.3% vs 90.9%, and NPV was 86.4% vs 88.9%, with no significant differences between groups. The non-nitroglycerin group was…

In 51 patients with 51 coronary plaques, PCCT VMI energy had a substantial effect on measured plaque attenuation and consequently on quantitative plaque composition when fixed HU thresholds were used. Mean plaque attenuation fell progressively from 723 ± 501 HU at 40 keV to 120 ± 112 HU at 180 keV, while 70-keV VMI most…

PCCT-derived virtual unenhanced (VUE) images showed no significant difference in mean attenuation compared with true unenhanced (TUE) images for adrenal adenomas (9.2 ± 8.6 HU vs 7.3 ± 8.4 HU; P = .07). Despite similar mean values, individual VUE measurements showed both over- and underestimation, resulting in 10 of 36…

In 18 patients with 44 coronary stents, ultra-high-resolution (UHR) PCCT angiography achieved high diagnostic accuracy for detecting ≥50% in-stent stenosis compared with invasive coronary angiography (ICA). Both readers identified all 5 stenotic stents, yielding 100% sensitivity. Specificity and overall accuracy were 92.3%…

In 170 patients, coronary artery calcium scores derived from PCCT PureCalcium virtual noncontrast images showed excellent correlation with true noncontrast (TNC) calcium scoring (ICC 0.98). Median Agatston scores were not significantly different: 4.8 vs 2.7, respectively (p = 0.99). High correlation did not translate into…

In 27 patients undergoing same-day PCCT and cardiac MRI, myocardial extracellular volume (ECV) measurements remained robust across a wide range of reconstruction settings, but reconstruction choices meaningfully affected agreement with MRI. The greatest improvement came from combining thin slices with low-keV VMI, rather…

Standard PCCT virtual noncontrast (VNC) calcium scoring performs well for larger and denser plaques but can miss subtle disease. Large/medium and high/medium-density plaques showed strong agreement with true noncontrast (TNC) scoring (r > 0.9; ICC ≥ 0.90), whereas low-density plaques showed poor agreement and small plaques…

In 39 patients with 45 lower-extremity run-off studies, PCCT angiography was compared directly with digital subtraction angiography (DSA) for peripheral arterial occlusive disease. The cohort was challenging, with 77.8% of studies representing Fontaine stage IV disease, making severe calcification and small crural vessels…

In this prospective same-day comparison of 29 patients, myocardial extracellular volume (ECV) measured with PCCT showed strong agreement with cardiac MRI, supporting spectral PCCT as a quantitative tool for myocardial tissue characterization. Dual-energy PCCT achieved correlations of r = 0.91 for global ECV and r = 0.82…

This prospective study compared 0.2-mm ultra-high-resolution (UHR) PCCT with 1-mm standard-resolution 40-keV VMI for abdominal CTA in 94 participants, equally divided between full-dose and low-dose protocols. Standard-resolution 40-keV VMI provided significantly higher SNR and CNR than all UHR reconstructions. UHR…

Prospective study testing whether low-dose (LD) ultra-high-resolution (UHR) photon-counting CT can preserve diagnostic image quality for visceral artery CTA. The study included 57 patients in the full-dose group and 57 in the low-dose group. Each acquisition was reconstructed two ways: 0.2 mm / Bv48 / QIR 4 and 1 mm / Bv40…

In 58 infants <10 kg, cardiac PCCT at 70 kV and 120 kV provided comparable image quality, with similar aortic CNR and median subjective image-quality scores of 5/5 in both groups. 70 kV reduced radiation dose by almost 50%, with CTDI decreasing from 0.25 mGy at 120 kV to 0.13 mGy at 70 kV (P<0.001). The key trade-off is…

This multicenter retrospective study evaluated 6,464 PCCT examinations in 4,772 pediatric patients across three French institutions and provides practical acquisition/reconstruction protocols across ten body regions. The cohort had a mean age of 7.9 ± 5.5 years (4 days–17.9 years); nearly one-third of examinations involved…

Combining UHR PCCT with low-keV virtual monoenergetic imaging (VMI) improved visualization of pancreatic ductal adenocarcinoma (PDAC), peripancreatic vessels, and fine pancreatic anatomy; the study identified 0.4-mm slices at 45 keV as the best overall reconstruction strategy for preoperative assessment. 40-keV VMI…