Photon-Counting Detector CT Angiography Versus Digital Subtraction Angiography in Patients with Peripheral Arterial
Anne Marie Augustin1, Viktor Hartung1, Jan-Peter Grunz1
1Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
Insights
Sharp kernels in photon-counting detector CT angiography (PCD-CTA) enhance diagnostic confidence for peripheral arterial occlusive disease (PAOD). This improves vessel visualization and reduces artifact, aiding in accurate diagnosis compared to digital subtraction angiography (DSA).
Area of Science:
- Medical Imaging
- Radiology
- Cardiovascular Imaging
Background:
- Peripheral arterial occlusive disease (PAOD) significantly impacts patient mobility and quality of life.
- Accurate imaging is crucial for diagnosing and managing PAOD, guiding treatment decisions.
- Photon-counting detector CT angiography (PCD-CTA) offers potential advancements in vascular imaging.
Purpose of the Study:
- To compare the diagnostic confidence of PCD-CTA using different vascular reformatting kernels against digital subtraction angiography (DSA) in patients with PAOD.
- To evaluate the impact of various kernels on image quality metrics and diagnostic performance in lower extremity CTA.
- To determine the optimal kernel for assessing stenosis and calcifications in PAOD.
Main Methods:
- Retrospective analysis of 45 lower extremity PCD-CTA examinations in 39 patients with PAOD.
- Post-processing of CTA data using three vascular kernels (Bv36, Bv48, Bv56).
- Objective (attenuation, noise, CNR, SNR) and subjective (calcium blooming, sharpness, noise) image quality assessments by three radiologists.
- Comparison of diagnostic performance and concordance with DSA as the reference standard.
Main Results:
- Luminal attenuation was consistent across kernels; however, sharper kernels increased image noise while decreasing SNR and CNR.
- The sharp Bv56 kernel subjectively reduced calcium blooming and improved vessel sharpness.
- Sensitivity for stenosis quantification was comparable across kernels, but specificity increased with sharper kernels, particularly in severely calcified tibial vessels.
- Diagnostic confidence was highest with the Bv56 kernel, showing improved concordance with DSA.
Conclusions:
- Sharp convolution kernels in lower leg PCD-CTA enhance diagnostic confidence.
- Improved vessel delineation and reduced calcium blooming with sharper kernels outweigh increased image noise.
- PCD-CTA with appropriate kernel selection, specifically Bv56, provides reliable assessment for PAOD, comparable to DSA.
Rationale And Objectives:
This study aims to compare the diagnostic confidence of photon-counting detector CT angiography (PCD-CTA) depending on the used vascular reformatting kernels with digital subtraction angiography (DSA) as diagnostic reference standard in peripheral arterial occlusive disease (PAOD).
Material And Methods:
In 39 patients, 45 lower extremity PCD-CTA with subsequent DSA were analyzed. Advanced PAOD (Fontaine stage 4) was ascertained in 77.8% of patients. CTA post-processing comprised three vascular kernels (Bv36/48/56). Objective image quality assessment included vessel attenuation, image noise, contrast-to-noise (CNR) and signal-to-noise ratios (SNR). Subjective evaluation of calcium blooming, vessel sharpness, luminal attenuation and image noise was performed by three radiologists. Diagnostic performance and concordance to DSA were assessed.
Results:
The luminal attenuation remained kernel-independent constant. With sharper kernels, image noise increased substantially, while SNR and CNR decreased. Subjective reduction of calcium blooming and increased vessel sharpness were noted for the sharp Bv56 kernel. While sensitivity in stenosis quantification was comparable between kernels (81.6% vs. 81.5% vs. 81.0%, p = 0.797), specificity increased slightly higher sharpness (71.1% vs. 76.9% vs. 79.6%, p = 0.067). Diagnostic concordance of stenosis ratings compared to DSA increased likewise (Bv36 vs. Bv56, p = 0.002). Severe crural vessel calcifications had no influence on sensitivity, regardless of kernel selection. Contrarily, specificity was substantially worse in severely calcified tibial vessels but could be improved by using the sharp Bv56 kernel (Bv36 vs. Bv56 p = 0.024). Diagnostic confidence was highest for Bv56.
Conclusion:
In lower leg PCD-CTA, sharp convolution kernels increase diagnostic confidence compared to DSA by improved vessel delineation and reduced calcium blooming with acceptable image noise.
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