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Imaging Corner

Using Photon-Counting CT to Determine In-Stent Restenosis

Images/courtesy Semmelweis University, Budapest, Hungary

March 2024
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Figure 1. Left anterior descending artery (LAD) curved planar reformat (CPR).
Figure 1. Left anterior descending artery (LAD) curved planar
reformat (CPR).

The high level of spatial resolution in a diagnostic cardiac computed tomography angiography (CCTA) scan conducted using photon-counting CT can help clinicians determine whether a patient with cardiac disease also requires an invasive coronary angiography procedure. In this case, a 5’6”, 180 lb male patient with coronary artery disease was scanned on a photon-counting CT scanner (the NAEOTOM Alpha, Siemens Healthineers) for follow-up care after stenting and evaluation for in-stent restenosis. The CT scan, which used a sequential Quantum HD Cardiac CCTA acquisition and was reconstructed in the Best Diastolic phase utilizing a 1024x1024 matrix, was performed at 140 kVp with an estimated patient radiation dose of 4 mSv. The scan revealed not only multiple areas of in-stent restenosis (Figures 1-2), but also soft and hard plaque in non-stented areas (Figures 1-3). 

Figure 2. Circumflex artery (Cx) CPR with portion of LAD.
Figure 2. Circumflex artery (Cx) CPR with portion of
LAD.

 

Figure 3. Right coronary artery (RCA) CPR.
Figure 3. Right coronary artery (RCA) CPR.
Figure 4. Cinematic-rendered cardiac image visualizing multiple stents.
Figure 4. Cinematic-rendered cardiac image visualizing
multiple stents.

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