ArticleInsights into imaging2025
Influence of virtual monoenergetic reconstructions on coronary CT angiography-based fractional flow reserve with photon-counting detector CT: intra-individual comparison with energy-integrating detector CT.
Article in Insights into imaging, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Improved diagnostic performance of CT-derived FFR using 70-keV monoenergetic spectral CT in coronary artery disease.The international journal of cardiovascular imaging · 2026Article
- Cardiac CT in the era of artificial intelligence: precision imaging, treatment guidance and optimised risk stratification for coronary artery disease.Open heart · 2025Review
- Myocardial characterization using late enhancement photon-counting detector CT in ventricular arrhythmia: comparison with electroanatomical mapping.Insights into imaging · 2025Article
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14 authors.
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Abstract
objectivesThis study aimed to assess the impact of the photon-counting detector (PCD)-CT-based virtual monoenergetic image (VMI) reconstruction keV levels on CT-based fractional flow reserve (CT-FFR), compared to the energy-integrating detector (EID)-CT.
methodsPatients undergoing clinically indicated coronary CT angiography (CCTA) on an EID-CT were prospectively enrolled for a research CCTA on a PCD-CT within 30 days. PCD-CT datasets were reconstructed at VMI levels of 45, 55, 70, and 90 keV. CT-FFR was obtained semiautomatically using an on-site machine learning algorithm by two readers. CT-FFR ≤ 0.80 was considered hemodynamically significant.
resultsA total of 20 patients (63.3 ± 8.8 years; 13 men (65%) were included. Median CT-FFR values in the per-vessel analysis for PCD-CT scans were 0.86 (0.81-0.92) for 45 keV, 0.87 (0.80-0.93) for 55 keV, 0.85 (0.79-0.92) for 70 keV and 0.82 (0.76-0.89) for 90 keV, and 0.86 (0.71-0.93) for EID-CT. Comparison among different VMIs showed significant differences only for 45 vs. 90 keV (p < 0.001), and 55 vs. 90 keV (p < 0.001). No significant differences were found in the pairwise comparison between any VMI and EID-CT (all p > 0.05). PCD-CT at 70 keV showed the highest correlation (r = 0.83, p < 0.001), agreement (ICC: 0.90 (0.84-0.94)), and the lowest bias (mean bias -0.01; limits of agreement, 0.84/0.94) when compared to EID-CT.
conclusionVMI reconstructions showed significant influence on CT-FFR values only at the extreme levels of the spectrum, while no significant differences were found in comparison with EID-CT. VMI at 70 keV demonstrates the highest correlation and agreement, with the lowest bias compared to EID-CT. CRITICAL RELEVANCE STATEMENT: Evidence on novel spectral photon-counting detector (PCD)-CT's impact on CT-fractional flow reserve (FFR) is limited; our results demonstrate the feasibility of CT-FFR using PCD-CT, showing no significant differences between various virtual monoenergetic images and energy-integrating detector (EID)-CT values KEY POINTS: The impact of spectral photon-counting detector (PCD)-CT on CT-derived fractional flow reserve (CT-FFR) is unclear. Spectral PCD-CT-based CT-FFR is feasible, differing only at extreme virtual monoenergetic image levels. CT-FFR from PCD-CT at 70 keV showed the strongest correlation with energy-integrating detector-CT.
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