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Quantification of Coronary Artery Stenosis in Very-High-Risk Patients Using Ultra-High Resolution Spectral
Guillaume Fahrni1, Sara Boccalini, Allal Mahmoudi
1From the Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (G.F., D.R.); University of Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Villeurbanne, France (G.F., S.B., H.L., A.H., P.D., S.A.S.-M.); Department of Radiology, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France (G.F., S.B., P.D., S.A.S.-M.); Cardiology Department, HFR Fribourg Hôpital Cantonal, Villars-Sur-Glâne, Fribourg, Switzerland (A.M.); Cardiology Department, Institute CARDIOMET, CHU-Toulouse, Toulouse, France (M.E.); Philips Healthcare, Suresnes, France (H.L., M.V.); and Department of Cardiology, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France (T.B.).
Objective:
Development of spectral photon-counting computed tomography (SPCCT) for ultra-high-resolution coronary CT angiography (CCTA) has the potential to accurately evaluate the coronary arteries of very-high-risk patients. The aim of this study was to compare the diagnostic performances of SPCCT against conventional CT for quantifying coronary stenosis in very-high-risk patients, with invasive coronary angiography (ICA) as the reference method.
Materials And Methods:
In this prospective institutional review board-approved study, very-high-risk patients addressed for ICA following an acute coronary syndrome were consecutively included. CCTA was performed for each patient with both SPCCT and conventional CT before ICA within 3 days. Stenoses were assessed using the minimal diameter over proximal and distal diameters method for CCTA and the quantitative coronary angiography method for ICA. Intraclass correlation coefficients and mean errors were assessed. Sensitivity and specificity were calculated for a >50% diameter stenosis threshold. Reclassification rates for conventional CT and SPCCT were assessed according to CAD-RADS 2.0, using ICA as the gold standard.
Results:
Twenty-six coronary stenoses were identified in 26 patients (4 women [15%]; age 64 ± 8 years) with 19 (73%) above 50% and 9 (35%) equal or above 70%. The median stenosis value was 64% (interquartile range, 48%-73%). SPCCT showed a lower mean error (6% [5%, 8%]) than conventional CT (12% [9%, 16%]). SPCCT demonstrated greater sensitivity (100%) and specificity (90%) than conventional CT (75% and 50%, respectively). Ten (38%) stenoses were reclassified with SPCCT and one (4%) with conventional CT.
Conclusions:
In very-high-risk patients, ultra-high-resolution SPCCT coronary angiography showed greater accuracy, sensitivity, and specificity, and led to more stenosis reclassifications than conventional CT.
