TY - JOUR
T1 - Photon-counting detector computed tomography for evaluation of coronary artery disease in older adults
AU - Parikh, Roosha
AU - Shin, Doosup
AU - Sakai, Koshiro
AU - Singh, Mandeep
AU - Caron, Emma
AU - Cannata, Matthew
AU - Ciftcikal, Yasemin
AU - Weber, Jonathan
AU - Volleberg, Rick H.J.A.
AU - Pipitone, Karli
AU - Cao, J. Jane
AU - Chen, Lu
AU - Sosa, Fernando
AU - Patel, Krishna K.
AU - Duggan, Mary Elizabeth
AU - Khan, Jaffar M.
AU - Cohen, David J.
AU - Moses, Jeffrey W.
AU - Shlofmitz, Richard A.
AU - Collet, Carlos
AU - Shlofmitz, Evan
AU - Jeremias, Allen
AU - Ali, Ziad A.
AU - Khalique, Omar K.
N1 - Publisher Copyright:
© 2025 Society of Cardiovascular Computed Tomography
PY - 2025/11/1
Y1 - 2025/11/1
N2 - Background: Coronary computed tomography angiography (CCTA) in older adults is often limited by heavy coronary artery calcification and associated blooming artifacts. Photon-counting detector CT (PCD-CT) offers higher spatial resolution and reduced artifacts compared with conventional energy-integrating detector CT (EID-CT). We sought to investigate diagnostic performance and clinical impact of PCD-CT in older adults. Methods: This retrospective, single-center study included consecutive individuals who underwent CCTA between 2022 and 2023. Patients were grouped by scanner type (EID-CT or PCD-CT) and age group (older [≥70 years] or younger [<70 years]). The rates of indeterminate readings, referral to invasive coronary angiography (ICA), and ICA without revascularization were compared. Among patients referred to ICA after CCTA, the diagnostic performance of CCTA in detecting obstructive CAD was evaluated using quantitative coronary angiography (QCA) as the reference standard. Results: Among older adults undergoing CCTA (n = 1571), the rate of indeterminate CCTA findings was lower in the PCD-CT group compared to the EID-CT group (8.8 % vs. 14.6 %; P < 0.001). PCD-CT was associated with lower rates of ICA referral (16.7 % [143/854] vs. 22.6 % [162/717]; P = 0.004) and ICA without revascularization (9.1 % [78/854] vs. 14.1 % [101/717]; P = 0.002) compared with EID-CT. Among 587 vessels in patients referred for ICA, PCD-CT (n = 289) showed higher vessel-level diagnostic accuracy than EID-CT (n = 298) (95.5 % vs. 90.3 %; P = 0.02). When comparing between age groups, the vessel-level diagnostic accuracy of PCD-CT was similar among older (n = 289) and younger adults (n = 471) (95.5 % vs. 96.8 %, p = 0.43). Conclusions: In older patients aged ≥70 years, PCD-CT was associated with improved diagnostic accuracy, fewer indeterminate findings, and consequently, reduced unnecessary invasive testing compared with EID-CT.
AB - Background: Coronary computed tomography angiography (CCTA) in older adults is often limited by heavy coronary artery calcification and associated blooming artifacts. Photon-counting detector CT (PCD-CT) offers higher spatial resolution and reduced artifacts compared with conventional energy-integrating detector CT (EID-CT). We sought to investigate diagnostic performance and clinical impact of PCD-CT in older adults. Methods: This retrospective, single-center study included consecutive individuals who underwent CCTA between 2022 and 2023. Patients were grouped by scanner type (EID-CT or PCD-CT) and age group (older [≥70 years] or younger [<70 years]). The rates of indeterminate readings, referral to invasive coronary angiography (ICA), and ICA without revascularization were compared. Among patients referred to ICA after CCTA, the diagnostic performance of CCTA in detecting obstructive CAD was evaluated using quantitative coronary angiography (QCA) as the reference standard. Results: Among older adults undergoing CCTA (n = 1571), the rate of indeterminate CCTA findings was lower in the PCD-CT group compared to the EID-CT group (8.8 % vs. 14.6 %; P < 0.001). PCD-CT was associated with lower rates of ICA referral (16.7 % [143/854] vs. 22.6 % [162/717]; P = 0.004) and ICA without revascularization (9.1 % [78/854] vs. 14.1 % [101/717]; P = 0.002) compared with EID-CT. Among 587 vessels in patients referred for ICA, PCD-CT (n = 289) showed higher vessel-level diagnostic accuracy than EID-CT (n = 298) (95.5 % vs. 90.3 %; P = 0.02). When comparing between age groups, the vessel-level diagnostic accuracy of PCD-CT was similar among older (n = 289) and younger adults (n = 471) (95.5 % vs. 96.8 %, p = 0.43). Conclusions: In older patients aged ≥70 years, PCD-CT was associated with improved diagnostic accuracy, fewer indeterminate findings, and consequently, reduced unnecessary invasive testing compared with EID-CT.
KW - Computed tomography
KW - Coronary artery disease
KW - Coronary computed tomography angiography
KW - Elderly
UR - https://www.scopus.com/pages/publications/105020313140
U2 - 10.1016/j.jcct.2025.10.005
DO - 10.1016/j.jcct.2025.10.005
M3 - Article
AN - SCOPUS:105020313140
SN - 1934-5925
VL - 19
SP - 658
EP - 664
JO - Journal of Cardiovascular Computed Tomography
JF - Journal of Cardiovascular Computed Tomography
IS - 6
ER -