Technical Development

European Radiology

, Volume 19, Issue 1, pp 42-49

Update on multidetector coronary CT angiography of coronary stents: in vitro evaluation of 29 different stent types with dual-source CT

  • David MaintzAffiliated withDepartment of Clinical Radiology, University of Münster Email author 
  • , Matthias C. BurgAffiliated withDepartment of Clinical Radiology, University of Münster
  • , Harald SeifarthAffiliated withDepartment of Clinical Radiology, University of Münster
  • , Alexander C. BunckAffiliated withDepartment of Clinical Radiology, University of Münster
  • , Murat ÖzgünAffiliated withDepartment of Clinical Radiology, University of Münster
  • , Roman FischbachAffiliated withDepartment of Clinical Radiology, University of MünsterDepartment of Radiology and Nuclear Medicine, Asklepios Klinikum Altona
  • , Kai Uwe JürgensAffiliated withDepartment of Clinical Radiology, University of Münster
  • , Walter HeindelAffiliated withDepartment of Clinical Radiology, University of Münster

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Abstract

The aim of this study was to test a large sample of the latest coronary artery stents using four image reconstruction approaches with respect to lumen visualization, lumen attenuation, and image noise in dual-source multidetector row CT (DSCT) in vitro and to provide a CT catalogue of currently used coronary artery stents. Twenty-nine different coronary artery stents (19 steel, 6 cobalt-chromium, 2 tantalum, 1 iron, 1 magnesium) were examined in a coronary artery phantom (vessel diameter 3 mm, intravascular attenuation 250 HU, extravascular density −70 HU). Stents were imaged in axial orientation with standard parameters: 32 × 0.6 collimation, pitch 0.24, 400 mAs, 120 kV, rotation time 0.33 s. Image reconstructions were obtained with four different convolution kernels (soft, medium-soft, standard high-resolution, stent-dedicated). To evaluate visualization characteristics of the stent, the lumen diameter, intraluminal density, and noise were measured. The stent-dedicated kernel offered best average lumen visualization (54 ± 8.3%) and most realistic lumen attenuation (222  ± 44 HU) at the expense of increased noise (23.9 ± 1.9 HU) compared with standard CTA protocols (p < 0.001 for all). The magnesium stent showed the least artifacts with a lumen visibility of 90%. The majority of stents (79%) exhibited a lumen visibility of 50–59%. Less than half of the stent lumen was visible in only six stents. Stent lumen visibility largely varies depending on the stent type. Magnesium is by far more favorable a stent material with regard to CT imaging when compared with the more common materials steel, cobalt-chromium, or tantalum. The magnesium stent exhibits a lumen visibility of 90%, whereas the majority of the other stents exhibit a lumen visibility of 50–59%.

Keywords

Coronary stents Multislice CT Dual-source CT CT angiography Coronary angiography Artifacts