New CT Technology Detects Heart Disease Without Entering the Body

Photon-counting computed tomography (PCCT) is a new advanced imaging technique that is going to transform the standard clinical use in heart disease patients.

New ultra-high-resolution Photon-counting computed tomography (PCCT) providing excellent image quality could be beneficial for accurate diagnosis in high-risk patients ineligible for non-invasive screening, according to a study published in Radiology, a journal of the Radiological Society of North America (RSNA).

Coronary artery disease is the most common form of heart disease. Coronary CT angiography (CCTA) is highly effective for ruling out coronary artery disease in patients at low or intermediate risk for the disease.

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Unfortunately, CCTA in a high-risk population is difficult due to the high prevalence of coronary calcifications and stents. Coronary calcifications tend to “bloom” on CCTA, making them appear more extensive than they are. This results in an overestimation of blockages and plaque and false-positive results.

Ultra-high-resolution coronary CT angiography (UHR-CCTA) () is a promising tool for the noninvasive assessment of patients at high risk for coronary artery disease. Because it uses recently introduced photon-counting CT scanners, it has not been extensively studied.

Hence, researchers compared the diagnostic accuracy of UHR-CCTA with that of the reference standard of invasive coronary angiography (ICA) in 68 patients. The patients had severe aortic valve stenosis, a common serious valve disease that reduces or blocks blood flow from the heart to the aorta.

Photon-Counting CT is the Beginning of a New Generation of Cardiac Imaging

UHR-CCTA was highly sensitive and specific for coronary artery disease detection. It delivered a median overall image quality score of 1.5 on the 5-point Likert scale, where 1 is excellent and 5 is non-diagnostic. Almost 80% of segments are rated as good or excellent.

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It appears that the spectrum of patients benefiting from undergoing non-invasive CCTA has been significantly broadened by photon-counting detector technology. This is excellent news for these patients and the imaging community.

The high resolution of UHR-CCTA () results from a greater number of emitted photons. This also increases radiation exposure compared with conventional CT scanners. However, the technology is at a very early stage, and researchers are developing methods to reduce the amount of radiation exposure.

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Currently, the technique is feasible for high-risk patients, in whom the benefits outweigh the risks, but should not be applied to all patients referred for cardiac CT imaging. While photon-counting CT is relatively scarce worldwide, experts anticipate that the technology will become more prevalent in the next 10 years.

The researchers are exploring the diagnostic ability of photon-counting CT technology in other clinical scenarios such as oncological imaging (). In the field of cardiac imaging, they are expanding their research to include subgroups for whom CT imaging is currently not feasible, such as patients with coronary stents.

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They also are looking into heart muscle assessment with photon-counting CT. Early findings suggest that the technology may improve soft tissue resolution. This would greatly benefit disease characterization.

References:

Coronary Computed Tomography Angiography From Clinical Uses to Emerging Technologies: JACC State-of-the-Art Review - (https://www.sciencedirect.com/science/article/pii/S0735109720359659?via%3Dihub)
Photon-Counting Computed Tomography (PCCT): Technical Background and Cardio-Vascular Applications - (https://www.mdpi.com/2075-4418/13/4/645)
Ultra-high resolution photon-counting coronary CT angiography improves coronary stenosis quantification over a wide range of heart rates – A dynamic phantom study - (https://www.ejradiology.com/article/S0720-048X(23)00060-8/fulltext)

Source-Eurekalert