Ultra-high-resolution photon-counting detector CT successfully identified detailed plaque composition, including a fibrous cap, which was subsequently confirmed by optical coherence tomography.
Case Report (n=1)
No
Does ultra-high-resolution photon-counting detector CCTA accurately visualize detailed plaque composition compared to optical coherence tomography?
Ultra-high-resolution photon-counting detector CT can accurately visualize detailed coronary plaque morphology, such as fibrous caps, correlating well with invasive optical coherence tomography.
A 68-year-old man presented to our chest pain unit with angina and a low pre-test probability for coronary artery disease (CAD). Troponin levels were normal, and echocardiography showed an intact left ventricular function. Coronary computed tomography angiography (CCTA) was performed using a first-generation dual-source photon-counting detector computed tomography (PCD-CT, NAEOTOM Alpha®, Siemens Healthineers) in a novel ultra-high resolution (UHR) mode. Data were reconstructed at 0.6 and 0.2 mm to reflect the typical appearance on standard and PCD-CT scanners (Panels A/D and B/E, respectively). The RCX presented with a mixed plaque and moderate-to-severe stenosis, right coronary artery (RCA) with a soft plaque and moderate-to-severe stenosis (Panels A and B), and LAD with a mostly a calcified plaque and mild stenosis (Figure 1D). UHR reconstructions revealed a fibrous cap on the calcified plaque (Panel E). Subsequent invasive coronary angiography including optical coherence tomography (OCT) confirmed a significant stenosis in the RCA Panel C, fibrous plaque with micro-calcifications (arrowhead) and left circumflex coronary artery (LCX) (mostly fibrotic components). Both were successfully treated with drug-eluting stents thrombolysis in myocardial infarction (TIMI) coronary grade flow 3 (TIMI 3). Further, OCT confirmed the mild stenosis of the LAD caused by lesion with a fibrous cap over the calcification (Panel F).
Emrich et al. (Fri,) conducted a case report in Coronary artery disease (n=1). Ultra-high-resolution coronary computed tomography angiography (CCTA) vs. Optical coherence tomography (OCT) was evaluated. Ultra-high-resolution photon-counting detector CT successfully identified detailed plaque composition, including a fibrous cap, which was subsequently confirmed by optical coherence tomography.