Abstract：
BACKGROUND: Cardiovascular CT is required for planning transcatheter aortic valve implantation (TAVI).
OBJECTIVE: To compare image quality, suitability for TAVI planning, and radiation dose of photon-counting CT (PCCT) with that of dual-source CT (DSCT).
METHODS: Retrospective study on consecutive TAVI candidates with aortic valve stenosis who underwent contrast-enhanced aorto-ilio-femoral PCCT and/or DSCT between 01/2022 and 07/2023. Signal-to-noise (SNR) and contrast-to-noise ratio (CNR) were calculated by standardized ROI analysis. Image quality and suitability for TAVI planning were assessed by four independent expert readers (two cardiac radiologists, two cardiologists) on a 5-point-scale. CT dose index (CTDI) and dose-length-product (DLP) were used to calculate effective radiation dose (eRD).
RESULTS: 300 patients (136 female, median age: 81 years, IQR: 76-84) underwent 302 CT examinations, with PCCT in 202, DSCT in 100; two patients underwent both. Although SNR and CNR were significantly lower in PCCT vs. DSCT images (33.0 ± 10.5 vs. 47.3 ± 16.4 and 47.3 ± 14.8 vs. 59.3 ± 21.9, P < .001, respectively), visual image quality was higher in PCCT vs. DSCT (4.8 vs. 3.3, P < .001), with moderate overall interreader agreement among radiologists and among cardiologists (κ = 0.60, respectively). Image quality was rated as \"excellent\" in 160/202 (79.2%) of PCCT vs. 5/100 (5%) of DSCT cases. Readers found images suitable to depict the aortic valve hinge points and to map the femoral access path in 99% of PCCT vs. 85% of DSCT (P < 0.01), with suitability ranked significantly higher in PCCT vs. DSCT (4.8 vs. 3.3, P < .001). Mean CTDI and DLP, and thus eRD, were significantly lower for PCCT vs. DSCT (22.4 vs. 62.9; 519.4 vs. 895.5, and 8.8 ± 4.5 mSv vs. 15.3 ± 5.8 mSv; all P < .001).
CONCLUSIONS: PCCT improves image quality, effectively avoids non-diagnostic CT imaging for TAVI planning, and is associated with a lower radiation dose compared to state-of-the-art DSCT. Radiologists and cardiologists found PCCT images more suitable for TAVI planning.
OBJECTIVE: To compare image quality, suitability for TAVI planning, and radiation dose of photon-counting CT (PCCT) with that of dual-source CT (DSCT).
METHODS: Retrospective study on consecutive TAVI candidates with aortic valve stenosis who underwent contrast-enhanced aorto-ilio-femoral PCCT and/or DSCT between 01/2022 and 07/2023. Signal-to-noise (SNR) and contrast-to-noise ratio (CNR) were calculated by standardized ROI analysis. Image quality and suitability for TAVI planning were assessed by four independent expert readers (two cardiac radiologists, two cardiologists) on a 5-point-scale. CT dose index (CTDI) and dose-length-product (DLP) were used to calculate effective radiation dose (eRD).
RESULTS: 300 patients (136 female, median age: 81 years, IQR: 76-84) underwent 302 CT examinations, with PCCT in 202, DSCT in 100; two patients underwent both. Although SNR and CNR were significantly lower in PCCT vs. DSCT images (33.0 ± 10.5 vs. 47.3 ± 16.4 and 47.3 ± 14.8 vs. 59.3 ± 21.9, P < .001, respectively), visual image quality was higher in PCCT vs. DSCT (4.8 vs. 3.3, P < .001), with moderate overall interreader agreement among radiologists and among cardiologists (κ = 0.60, respectively). Image quality was rated as \"excellent\" in 160/202 (79.2%) of PCCT vs. 5/100 (5%) of DSCT cases. Readers found images suitable to depict the aortic valve hinge points and to map the femoral access path in 99% of PCCT vs. 85% of DSCT (P < 0.01), with suitability ranked significantly higher in PCCT vs. DSCT (4.8 vs. 3.3, P < .001). Mean CTDI and DLP, and thus eRD, were significantly lower for PCCT vs. DSCT (22.4 vs. 62.9; 519.4 vs. 895.5, and 8.8 ± 4.5 mSv vs. 15.3 ± 5.8 mSv; all P < .001).
CONCLUSIONS: PCCT improves image quality, effectively avoids non-diagnostic CT imaging for TAVI planning, and is associated with a lower radiation dose compared to state-of-the-art DSCT. Radiologists and cardiologists found PCCT images more suitable for TAVI planning.
摘要：
背景：计划经导管主动脉瓣植入术（TAVI）需要心血管CT。
目的：为了比较图像质量，适合TAVI规划，光子计数CT（PCCT）和双源CT（DSCT）的辐射剂量。
方法：在2022年1月7日和2023年7月之间接受对比增强主动脉-髂-股PCCT和/或DSCT的连续主动脉瓣狭窄TAVI候选人的回顾性研究。通过标准化ROI分析计算信噪比（SNR）和对比度（CNR）。由四名独立专家读者（两名心脏放射科医生，两名心脏病专家）以5分制。使用CT剂量指数（CTDI）和剂量长度乘积（DLP）计算有效辐射剂量（eRD）。
结果：300名患者（136名女性，平均年龄：81岁，IQR：76-84）接受了302次CT检查，PCCT为202例，DSCT为100例；两名患者同时接受。尽管在PCCT中SNR和CNR明显较低。DSCT图像(33.0±10.5vs.47.3±16.4和47.3±14.8vs.分别为59.3±21.9，P<.001），PCCT的视觉图像质量较高。DSCT（4.8vs.3.3,P<.001),放射科医师和心脏科医师之间的总体互读协议（分别为κ=0.60）。在160/202（79.2％）的PCCT中，图像质量被评为“优秀”5/100(5%)的DSCT病例。读者发现图像适用于描绘主动脉瓣铰链点，并在99%的PCCT与85%的DSCT（P<0.01），在PCCT中的适用性明显高于DSCT（4.8vs.3.3,P<.001)。平均CTDI和DLP，因此ERD，PCCT明显低于DSCT（22.4与62.9;519.4vs.895.5和8.8±4.5mSvvs.15.3±5.8mSv；所有P<.001）。
结论：PCCT提高了图像质量，有效避免了非诊断性CT成像对TAVI规划，并且与最先进的DSCT相比具有较低的辐射剂量。放射科医生和心脏病学家发现PCCT图像更适合TAVI计划。
目的：为了比较图像质量，适合TAVI规划，光子计数CT（PCCT）和双源CT（DSCT）的辐射剂量。
方法：在2022年1月7日和2023年7月之间接受对比增强主动脉-髂-股PCCT和/或DSCT的连续主动脉瓣狭窄TAVI候选人的回顾性研究。通过标准化ROI分析计算信噪比（SNR）和对比度（CNR）。由四名独立专家读者（两名心脏放射科医生，两名心脏病专家）以5分制。使用CT剂量指数（CTDI）和剂量长度乘积（DLP）计算有效辐射剂量（eRD）。
结果：300名患者（136名女性，平均年龄：81岁，IQR：76-84）接受了302次CT检查，PCCT为202例，DSCT为100例；两名患者同时接受。尽管在PCCT中SNR和CNR明显较低。DSCT图像(33.0±10.5vs.47.3±16.4和47.3±14.8vs.分别为59.3±21.9，P<.001），PCCT的视觉图像质量较高。DSCT（4.8vs.3.3,P<.001),放射科医师和心脏科医师之间的总体互读协议（分别为κ=0.60）。在160/202（79.2％）的PCCT中，图像质量被评为“优秀”5/100(5%)的DSCT病例。读者发现图像适用于描绘主动脉瓣铰链点，并在99%的PCCT与85%的DSCT（P<0.01），在PCCT中的适用性明显高于DSCT（4.8vs.3.3,P<.001)。平均CTDI和DLP，因此ERD，PCCT明显低于DSCT（22.4与62.9;519.4vs.895.5和8.8±4.5mSvvs.15.3±5.8mSv；所有P<.001）。
结论：PCCT提高了图像质量，有效避免了非诊断性CT成像对TAVI规划，并且与最先进的DSCT相比具有较低的辐射剂量。放射科医生和心脏病学家发现PCCT图像更适合TAVI计划。
