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  • Title: Evaluation of soft-plaque stenoses in coronary artery stents using conventional and monoenergetic images: first in-vitro experience and comparison of two different dual-energy techniques.
    Author: Hickethier T, Wenning J, Bratke G, Maintz D, Michels G, Bunck AC.
    Journal: Quant Imaging Med Surg; 2020 Mar; 10(3):612-623. PubMed ID: 32269922.
    Abstract:
    BACKGROUND: Non-invasive coronary imaging after stent placement remains challenging. Favorable results for dual-energy computed tomography (DECT) derived monoenergetic (MonoE) images have been reported for this purpose. Nowadays, there are different dual-energy techniques available, each with specific advantages and disadvantages. However, for the evaluation of coronaries after stent implantation there is no systematic comparison between different dual-energy techniques. Therefore, the aim of our study was to compare two widely used DECT systems using an in-stent restenosis (ISR) phantom setup. METHODS: Soft-plaque-like stenoses (~50% of lumen) were inserted into ten coronary stents embedded in contrast-filled vessel phantoms. A dual-source CT (DSCT) and a dual-layer CT (DLCT) with comparable acquisition and reconstruction parameters were used. Conventional polyenergetic (PolyE) and MonoE images with 9 different levels (40-120 keV) were calculated. ISR assessability was evaluated by subjective scoring using a 5-point scale and by the following quantitative parameters: image noise, visible lumen diameter (VLD) and ISR contrast-to-noise ratio (CNR). RESULTS: A non-significant trend towards larger VLD in DLCT images was observed. Highest noise was found in low-keV MonoE with significantly higher values for DSCT than for DLCT. Conversely, noise was significantly lower for DSCT at higher-keV MonoE. Peak ISR CNR values were found at low-keV MonoE with no significant difference between both systems. However, for PolyE and mid-energy MonoE, CNRs were significantly higher for DSCT. Subjective image quality was significantly better for PolyE and low-keV MonoE than for high-keV MonoE, also without significant difference between both systems. CONCLUSIONS: Conspicuity of ISR benefits from DECT. Peak CNRs were comparable for both DECT systems and low-keV MonoE offered the highest CNR values and best subjective image quality. In contrast, high-keV MonoE cannot be recommended for stent evaluation due to poor CNR values and therefore significantly limited visualization of stenoses.
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