Comprehensive characterization of coronary atherosclerotic disease using photon-counting-detector dual-source CT and its impact on patient management

项目总结/摘要 冠状动脉疾病（CAD）仍然是美国发病率和死亡率的主要原因。心脏 CT提供了快速的CAD非侵入性评估，具有高灵敏度和阴性预测值- 只要内腔可以被看见。然而，严重钙化或植入支架的冠状动脉节段是非- 可评估的，排除了在估计200万美国人中对血流限制性冠状动脉斑块的非侵入性诊断。 成年人了此外，最先进的CT系统的空间分辨率不足以实现对肿瘤的鲁棒可视化。 与高风险斑块相关的特征。此外，虽然CT可以定量评估 阻塞性CAD心肌功能使用动态灌注成像，这需要相对较高的患者 辐射剂量，这限制了广泛采用。考虑到个人和社会的高昂代价， CAD，钙化和支架植入冠状动脉的稳健、准确、无创成像，高风险斑块 因此，迫切需要在一次低辐射剂量的检查中检查心肌灌注缺陷。 由西门子医疗集团（Siemens Healthcare）制造的首款全身光子计数探测器（PCD）CT系统， 安装于2014年的马约诊所。在NIH奖EB 016966的支持下，我们发现， 碘对比度噪声比、降低的电子噪声、光谱成像能力和改善的空间 PCD-CT相对于商业CT的分辨率使我们能够准确测量血管增加 密度在受伤的猪颈动脉壁，证明了特殊的潜力PCD-CT血管 显像由于该系统缺乏心脏成像能力，我们的目标是开发和验证一种 PCD双源（DS）CT系统和新型成像算法，可准确评估人体CAD， 特别是在严重钙化、支架植入或高危斑块的患者中， 心肌灌注缺损我们的前提是，与DS一起使用的PCD-CT的既定益处 几何和先进的降噪和材料分解算法，可以满足这些目标。 我们的建议在许多方面都很重要：技术发展将使所有CT成像受益;稳健， 钙化和支架冠状动脉、高危斑块特征的准确、无创成像，以及 单次低辐射剂量检查中的心肌灌注缺陷将减少额外成像的需要， 减少了全面评估CAD及其临床意义的总体时间和成本。延长 证明PCD对心脏CT的益处需要大量的物理、工程和算法 创新，包括新的降噪和材料分解算法，使用能量，空间和 时域冗余以及深度学习。这些进展将最终在一个大的临床 研究证明，不仅是图像“更好”，因为经常这样做，但PCD-DSCT提供 对疑似CAD患者的诊断和管理有临床意义的改善。

PROJECT SUMMARY/ABSTRACT Coronary artery disease (CAD) remains the main cause of morbidity and mortality in the United States. Cardiac CT provides fast non-invasive assessment of CAD with a high sensitivity and negative predictive value – provided that the lumen can be visualized. However, heavily calcified or stented coronary segments are non- assessable, precluding non-invasive diagnosis of flow-limiting coronary plaques in an estimated 2 million U.S. adults. In addition, the spatial resolution of state-of-the-art CT systems is insufficient for robust visualization of features associated with high risk plaques. Further, while CT can quantitatively evaluate the impact of obstructive CAD on myocardial function using dynamic perfusion imaging, this requires relatively high patient radiation doses, which has limited widespread adoption. Considering the high personal and societal cost of CAD, robust, accurate, non-invasive imaging of calcified and stented coronary arteries, high-risk plaque features, and myocardial perfusion defects in a single, low-radiation-dose exam is critically needed. Built by Siemens Healthcare, a first-of-its-kind, whole-body, photon-counting-detector (PCD) CT system was installed in 2014 at the Mayo Clinic. With support from NIH award EB016966, we showed that the increased iodine contrast-to-noise ratio, decreased electronic noise, spectral imaging capabilities, and improved spatial resolution of PCD-CT relative to commercial CT enabled us to accurately measure increased vasa vasorum density in injured swine carotid arterial walls, demonstrating the exceptional potential of PCD-CT in vascular imaging. Because this system lacks cardiac imaging capabilities, our objective is to develop and validate a PCD dual-source (DS) CT system and novel imaging algorithms to accurately assess CAD in humans, especially in patients with heavily calcified, stented, or high-risk plaques, and to identify patients with myocardial perfusion defects. Our premise is that the established benefits of PCD-CT, used with a DS geometry and advanced noise reduction and material decomposition algorithms, can meet these objectives. Our proposal is significant in many ways: the technology developments will benefit all of CT imaging; robust, accurate, non-invasive imaging of calcified and stented coronary arteries, high-risk plaque features, and myocardial perfusion defects in a single, low-radiation-dose exam will obviate the need for additional imaging, reducing the overall time and cost to comprehensively evaluate CAD and its clinical significance. To extend the demonstrated benefits of PCDs to cardiac CT will require numerous physics, engineering, and algorithm innovations, including novel noise reduction and material decomposition algorithms using energy, spatial and temporal domain redundancies, as well as deep learning. These advances will culminate in a large clinical study to demonstrate not merely that the images are “better,” as is so often done, but that PCD-DSCT provides clinically-significant improvements in the diagnosis and management of patients with suspected CAD.