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      Ultra-High-Resolution Coronary CT Angiography With Photon-Counting Detector CT : Feasibility and Image Characterization

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          Objectives

          The aim of this study was to evaluate the feasibility and quality of ultra-high-resolution coronary computed tomography angiography (CCTA) with dual-source photon-counting detector CT (PCD-CT) in patients with a high coronary calcium load, including an analysis of the optimal reconstruction kernel and matrix size.

          Materials and Methods

          In this institutional review board–approved study, 20 patients (6 women; mean age, 79 ± 10 years; mean body mass index, 25.6 ± 4.3 kg/m 2) undergoing PCD-CCTA in the ultra-high-resolution mode were included. Ultra-high-resolution CCTA was acquired in an electrocardiography-gated dual-source spiral mode at a tube voltage of 120 kV and collimation of 120 × 0.2 mm. The field of view (FOV) and matrix sizes were adjusted to the resolution properties of the individual reconstruction kernels using a FOV of 200 × 200 mm 2 or 150 × 150 mm 2 and a matrix size of 512 × 512 pixels or 1024 × 1024 pixels, respectively. Images were reconstructed using vascular kernels of 8 sharpness levels (Bv40, Bv44, Bv56, Bv60, Bv64, Bv72, Bv80, and Bv89), using quantum iterative reconstruction (QIR) at a strength level of 4, and a slice thickness of 0.2 mm. Images with the Bv40 kernel, QIR at a strength level of 4, and a slice thickness of 0.6 mm served as the reference. Image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), vessel sharpness, and blooming artifacts were quantified. For subjective image quality, 2 blinded readers evaluated image noise and delineation of coronary artery plaques and the adjacent vessel lumen using a 5-point discrete visual scale. A phantom scan served to characterize image noise texture by calculating the noise power spectrum for every reconstruction kernel.

          Results

          Maximum spatial frequency (f peak) gradually shifted to higher values for reconstructions with the Bv40 to Bv64 kernel (0.15 to 0.56 mm −1), but not for reconstructions with the Bv72 to Bv89 kernel. Ultra-high-resolution CCTA was feasible in all patients (median calcium score, 479). In patients, reconstructions with the Bv40 kernel and a slice thickness of 0.6 mm showed largest blooming artifacts (55.2% ± 9.8%) and lowest vessel sharpness (477.1 ± 73.6 ΔHU/mm) while achieving highest SNR (27.4 ± 5.6) and CNR (32.9 ± 6.6) and lowest noise (17.1 ± 2.2 HU). Considering reconstructions with a slice thickness of 0.2 mm, image noise, SNR, CNR, vessel sharpness, and blooming artifacts significantly differed across kernels (all P's < 0.001). With higher kernel sharpness, SNR and CNR continuously decreased, whereas image noise and vessel sharpness increased, with highest sharpness for the Bv89 kernel (2383.4 ± 787.1 ΔHU/mm). Blooming artifacts continuously decreased for reconstructions with the Bv40 (slice thickness, 0.2 mm; 52.8% ± 9.2%) to the Bv72 kernel (39.7% ± 9.1%). Subjective noise was perceived by both readers in agreement with the objective measurements. Considering delineation of coronary artery plaques and the adjacent vessel lumen, reconstructions with the Bv64 and Bv72 kernel (for both, median score of 5) were favored by the readers providing an excellent anatomic delineation of plaque characteristics and vessel lumen.

          Conclusions

          Ultra-high-resolution CCTA with PCD-CT is feasible and enables the visualization of calcified coronaries with an excellent image quality, high sharpness, and reduced blooming. Coronary plaque characterization and delineation of the adjacent vessel lumen are possible with an optimal quality using Bv64 kernel, a FOV of 200 × 200 mm 2, and a matrix size of 512 × 512 pixels.

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          Most cited references27

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          Fiji is a distribution of the popular open-source software ImageJ focused on biological-image analysis. Fiji uses modern software engineering practices to combine powerful software libraries with a broad range of scripting languages to enable rapid prototyping of image-processing algorithms. Fiji facilitates the transformation of new algorithms into ImageJ plugins that can be shared with end users through an integrated update system. We propose Fiji as a platform for productive collaboration between computer science and biology research communities.
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                Author and article information

                Contributors
                Journal
                Invest Radiol
                Invest Radiol
                IR
                Investigative Radiology
                Lippincott Williams & Wilkins
                0020-9996
                1536-0210
                December 2022
                31 May 2022
                : 57
                : 12
                : 780-788
                Affiliations
                From the []Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
                []Department of Radiology and Nuclear Medicine, Maastricht University Medical Center
                []Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
                [§ ]Siemens Healthcare GmbH, Forchheim, Germany.
                Author notes
                [*]Correspondence to: Hatem Alkadhi, MD, MPH, EBCR, FESER, Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. E-mail: hatem.alkadhi@ 123456usz.ch .
                Article
                IR_220144 00002
                10.1097/RLI.0000000000000897
                10184822
                35640019
                eb4ac971-4a16-41c3-9a92-c45b185a7903
                Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                : 11 April 2022
                : 11 May 2022
                Categories
                Original Articles
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                photon-counting computed tomography,coronary ct angiography,ultra-high-resolution

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