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

项目摘要/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对冠心病的快速无创评估具有较高的敏感性和阴性预测值。 只要管腔可以被视觉化。然而，严重钙化或支架化的冠状动脉节段是非 可评估，排除了在美国约200万人中对限流性冠状动脉斑块的非侵入性诊断。 成年人。此外，最先进的CT系统的空间分辨率不足以进行稳健的可视化 与高危斑块相关的特征。此外，虽然CT可以定量评估 梗阻性CAD对心肌功能的动态灌注成像，这对患者的要求相对较高 辐射剂量，这限制了广泛采用。考虑到高昂的个人和社会成本， 冠状动脉钙化和支架化、高危斑块的CAD、稳健、准确、无创成像 在单一、低辐射剂量的检查中发现心肌灌注缺陷是非常必要的。 由西门子医疗保健公司制造的首个同类全身光子计数探测器(PCD)CT系统， 2014年在梅奥诊所安装。在NIH奖EB016966的支持下，我们表明 碘对比度噪声比、电子噪声降低、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地测量增加的血管 损伤的猪颈动脉壁中的密度，表明PCD-CT在血管中的特殊潜力 成像。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系统和新的成像算法，可准确评估人类的CAD， 尤其是在有严重钙化、支架或高危斑块的患者中，并识别患有 心肌灌注缺陷症。我们的前提是，与DS一起使用的PCD-CT的既定好处 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； 钙化和支架冠状动脉的准确、非侵入性成像、高危斑块特征以及 单一、低辐射剂量检查中的心肌灌注缺陷将消除对额外成像的需要， 减少总体时间和成本，全面评价CAD及其临床意义。要扩展 要证明PCDS对心脏CT的好处，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 时间域冗余，以及深度学习。这些进展将在一个大型临床试验中达到顶峰 研究表明，不仅是像通常所做的那样，图像更好，而且PCD-DSCT提供了 临床-对疑似冠心病患者的诊断和管理方面的显著改进。

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.