One-stop photon-counting CT angiography for simultaneous assessment of cardio-cerebrovascular lesions: A case report

We report a 73-year-old male admitted for 2-year progressive dysuria, with incidental detection of abnormal cardiovascular signs on physical examination. Initial evaluation via energy-integrating detector computed tomography (EID-CT) coronary angiography and cranial magnetic resonance imaging identified key vascular abnormalities, while subsequent photon-counting detector CT (PCD-CT) combined cardio-cerebral computed tomography angiography (CTA) provided more detailed assessment of stenosis severity, plaque composition, and the entire vascular bed. The combined PCD-CT scan delineated synchronous lesions in detail: proximal left anterior descending (LAD) coronary artery plaque, ascending aortic dilatation with left coronary sinus aneurysm compressing the left atrium, and occlusion of the intracranial right vertebral artery. Importantly, PCD-CT cardio-cerebral CTA yielded a lower radiation dose compared with standalone EID-CT coronary angiography. With spectral reconstruction, the severity of LAD stenosis was re-evaluated and interpreted as mild stenosis, a lower grade than that assessed by EID-CT; meanwhile, 0.4 mm thin-slice imaging enabled detailed compositional analysis of the coronary plaque, with imaging features suggestive of a stable plaque. Based on multidisciplinary discussion integrating all imaging findings and clinical context, a treatment strategy was formulated: prioritize high-risk aortic lesion management, synchronously perform coronary artery bypass grafting for myocardial ischemia prevention, and electively address intracranial stenosis. This case demonstrates the preliminary clinical value of PCD-CT as a supportive imaging modality for the evaluation and multidisciplinary management of concurrent cardio-cerebrovascular diseases.