TY - JOUR
T1 - Benchmarking Photon-Counting Computed Tomography Angiography Against Invasive Assessment of Coronary Stenosis
T2 - Implications for Severely Calcified Coronaries
AU - Kotronias, Rafail A.
AU - de Maria, Giovanni L.
AU - Xie, Cheng
AU - Thomas, Sheena
AU - Chan, Kenneth
AU - Portolan, Leonardo
AU - Langrish, Jeremy P.
AU - Walsh, Jason
AU - Cahill, Thomas J.
AU - Lucking, Andrew J.
AU - Denton, Jonathan
AU - Farrall, Robyn
AU - Taylor, Caroline
AU - Sabharwal, Nikant
AU - Holdsworth, David A.
AU - Halborg, Thomas
AU - Neubauer, Stefan
AU - Banning, Adrian P.
AU - Channon, Keith M.
AU - Antoniades, Charalambos
AU - OxAMI and ORFAN Investigators
AU - Choudhury, Robin
AU - Dawkins, Sam
AU - Qin, Wendy
AU - Kasongo, Mary
AU - Ledesma, Chrisha
AU - Darby, Damaris
AU - Santos, Bruno Silva
AU - Antonopoulos, Alexios S.
AU - Mavrogiannis, Michail C.
AU - Kelion, Andrew
AU - Anthony, Susan
AU - Banning, Adrian
AU - Kingham, Lucy
AU - Kharbanda, Rajesh K.
AU - Mathers, Chris
AU - Mittal, Tarun K.
AU - Rose, Anne
AU - Hudson, George
AU - Bajaj, Amrita
AU - Das, Intrajeet
AU - Deshpande, Aparna
AU - Rao, Praveen
AU - Lawday, Dan
AU - Pugliese, Francesca
AU - Petersen, Steffen E.
AU - Mirsadraee, Saeed
AU - Screaton, Nicholas
AU - Rodrigues, Jonathan
AU - Hudson, Benjamin
AU - Graby, John
AU - Berry, Colin
AU - Marwan, Mohamed
AU - Maurovich-Horvat, Pál
AU - He, Guo Wei
AU - Lin, Wen Hua
AU - Fan, Li Juan
AU - Takahashi, Naohiko
AU - Kondo, Hidekazu
AU - Dai, Neng
AU - Ge, Junbo
AU - Koo, Bon Kwon
AU - Guglielmo, Marco
AU - Pontone, Gianluca
AU - Huck, Daniel
AU - Benedek, Theodora
AU - Rajani, Ronak
AU - Vilic, Dijana
AU - Aljazzaf, Haleema
AU - Mun, Mak S.
AU - Benedetti, Giulia
AU - Preston, Rebecca L.
AU - Raisi-Estabragh, Zahra
AU - Connolly, Derek L.
AU - Sharma, Vinoda
AU - Grenfell, Rebecca
AU - Bradlow, William
AU - Schmitt, Matthias
AU - Serfaty, Fabiano
AU - Gottlieb, Ilan
AU - Neves, Mario FT
AU - Newby, David E.
AU - Dweck, Marc R.
AU - Gersh, Bernard J.
AU - Hatem, Stéphane
AU - Redheuil, Alban
AU - Benetos, Georgios
AU - Beer, Meinrad
AU - Rodriguez-Granillo, Gastón A.
AU - Selvanayagam, Joseph
AU - Lopez-Jimenez, Francisco
AU - De Bosscher, Ruben
AU - Tavildari, Alain
AU - Figtree, Gemma
AU - Danad, Ibrahim
AU - Shantouf, Ronney
AU - Kietselaer, Bas
AU - Tousoulis, Dimitris
AU - Dangas, George
AU - Mehta, Nehal N.
AU - Kotanidis, Christos
AU - Kunadian, Vijay
AU - Fairbairn, Timothy A.
PY - 2025/5
Y1 - 2025/5
N2 - Background: Clinical guidelines do not recommend coronary computed tomographic angiography (CTA) in elderly patients or in the presence of heavy coronary calcification. Photon-counting coronary computed tomographic angiography (PCCTA) introduces ultrahigh in-plane resolution and multienergy imaging, but the ability of this technology to overcome these limitations is unclear. Objectives: The authors evaluate the ability of PCCTA to quantitatively assess coronary luminal stenosis in the presence and absence of calcification, comparing both the ultrahigh-resolution (UHR)-PCCTA and the multienergy standard-resolution (SR)-PCCTA with the criterion-standard 3-dimensional invasive quantitative coronary angiography (3D QCA). Methods: The authors included 100 patients who had both PCCTA and invasive coronary angiography (ICA). They comparatively evaluated luminal diameter stenosis with PCCTA and 3D QCA, anatomic disease severity (according to CAD-RADS [Coronary Artery Disease–Reporting and Data System]) and the diagnostic performance of PCCTA in identifying coronary arteries with ≥50% diameter stenosis on 3D QCA requiring invasive hemodynamic severity evaluation and/or revascularization. Results: The authors analyzed 257 vessels and 343 plaques. UHR-PCCTA luminal evaluation relative to 3D QCA was more precise than SR-PCCTA (median difference: 3% [Q1-Q3: 1%-6%] vs 6% [Q1-Q3: 2%-11%]; P < 0.001), particularly in severely calcified arteries (median difference 3% [Q1-Q3: 1%-6%] vs 6% [Q1-Q3: 3%-13%]; P = 0.002). Per-vessel agreement for CAD-RADS between UHR-PCCTA and 3D QCA was near-perfect (κ = 0.90 [Q1-Q3: 0.84-0.95]; P < 0.001), and it was substantial for SR-PCCTA (κ = 0.63 [Q1-Q3: 0.54-0.71]; P < 0.001), especially in severely calcified arteries: κ = 0.90 (Q1-Q3: 0.83-0.97; P < 0.001) and κ = 0.67 (Q1-Q3: 0.56-0.77; P < 0.001), respectively. Per-vessel diagnostic performance of SR- and UHR-PCCTA was excellent: AUC: 0.94 (95% CI: 0.91-0.98; P < 0.001) and 0.99 (95% CI: 0.98-1.00; P < 0.001), respectively. UHR-PCCTA diagnostically outperformed SR-PCCTA: ΔAUC: 0.05 (95% CI: 0.01-0.08; P = 0.01). Conclusions: PCCTA compares favorably with ICA for lumen assessment and anatomic disease severity classification in patients presenting with acute coronary syndrome or patients referred for ICA. UHR-PCCTA luminal evaluation is superior to SR-PCCTA, especially in patients with heavy coronary calcification. UHR-PCCTA has excellent diagnostic performance in identifying coronary arteries with ≥50% luminal stenosis on 3D QCA, outperforming standard-resolution imaging.
AB - Background: Clinical guidelines do not recommend coronary computed tomographic angiography (CTA) in elderly patients or in the presence of heavy coronary calcification. Photon-counting coronary computed tomographic angiography (PCCTA) introduces ultrahigh in-plane resolution and multienergy imaging, but the ability of this technology to overcome these limitations is unclear. Objectives: The authors evaluate the ability of PCCTA to quantitatively assess coronary luminal stenosis in the presence and absence of calcification, comparing both the ultrahigh-resolution (UHR)-PCCTA and the multienergy standard-resolution (SR)-PCCTA with the criterion-standard 3-dimensional invasive quantitative coronary angiography (3D QCA). Methods: The authors included 100 patients who had both PCCTA and invasive coronary angiography (ICA). They comparatively evaluated luminal diameter stenosis with PCCTA and 3D QCA, anatomic disease severity (according to CAD-RADS [Coronary Artery Disease–Reporting and Data System]) and the diagnostic performance of PCCTA in identifying coronary arteries with ≥50% diameter stenosis on 3D QCA requiring invasive hemodynamic severity evaluation and/or revascularization. Results: The authors analyzed 257 vessels and 343 plaques. UHR-PCCTA luminal evaluation relative to 3D QCA was more precise than SR-PCCTA (median difference: 3% [Q1-Q3: 1%-6%] vs 6% [Q1-Q3: 2%-11%]; P < 0.001), particularly in severely calcified arteries (median difference 3% [Q1-Q3: 1%-6%] vs 6% [Q1-Q3: 3%-13%]; P = 0.002). Per-vessel agreement for CAD-RADS between UHR-PCCTA and 3D QCA was near-perfect (κ = 0.90 [Q1-Q3: 0.84-0.95]; P < 0.001), and it was substantial for SR-PCCTA (κ = 0.63 [Q1-Q3: 0.54-0.71]; P < 0.001), especially in severely calcified arteries: κ = 0.90 (Q1-Q3: 0.83-0.97; P < 0.001) and κ = 0.67 (Q1-Q3: 0.56-0.77; P < 0.001), respectively. Per-vessel diagnostic performance of SR- and UHR-PCCTA was excellent: AUC: 0.94 (95% CI: 0.91-0.98; P < 0.001) and 0.99 (95% CI: 0.98-1.00; P < 0.001), respectively. UHR-PCCTA diagnostically outperformed SR-PCCTA: ΔAUC: 0.05 (95% CI: 0.01-0.08; P = 0.01). Conclusions: PCCTA compares favorably with ICA for lumen assessment and anatomic disease severity classification in patients presenting with acute coronary syndrome or patients referred for ICA. UHR-PCCTA luminal evaluation is superior to SR-PCCTA, especially in patients with heavy coronary calcification. UHR-PCCTA has excellent diagnostic performance in identifying coronary arteries with ≥50% luminal stenosis on 3D QCA, outperforming standard-resolution imaging.
KW - 3D QCA
KW - coronary CTA
KW - diagnostic performance
KW - photon-counting
UR - http://www.scopus.com/inward/record.url?scp=86000366251&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2024.11.005
DO - 10.1016/j.jcmg.2024.11.005
M3 - Article
C2 - 39985506
AN - SCOPUS:86000366251
SN - 1936-878X
VL - 18
SP - 572
EP - 585
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 5
ER -
