Gadolinium-based coronary CT angiography on a clinical photon-counting-detector system: a dynamic circulating phantom study.

Autor: Kravchenko D; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.; Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany.; Quantitative Imaging Laboratory Bonn (QILaB), Bonn, Germany., Gnasso C; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.; Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy., Schoepf UJ; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA., Vecsey-Nagy M; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.; Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Tremamunno G; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.; Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome-Radiology Unit-Sant'Andrea University Hospital, Rome, Italy., O'Doherty J; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.; Siemens Medical Solutions USA Inc, Malvern, PA, USA., Zhang A; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA., Luetkens JA; Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany.; Quantitative Imaging Laboratory Bonn (QILaB), Bonn, Germany., Kuetting D; Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany.; Quantitative Imaging Laboratory Bonn (QILaB), Bonn, Germany., Attenberger U; Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany., Schmidt B; Siemens Medical Solutions, Forchheim, Germany., Varga-Szemes A; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA., Emrich T; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. tilman.emrich@unimedizin-mainz.de.; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany. tilman.emrich@unimedizin-mainz.de.; German Centre for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany. tilman.emrich@unimedizin-mainz.de.
Jazyk: angličtina
Zdroj: European radiology experimental [Eur Radiol Exp] 2024 Oct 18; Vol. 8 (1), pp. 118. Date of Electronic Publication: 2024 Oct 18.
DOI: 10.1186/s41747-024-00501-w
Abstrakt: Background: Coronary computed tomography angiography (CCTA) offers non-invasive diagnostics of the coronary arteries. Vessel evaluation requires the administration of intravenous contrast. The purpose of this study was to evaluate the utility of gadolinium-based contrast agent (GBCA) as an alternative to iodinated contrast for CCTA on a first-generation clinical dual-source photon-counting-detector (PCD)-CT system.
Methods: A dynamic circulating phantom containing a three-dimensional-printed model of the thoracic aorta and the coronary arteries were used to evaluate injection protocols using gadopentetate dimeglumine at 50%, 100%, 150%, and 200% of the maximum approved clinical dose (0.3 mmol/kg). Virtual monoenergetic image (VMI) reconstructions ranging from 40 keV to 100 keV with 5 keV increments were generated on a PCD-CT. Contrast-to-noise ratio (CNR) was calculated from attenuations measured in the aorta and coronary arteries and noise measured in the background tissue. Attenuation of at least 350 HU was deemed as diagnostic.
Results: The highest coronary attenuation (441 ± 23 HU, mean ± standard deviation) and CNR (29.5 ± 1.5) was achieved at 40 keV and at the highest GBCA dose (200%). There was a systematic decline of attenuation and CNR with higher keV reconstructions and lower GBCA doses. Only reconstructions at 40 and 45 keV at 200% and 40 keV at 150% GBCA dose demonstrated sufficient attenuation above 350 HU.
Conclusion: Current PCD-CT protocols and settings are unsuitable for the use of GBCA for CCTA at clinically approved doses. Future advances to the PCD-CT system including a 4-threshold mode, as well as multi-material decomposition may add new opportunities for k-edge imaging of GBCA.
Relevance Statement: Patients allergic to iodine-based contrast media and the future of multicontrast CT examinations would benefit greatly from alternative contrast media, but the utility of GBCA for coronary photon-counting-dector-CT angiography remains limited without further optimization of protocols and scanner settings.
Key Points: GBCA-enhanced coronary PCD-CT angiography is not feasible at clinically approved doses. GBCAs have potential applications for the visualization of larger vessels, such as the aorta, on PCD-CT angiography. Higher GBCA doses and lower keV reconstructions achieved higher attenuation values and CNR.
(© 2024. The Author(s).)
Databáze: MEDLINE
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