Feasibility of ultra-low flow rate coronary CT angiography using photon-counting detector CT: a prospective randomized trial
Abstract
Objective: This study evaluates the feasibility of photon-counting detector CT (PCD-CT)-based coronary CT angiography (CCTA) using ultra-low flow contrast rate while maintaining diagnostic image quality.
Materials and methods: In this prospective trial, 292 patients underwent CCTA assigned to one of three protocols: ultra-low (1.5-1.8 mL/s) or routine (4.0-5.0 mL/s) contrast injection with PCD-CT, or routine injection with EID-CT. All scans utilized a high-pitch prospective electrocardiogram-triggering acquisition. PCD-CT images were reconstructed at 45 keV (ultra-low) or 60 keV (routine). Objective image quality was quantitatively assessed by measuring vessel attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Subjective image quality parameters (vascular contrast, image noise, artifacts, and vessel clarity) were independently evaluated by two blinded readers using a 4-point Likert scale (1: non-diagnostic; 2: adequate; 3: good; 4: excellent).
Results: Objective image quality demonstrated comparable attenuation, CNR, and SNR in proximal coronary segments across all groups (all p > 0.05). The ultra-low PCD-CT protocol significantly lowers attenuation in the distal LAD (373.20 ± 49.58 HU) compared to routine protocols (PCD-CT: 393.52 ± 49.38 HU; EID-CT: 396.72 ± 47.55 HU; p = 0.01). While distal vessel clarity scores were modestly reduced in distal vessel clarity (ultra-low PCD-CT: 2.91 ± 0.81 versus routine PCD-CT: 3.58 ± 0.50 versus routine EID-CT:…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 292 participants or records.
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