ArticleEuropean radiology2023
Impact of virtual monoenergetic levels on coronary plaque volume components using photon-counting computed tomography.
Article in European radiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
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Who cites it
28 citing papers in PubMed, 38 citations in OpenAlex.
- Feasibility of ultra-low flow rate coronary CT angiography using photon-counting detector CT: a prospective randomized trial.European radiology experimental · 2026Trial
- A scoping review of photon-counting detector computed tomography in cardiovascular imaging.Diagnostic and interventional radiology (Ankara, Turkey) · 2026Article
- Plaque-Adapted Virtual Monoenergetic Image Selection for Carotid Plaque Visualization Using Photon-Counting CT.Diagnostics (Basel, Switzerland) · 2026Article
- Coronary plaque burden and composition in an ESC guideline-selected outpatient CCTA cohort: age- and sex-specific percentile distributions.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Mixed coronary plaque phantom analysis by photon-counting CT: impact of calcium and iodine on low-attenuation plaque detection.European heart journal. Imaging methods and practice · 2026Article
- Photon-Counting Detector CT-Based Virtual Monoenergetic Imaging With Metal Artifact Reduction for Endodontic Diagnostics.International dental journal · 2026Article
- Mitigating CT number variability between scanners, tube potentials, and patient sizes using spectral CT virtual monoenergetic imaging.Physics in medicine and biology · 2026Article
- Clinical benefits and current challenges of photon-counting detector CT in vascular imaging.Radiology advances · 2026Review
- Comparative analysis of photon-counting and energy-integrating detector CT to identify obstructive coronary artery disease.European radiology · 2026Article
- Coronary CT angiography evaluation with artificial intelligence for individualized medical treatment of atherosclerosis: a Consensus Statement from the QCI Study Group.Nature reviews. Cardiology · 2026Review
- Reduction of radiation exposure and preserved image quality using photon-counting detector cardiac computed tomography without electrocardiographic gating in children with congenital heart disease.European radiology · 2026Article
- High-pitch photon-counting detector computed tomography angiography of the coronary arteries: Qualitative and quantitative evaluation of monoenergetic image reconstructions.European journal of radiology open · 2025Article
- Contrast media and radiation dose optimization with task-based automatic keV selection: a proof-of-concept study with photon-counting detector CT.European radiology · 2025Article
- Coronary angiography with photon-counting detector CT-new options and some critical decisions.The British journal of radiology · 2025Review
- Spectral Imaging Techniques in Heart Disease Assessment Using Photon-Counting Detector Computed Tomography.Echocardiography (Mount Kisco, N.Y.) · 2025Review
- The research advancements on the advantages and limitations of coronary computed tomography angiography at low tube voltage: a literature review.Quantitative imaging in medicine and surgery · 2025Review
- Ultra-high-resolution 40 keV virtual monoenergetic imaging using spectral photon-counting CT in high-risk patients for coronary stenoses.European radiology · 2025Article
- Photon-counting detector CT: a disrupting innovation in medical imaging.European radiology experimental · 2025Article
- Editorial: Photon counting CT technology in cardiovascular imaging.Frontiers in cardiovascular medicine · 2025Article
- Development of a new threshold for pericoronary fat attenuation based on 40 keV virtual monoenergetic images from dual-energy spectral CT.Frontiers in cardiovascular medicine · 2025Article
Corrections and comments
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Authors and funding
13 authors at 5 institutions in 4 countries.
Funding
Abstract
objectivesVirtual monoenergetic images (VMIs) from photon-counting CT (PCCT) may change quantitative coronary plaque volumes. We aimed to assess how plaque component volumes change with respect to VMIs.
methodsCoronary CT angiography (CTA) images were acquired using a dual-source PCCT and VMIs were reconstructed between 40 and 180 keV in 10-keV increments. Polychromatic images at 120 kVp (T3D) were used as reference. Quantitative plaque analysis was performed on T3D images and segmentation masks were copied to VMI reconstructions. Calcified plaque (CP; > 350 Hounsfield units, HU), non-calcified plaque (NCP; 30 to 350 HU), and low-attenuation NCP (LAP; - 100 to 30 HU) volumes were calculated using fixed thresholds.
resultsWe analyzed 51 plaques from 51 patients (67% male, mean age 65 ± 12 years). Average attenuation and contrast-to-noise ratio (CNR) decreased significantly with increasing keV levels, with similar values observed between T3D and 70 keV images (299 ± 209 vs. 303 ± 225 HU, p = 0.15 for mean HU; 15.5 ± 3.7 vs. 15.8 ± 3.5, p = 0.32 for CNR). Mean NCP volume was comparable between T3D and 100-180-keV reconstructions. There was a monotonic decrease in mean CP volume, with a significant difference between all VMIs and T3D (p < 0.05). LAP volume increased with increasing keV levels and all VMIs showed a significant difference compared to T3D, except for 50 keV (28.0 ± 30.8 mm
conclusionsEstimated coronary plaque volumes significantly differ between VMIs. Normalization protocols are needed to have comparable results between future studies, especially for LAP volume which is currently defined using a fixed HU threshold. CLINICAL RELEVANCE STATEMENT: Different virtual monoenergetic images from photon-counting CT alter attenuation values and therefore corresponding plaque component volumes. New clinical standards and protocols are required to determine the optimal thresholds to derive plaque volumes from photon-counting CT. KEY POINTS: • Utilizing different VMI energy levels from photon-counting CT for the analysis of coronary artery plaques leads to substantial changes in attenuation values and corresponding plaque component volumes. • Low-energy images (40-70 keV) improved contrast-to-noise ratio, however also increased image noise. • Normalization protocols are needed to have comparable results between future studies, especially for low-attenuation plaque volume which is currently defined using a fixed HU threshold.
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