Assessing coronary in-stent restenosis using ultrahigh-resolution photon-counting detector CT: results from a two-center study

Szilveszter, Bálint and Hagar, Muhammad Taha and Kulyassa, Péter and Sipos, Barbara and Kubovje, Anikó and Vattay, Borbála and Boussoussou, Melinda and Beke, Sámuel and Nagy, Kristóf and Száraz, Lili and Maurovich-Horvat, Pál and Varga-Szemes, Ákos and Emrich, Tilman and Vecsey-Nagy, Milán (2026) Assessing coronary in-stent restenosis using ultrahigh-resolution photon-counting detector CT: results from a two-center study. EUROPEAN JOURNAL OF RADIOLOGY, 199. No. 112766. ISSN 0720-048X

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Abstract

Introduction: To assess the diagnostic accuracy of ultrahigh-resolution (UHR) photon-counting detector (PCD)-CT for detecting obstructive and non-obstructive coronary in-stent restenosis (ISR), using invasive coronary angiography (ICA) as the reference. Methods: Consecutive patients with coronary stents who underwent clinically indicated coronary CT angiography (CCTA) on a dual-source PCD-CT were retrospectively identified from two academic centers. All UHR scans were reconstructed at 0.2 mm and 0.4 mm slice thickness, the latter served as an energy-integrating detector CT-like proxy. Series were assessed for the presence of non-obstructive (<50%) and obstructive (≥50%) ISR, with diagnostic accuracy validated against ICA in the overall cohort and in a sub-analysis of stents < 3 mm in diameter. Results: Fifty patients (16.0% women; 70.9 ± 10.8 years) with 106 coronary stents were included. ICA identified 17 non-obstructive and 27 obstructive ISR. Non-obstructive ISR was detected in 10 stents on 0.2 mm UHR and 14 on 0.4 mm EID-like standard-resolution reconstructions.Obstructive ISR was described in 26 (0.2 mm) vs. 32 (0.4 mm) stents, respectively. The proportion of evaluable stents increased from 91.5% based on 0.4 mm to 99.1% with 0.2 mm UHR. Compared with standard-resolution images, 0.2-mm UHR improved non-obstructive ISR sensitivity (90.5%vs82.9%), specificity (100.0%vs78.5%), and accuracy (96.2%vs80.2%); and in obstructive ISR, specificity (98.7%vs82.3%), positive predictive value (96.3%vs64.1%), and accuracy (98.1%vs84.9%). Thin-slice UHR achieved higher accuracy in small-caliber stents (<3mm), for both non-obstructive (94.1vs73.5%) and obstructive ISR (94.1%vs79.4%). Conclusion: UHR PCD-CT demonstrated excellent diagnostic accuracy and significant improvements in ISR detection compared to the quasi-standard reconstructions, including non-obstructive and small-caliber stent ISR.

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