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Photon-Counting CT Improves Coronary Artery Disease Assessment

By MedImaging International staff writers
Posted on 21 Feb 2024

Coronary CT angiography serves as a primary diagnostic tool in evaluating coronary artery disease (CAD), yet its effectiveness can be limited in patients with extensive calcifications, or calcium deposits within the coronary artery plaque. A recent advancement in this field is the ultrahigh-spatial-resolution photon-counting detector CT (PCD-CT), which surpasses conventional CT in image quality and spatial resolution, enhancing the ability to distinguish between two closely situated structures. Now, a new study has found that ultrahigh-spatial-resolution PCD-CT significantly improves the assessment of CAD, enabling a reclassification to a less severe disease category in over half of the patients studied. This breakthrough could enhance patient treatment plans and potentially reduce unnecessary medical procedures.

For the study, researchers at the University Medical Center Mainz (Mainz, Germany) assessed coronary stenoses, or narrowing in the coronary arteries in a vessel phantom (in-vitro) containing two different stenosis grades (25%, 50%), and retrospectively in 114 patients (in-vivo) who underwent ultrahigh-spatial-resolution cardiac PCD-CT for the evaluation of CAD. The in-vitro findings were compared against the phantom's manufacturer specifications, while the patient results were examined for their impact on CAD reporting and data system reclassification (CAD-RADS). The in-vitro study showed that ultrahigh-spatial-resolution scans significantly reduced the overestimation of stenosis by minimizing the adverse effects of calcifications on the images.

Patient results from those with suspected or confirmed CAD revealed a more accurate median stenosis degree for calcified plaques using ultrahigh-spatial-resolution PCD-CT compared to standard CT, showing 29% versus 42%. This advanced resolution often led to a lower CAD-RADS category for the patients, with 54% of the 114 participants receiving a downgraded classification. The study also found that the in-vitro quantification of 193 coronary CT angiography-based stenoses was more precise with ultrahigh-spatial resolution than with standard resolution. The researchers suggest that ultrahigh-spatial resolution could potentially overcome the limitations of conventional cardiac CT angiography, specifically by reducing the overestimation of stenosis caused by calcium blooming. This phenomenon can make small, dense structures, such as calcifications, appear larger than their actual size.

"Our study provides a glimpse into the potential impact of performing coronary CT angiography using ultrahigh spatial resolution technology on risk reclassification and recommended downstream testing," said Tilman Emrich, M.D., attending radiologist at the University Medical Center Mainz. We found that ultrahigh-spatial-resolution reconstructions resulted in significant changes in recommendations for over 50% of patients. The impact was particularly notable in cases with calcified plaques, where ultrahigh-spatial-resolution reduced the overestimation of stenosis.”

"This could significantly alter recommendations for downstream testing, potentially leading to a reduction of unnecessary procedures (and their potential complications) and reduced healthcare costs," added Emrich.

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82 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (!!!!! 1940.0119781494): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (44.822692871094): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 1623.8689422607): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (54.121017456055): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (166.17774963379): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (!!!!! 3319.0250396729): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

92 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

93 (382.90023803711): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294800335 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

94 (174.99923706055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

95 (50.783157348633): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

96 (370.97930908203): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294800335 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

97 (648.02169799805): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

98 (587.94021606445): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

99 (!!!!! 1024.9614715576): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

100 (138.0443572998): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

101 (299.93057250977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

102 (161.88621520996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

103 (254.86946105957): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

104 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

105 (397.2053527832): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

106 (!!!!! 44341.087341309): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

107 (!!!!! 2434.9689483643): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

108 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

109 (481.12869262695): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800335 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800335 AND type='deeppockets_item' AND published='1' LIMIT 1

110 (!!!!! 1704209.0892792): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

111 (185.01281738281): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

112 (725.98457336426): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

113 (166.89300537109): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

114 (735.99815368652): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

115 (62.942504882812): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

116 (208.85467529297): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

117 (46.968460083008): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

118 (282.04917907715): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

119 (149.01161193848): SELECT name FROM jos_deeppockets WHERE id=215

120 (55.074691772461): SELECT name FROM jos_deeppockets WHERE id=215

121 (464.91622924805): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

122 (349.99847412109): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

123 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

124 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

125 (!!!!! 3663.0630493164): TRUNCATE TABLE jos_trademed_module

126 (!!!!! 3951.7879486084): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294800335 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

127 (377.17819213867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

128 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

129 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

130 (36.954879760742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

131 (!!!!! 1011.1331939697): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

132 (55.789947509766): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

133 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

134 (61.988830566406): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800335 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800335 AND type='deeppockets_item' AND published='1' LIMIT 1

135 (30.040740966797): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=215 or channel_id is null)

136 (26.941299438477): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=215 or channel_id is null)

137 (29.802322387695): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

138 (114.20249938965): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

139 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800335 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800335 AND published='1' LIMIT 1

140 (105.14259338379): select jos_twitters.link from jos_twitters where cat=10

141 (28.133392333984): select jos_facebook.link from jos_facebook where cat=10

142 (45.061111450195): select jos_google_plus.link from jos_google_plus where cat=10

143 (28.133392333984): select jos_linkedin.link from jos_linkedin where cat=10

144 (746.01173400879): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

145 (!!!!! 8023.0236053467): insert into jos_banners_delta values (14615,'2025-04-30 02:55:29','18.224.184.62','view'),(14202,'2025-04-30 02:55:29','18.224.184.62','view'),(14203,'2025-04-30 02:55:29','18.224.184.62','view')

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