Comparative analysis of photon-counting and energy-integrating detector CT to identify obstructive coronary artery disease

Boussoussou, Melinda and Vecsey-Nagy, Milán and Jokkel, Zsófia and Vattay, Borbála and Kubovje, Anikó and Sipos, Barbara and Kolossváry, Márton and Nagy, Anikó Ilona and Száraz, Lili and Beke, Sámuel and Schmidt, Bernard and Kiss, Máté and Merkely, Béla and Decker, Josua A. and Emrich, Tilman and Varga-Szemes, Ákos and Maurovich-Horvat, Pál and Szilveszter, Bálint (2025) Comparative analysis of photon-counting and energy-integrating detector CT to identify obstructive coronary artery disease. EUROPEAN RADIOLOGY, 36. pp. 3091-3102. ISSN 0938-7994

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Abstract

Objective To evaluate the patient-, vessel- and segment-based diagnostic performance of photon-counting detector CT (PCD-CT) compared to energy-integrating detector CT (EID-CT) for detecting ≥ 50% or ≥ 70% stenosis using invasive coronary angiography (ICA) as a reference standard. Materials and methods Patients with stable chest pain and ≥ 50% stenosis detected on dual source PCD-CT who subsequently underwent ICA were prospectively enroled. Diagnostic accuracy was calculated for PCD-CT vs ICA and additionally for a patient cohort scanned with EID-CT with similar risk profiles and disease prevalence. A Monte Carlo simulation based on diagnostic accuracy parameters was performed to estimate the potential reduction in ICA referrals. Results A total of 143 patients (66 ± 9 years, 27.3% female) with 572 vessels and 2431 segments were evaluated with PCD-CT and ICA. Regarding EID-CT, 109 patients (65 ± 9 years, 31.0% female), 436 vessels and 1853 segments were assessed, with every patient undergoing ICA. PCD-CT demonstrated significantly higher accuracy than EID-CT in detecting ≥ 50% stenosis: 88.1% vs 77.9% (patient level), 91.6% vs 77.8% (vessel level), and 97.7% vs 92.4% (segment level) (p < 0.01 for all). For detecting ≥ 70% stenosis, PCD-CT also showed higher accuracy than EID-CT: 90.9% vs 70.6% (patient level), 94.6% vs 80.9% (vessel level), and 98.6% vs 94.1% (segment level) (p < 0.01 for all). We demonstrated a potential mean reduction of 14.8% in ICA referrals when utilising PCD-CT compared to EID-CT. Conclusions PCD-CT provides improved per-patient, per-vessel and per-segment diagnostic performance in detecting obstructive CAD in symptomatic patients when compared to patients scanned on EID-CT. PCD-CT may lead to a significant decrease in ICA utilisation.

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