Abstract

Background

Coronary computed tomography angiography (CCTA) offers non-invasive diagnostics of the coronary arteries. Vessel evaluation requires the administration of intravenous contrast. The purpose of this study was to evaluate the utility of gadolinium-based contrast agent (GBCA) as an alternative to iodinated contrast for CCTA on a first-generation clinical dual-source photon-counting-detector (PCD)-CT system.

Methods

A dynamic circulating phantom containing a three-dimensional-printed model of the thoracic aorta and the coronary arteries were used to evaluate injection protocols using gadopentetate dimeglumine at 50%, 100%, 150%, and 200% of the maximum approved clinical dose (0.3 mmol/kg). Virtual monoenergetic image (VMI) reconstructions ranging from 40 keV to 100 keV with 5 keV increments were generated on a PCD-CT. Contrast-to-noise ratio (CNR) was calculated from attenuations measured in the aorta and coronary arteries and noise measured in the background tissue. Attenuation of at least 350 HU was deemed as diagnostic.

Results

The highest coronary attenuation (441 ± 23 HU, mean ± standard deviation) and CNR (29.5 ± 1.5) was achieved at 40 keV and at the highest GBCA dose (200%). There was a systematic decline of attenuation and CNR with higher keV reconstructions and lower GBCA doses. Only reconstructions at 40 and 45 keV at 200% and 40 keV at 150% GBCA dose demonstrated sufficient attenuation above 350 HU.

Conclusion

Current PCD-CT protocols and settings are unsuitable for the use of GBCA for CCTA at clinically approved doses. Future advances to the PCD-CT system including a 4-threshold mode, as well as multi-material decomposition may add new opportunities for k-edge imaging of GBCA.

Relevance statement

Patients allergic to iodine-based contrast media and the future of multicontrast CT examinations would benefit greatly from alternative contrast media, but the utility of GBCA for coronary photon-counting-dector-CT angiography remains limited without further optimization of protocols and scanner settings.

Key Points

GBCA-enhanced coronary PCD-CT angiography is not feasible at clinically approved doses.

GBCAs have potential applications for the visualization of larger vessels, such as the aorta, on PCD-CT angiography.

Higher GBCA doses and lower keV reconstructions achieved higher attenuation values and CNR.

Details

Title
Gadolinium-based coronary CT angiography on a clinical photon-counting-detector system: a dynamic circulating phantom study
Author
Kravchenko, Dmitrij 1 ; Gnasso, Chiara 2 ; Schoepf, U. Joseph 3 ; Vecsey-Nagy, Milan 4 ; Tremamunno, Giuseppe 5 ; O’Doherty, Jim 6 ; Zhang, Andrew 3 ; Luetkens, Julian A. 7 ; Kuetting, Daniel 7 ; Attenberger, Ulrike 8 ; Schmidt, Bernhard 9 ; Varga-Szemes, Akos 3 ; Emrich, Tilman 10   VIAFID ORCID Logo 

1  Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, USA (GRID:grid.259828.c) (ISNI:0000 0001 2189 3475); University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Bonn, Germany (GRID:grid.15090.3d) (ISNI:0000 0000 8786 803X); Quantitative Imaging Laboratory Bonn (QILaB), Bonn, Germany (GRID:grid.15090.3d) 
2  Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, USA (GRID:grid.259828.c) (ISNI:0000 0001 2189 3475); IRCCS San Raffaele Scientific Institute, Clinical and Experimental Radiology Unit, Experimental Imaging Center, Milan, Italy (GRID:grid.259828.c) (ISNI:0000 0004 1784 8390); Vita-Salute San Raffaele University, School of Medicine, Milan, Italy (GRID:grid.15496.3f) (ISNI:0000 0001 0439 0892) 
3  Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, USA (GRID:grid.259828.c) (ISNI:0000 0001 2189 3475) 
4  Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, USA (GRID:grid.259828.c) (ISNI:0000 0001 2189 3475); Semmelweis University, Cardiovascular Imaging Research Group, Heart and Vascular Center, Budapest, Hungary (GRID:grid.11804.3c) (ISNI:0000 0001 0942 9821) 
5  Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, USA (GRID:grid.259828.c) (ISNI:0000 0001 2189 3475); Sapienza University of Rome—Radiology Unit—Sant’Andrea University Hospital, Department of Medical Surgical Sciences and Translational Medicine, Rome, Italy (GRID:grid.7841.a) 
6  Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, USA (GRID:grid.259828.c) (ISNI:0000 0001 2189 3475); Siemens Medical Solutions USA Inc, Malvern, USA (GRID:grid.415886.6) (ISNI:0000 0004 0546 1113) 
7  University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Bonn, Germany (GRID:grid.15090.3d) (ISNI:0000 0000 8786 803X); Quantitative Imaging Laboratory Bonn (QILaB), Bonn, Germany (GRID:grid.15090.3d) 
8  University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Bonn, Germany (GRID:grid.15090.3d) (ISNI:0000 0000 8786 803X) 
9  Siemens Medical Solutions, Forchheim, Germany (GRID:grid.481749.7) (ISNI:0000 0004 0552 4145) 
10  Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, USA (GRID:grid.259828.c) (ISNI:0000 0001 2189 3475); University Medical Center of the Johannes Gutenberg-University, Department of Diagnostic and Interventional Radiology, Mainz, Germany (GRID:grid.410607.4); Partner Site Rhine-Main, German Centre for Cardiovascular Research, Mainz, Germany (GRID:grid.452396.f) (ISNI:0000 0004 5937 5237) 
Pages
118
Publication year
2024
Publication date
Dec 2024
Publisher
Springer Nature B.V.
e-ISSN
25099280
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1186/s41747-024-00501-w
ProQuest document ID
3118122413
Copyright
© The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.