Stent imaging on a clinical dual-source photon-counting detector CT system—impact of luminal attenuation and sharp kernels on lumen visibility

Objectives To assess the impact of scan modes and reconstruction kernels using a novel dual-source photon-counting detector CT (PCD-CT) on lumen visibility and sharpness of different stent sizes. Methods A phantom containing six balloon-expandable stents (2.5 to 9 mm diameter) in silicone tubing was scanned on a PCD-CT with standard (0.6 mm and 0.4 mm thicknesses) and ultra-high-resolution (0.2 mm thickness) modes. With the use of increasing contrast medium concentrations, densities of 0, 200, 400, and 600 HU were achieved. Standard-resolution scans were reconstructed using increasing sharpness kernels, using both polyenergetic quantitative soft tissue “conventional” ((Qr40 c (0.6 mm), Qr40 c (0.4 mm), Qr72 c (0.2 mm)) and vascular (Bv) virtual monoenergetic reconstructions (Bv44 m (0.4 mm), Bv60 m (0.4 mm)) at 70 keV. In-stent lumen visibility, sharpness (max. ΔHU of the stent measured in profile plots), and in-stent noise (standard deviation of HU) were measured. Results In-stent lumen visibility was highest for Qr72 c (0.2 mm) (86.5 ± 2.8% to 88.3 ± 2.6%) and in Bv60 m (0.4 mm) reconstructions (77.3 ± 2.9 to 82.7 ± 2.5%). Lumen visibility was lowest in the smallest stent (2.5 mm) ranging from 54.1% in Qr40 c (0.6 mm) to 74.1% in Qr72 c (0.2 mm) and highest in the largest stent (9 mm) ranging from 93.8% in Qr40c(0.6 mm) to 99.1% in the Qr72 c (0.2 mm) series. Lumen visibility decreased by 2.1% for every 200-HU increase in lumen attenuation. Max. ΔHU between stents and stent lumen was highest in Qr72 c (0.2 mm) (ΔHU 892 ± 504 to 1526 ± 517) and Bv60 m (0.4 mm) series (ΔHU 480 ± 357 to 1030 ± 344). Improvement of lumen visibility and sharpness in UHR and Bv60 m (0.4 mm) series was strongest in smaller stent sizes. Conclusion UHR acquisition mode and sharp reconstruction kernels on a novel PCD-CT system significantly improve in-stent lumen visibility and sharpness—especially for smaller stent sizes. Key Points • In-stent lumen visibility and sharpness of stents significantly improve using sharp reconstruction kernels (Bv60) and ultra-high-resolution mode in photon-counting detector computed tomography. • The observed improvement of stent-lumen visibility was highest in smaller stent sizes.