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Initial exploration of coronary stent image subtraction using dual-layer spectral CT

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

This study aimed to investigate the feasibility of coronary stent image subtraction using spectral tools derived from dual-layer spectral computed tomography (CT).

Methods

Forty-three patients (65 stents) who underwent coronary CT angiography using dual-layer spectral CT were included. Conventional, 50-keV (kilo electron-volt), 100-keV, and virtual non-contrast (VNC) images were reconstructed from the same cardiac phase. Stents were subtracted on VNC images from conventional (convsub), 100-keV (100-keVsub), and 50-keV (50-keVsub) images. The in-stent lumen diameters were measured on subtraction, conventional, and 100-keV images. Subjective evaluation of reader confidence and subtractive quality was evaluated. Friedman tests were performed to compare in-stent lumen diameters and subjective evaluation among different images. Correlation between stent diameter and subjective evaluation was expressed as Spearman’s rank correlation coefficient (rs). The diagnostic accuracy was assessed according to invasive coronary angiography (ICA) performed in 11 patients (20 stents).

Results

In-stent lumen diameters were significantly larger on subtraction images than those on conventional and 100-keV images (p < 0.05). Higher reader confidence was found on 100-keV, convsub, 100-keVsub, and 50-keVsub images compared with conventional images (p < 0.05). Subtractive quality of 100-keVsub images was better than that of convsub images (p = 0.037). A moderate-to-strong correlation between stent diameter and subjective evaluation was found (rs = 0.527~0.790, p < 0.05). Higher specificity, positive predictive value, and negative predictive value of subtraction images were shown by ICA results.

Conclusions

Subtraction images derived from dual-layer spectral CT enhanced in-stent lumen visibility and could potentially improve diagnostic performance for evaluating coronary stents.

Key Points

• Dual-layer spectral CT enabled good subtractive quality of coronary stents without misregistration artifacts.

• Subtraction images could improve in-stent lumen visibility.

• Reader confidence and diagnostic performance were enhanced with subtraction images.

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Abbreviations

BMI:

Body mass index

CCTA:

Coronary computed tomography angiography

CTDIvol :

Volume of CT dose index

DLP:

Dose length product

ECG:

Electrocardiogram

ED:

Effective dose

HR:

Heart rate

HU:

Hounsfield unit

ICA:

Invasive coronary angiography

ICC:

Intraclass correlation coefficient

ISR:

In-stent restenosis

keV:

Kilo electron-volt

NPV:

Negative predictive value

PCI:

Percutaneous coronary intervention

PPV:

Positive predictive value

ROI:

Region of interest

SEM:

Standard error of measurement

VNC:

Virtual non-contrast

WL:

Window level

WW:

Window width

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Acknowledgements

The authors thank Baisong Wang, PhD, a statistic teacher at Shanghai JiaoTong University, for providing statistical analysis. We also thank Yan Jiang and JianQing Sun for their great technical support.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai, 200025, China

    Le Qin, ShengJia Gu, ChiHua Chen, Huan Zhang, FuHua Yan & WenJie Yang

  2. Department of Cardiology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai, 200025, China

    ZhenBin Zhu

  3. Philips Healthcare, A1, Lane 718, Lingshi Road, Shanghai, 200233, China

    XingBiao Chen & Qun Han

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  1. Le Qin
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Correspondence to WenJie Yang.

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The scientific guarantor of this publication is WenJie Yang.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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• retrospective

• cross-sectional study

• performed at one institution

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Qin, L., Gu, S., Chen, C. et al. Initial exploration of coronary stent image subtraction using dual-layer spectral CT. Eur Radiol 29, 4239–4248 (2019). https://doi.org/10.1007/s00330-018-5990-1

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  • DOI: https://doi.org/10.1007/s00330-018-5990-1

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