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Updated: Jul 6, 2025
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Ultra-high-resolution photon-counting detector CT in evaluating coronary stent patency: a comparison to invasive
Muhammad Taha Hagar1, Martin Soschynski2, Ruben Saffar2
1Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Hugstetter Straße 55, Freiburg im Breisgau, 79106, Germany. taha.hagar@uniklinik-freiburg.de.
Insights
Ultra-high-resolution photon-counting detector CT angiography (UHR PCD-CTA) accurately assesses coronary stent patency. This non-invasive method shows high diagnostic accuracy, offering a promising alternative to invasive coronary angiography for ruling out in-stent stenosis.
Area of Science:
- Cardiovascular imaging
- Radiology
- Medical devices
Background:
- Coronary stent patency assessment is crucial for cardiovascular health.
- CT-based evaluation can be limited by artifacts and spatial resolution.
- Non-invasive methods with high accuracy are needed.
Purpose of the Study:
- To evaluate the diagnostic accuracy of ultra-high-resolution photon-counting detector CT angiography (UHR PCD-CTA) for coronary stent patency.
- To compare UHR PCD-CTA with invasive coronary angiography (ICA) as the reference standard.
Main Methods:
- Prospective enrollment of patients with prior coronary stents.
- UHR PCD-CTA acquisition with specific collimation settings.
- Independent analysis of image quality and stent stenosis by two radiologists, with ICA as the gold standard.
Main Results:
- Analysis included 44 stents in 18 participants.
- UHR PCD-CTA demonstrated high sensitivity (100%) and specificity (92.3% and 87.2%) for detecting in-stent stenosis.
- Excellent inter-reader agreement (90.1%) and a substantial Cohen's kappa (0.72) were observed.
Conclusions:
- UHR PCD-CTA provides high image quality and diagnostic accuracy for non-invasive assessment of coronary stent patency.
- The high negative predictive value makes UHR PCD-CTA a potential alternative to ICA for excluding in-stent stenosis.
Objectives:
To determine the diagnostic accuracy of ultra-high-resolution photon-counting detector CT angiography (UHR PCD-CTA) for evaluating coronary stent patency compared to invasive coronary angiography (ICA).
Methods:
Consecutive, clinically referred patients with prior coronary stent implantation were prospectively enrolled between August 2022 and March 2023 and underwent UHR PCD-CTA (collimation, 120 × 0.2 mm). Two radiologists independently analyzed image quality of the in-stent lumen using a 5-point Likert scale, ranging from 1 ("excellent") to 5 ("non-diagnostic"), and assessed all coronary stents for the presence of in-stent stenosis (≥ 50% lumen narrowing). The diagnostic accuracy of UHR PCD-CTA was determined, with ICA serving as the standard of reference.
Results:
A total of 44 coronary stents in 18 participants (mean age, 83 years ± 6 [standard deviation]; 12 women) were included in the analysis. In 3/44 stents, both readers described image quality as non-diagnostic, whereas reader 2 noted a fourth stent to have non-diagnostic image quality. In comparison to ICA, UHR PCD-CTA demonstrated a sensitivity, specificity, and accuracy of 100% (95% CI [confidence interval] 47.8, 100), 92.3% (95% CI 79.1, 98.4), and 93.2% (95% CI 81.3, 98.6) for reader 1 and 100% (95% CI 47.8, 100), 87.2% (95% CI 72.6, 95.7), and 88.6% (95% CI 75.4, 96.2) for reader 2, respectively. Both readers observed a 100% negative predictive value (36/36 stents and 34/34 stents). Stent patency inter-reader agreement was 90.1%, corresponding to a substantial Cohen's kappa value of 0.72.
Conclusions:
UHR PCD-CTA enables non-invasive assessment of coronary stent patency with high image quality and diagnostic accuracy.
Clinical Relevance Statement:
Ultra-high-resolution photon-counting detector CT angiography represents a reliable and non-invasive method for assessing coronary stent patency. Its high negative predictive value makes it a promising alternative over invasive coronary angiography for the rule-out of in-stent stenosis.
Key Points:
• CT-based evaluation of coronary stent patency is limited by stent-induced artifacts and spatial resolution. • Ultra-high-resolution photon-counting detector CT accurately evaluates coronary stent patency compared to invasive coronary angiography. • Photon-counting detector CT represents a promising method for the non-invasive rule-out of in-stent stenosis.
