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Innovative computed tomography improves assessment of coronary heart disease

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Innovative computed tomography improves assessment of coronary heart disease

Wednesday, February 21, 2024, 11:10 a.m

Study by the Mainz University Medical Center shows that the severity of the disease is rated too high in over 50 percent of patients using standard procedures

Researchers at Mainz University Medical Center have shown that a new type of computer tomography (CT) with a so-called photon counting detector (PCD-CT) can improve the assessment of coronary heart disease. Ultra-high-resolution PCD-CT allows blood vessels and vascular deposits to be depicted more precisely than before. With the help of the innovative diagnostic method, over 50 percent of the patients in the Mainz study were classified into a lower disease category. The technology has the potential to improve patient care and reduce healthcare costs. At the Mainz University Medical Center, PCD-CT is already routinely used on patients with severe vascular calcifications. The research results have now been published in the renowned journal Radiology.

Coronary heart disease (CHD) is one of the most common heart diseases. In Germany alone, more than five million people are affected. In most cases, CHD is caused by calcification of the arteries, known as arteriosclerosis. The deposits cause the blood vessels that supply the heart to steadily narrow. Initially, physical exertion causes symptoms such as chest pain and shortness of breath. If left untreated, blood clots can form from the deposits, which can completely block the vessel and lead to a heart attack.

A heart examination using computer tomography is one of the diagnostic procedures used to assess coronary heart disease. However, this imaging method has so far reached its limits, particularly in those affected whose deposits are already heavily calcified. “Calcified vascular deposits have a higher density and appear more serious than they actually are due to the so-called calcium blooming effect on cardiac CT. This can lead to the narrowing of the vessels, i.e. the stenosis, being overestimated,” explains Dr. Tilman Emrich, senior physician in the clinic and polyclinic for diagnostic and interventional radiology at the Mainz University Medical Center and assistant professor of radiology at the Medical University of South Carolina in Charleston.

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A new generation of computer tomographs, the so-called photon counting detector CTs (PCD-CT), have significantly improved image quality compared to conventional CT. In addition, they offer better spatial resolution. It helps to distinguish two neighboring structures such as the vessel and the deposits more precisely. “The new technology could be a significant advantage for patients whose stenosis has been overestimated by the blooming effect. Better assessment of coronary heart disease may significantly change recommendations for downstream testing. This can potentially reduce unnecessary invasive procedures and reduce healthcare costs,” said Emrich.

The interdisciplinary cardiological-radiological research group led by Dr. Tilman Emrich (Radiology) and Prof. Dr. In her study, Michaela Hell (cardiology) examined 114 patients with suspected or diagnosed coronary heart disease using PCD-CT. They found that ultra-high-resolution CT revealed a lower degree of stenosis than conventional CT in many cases. With a standard resolution, the degree of stenosis measured by the experts was significantly greater, with a narrowing of 42 percent, compared to 29 percent with the ultra-high resolution. With the help of PCD-CT, around 54 percent of the study participants were able to be classified into a lower stenosis category, the so-called CAD-RADS (Coronary Artery Disease Reporting and Data System) class, than they had originally been assigned. The effect was particularly great in people who had severe vascular calcification. However, for mixed and non-calcified plaques with a low blooming effect, the scientists did not find any significant advantages of ultra-high resolution.

“In our study, we also examined the effect of PCD-CT on an artificial vascular model. The model simulated a vessel with calcified deposits corresponding to a degree of stenosis of 25 and 50 percent. The advantage of the ultra-high spatial resolution was also evident here. The reconstruction of the scans with the ultra-high resolution only deviated around two to three percent from the model value. With the standard resolution there was a deviation of around 10 percent,” explains Dr. Moritz Halfmann, first author of the publication and assistant doctor in the clinic and polyclinic for diagnostic and interventional radiology at the Mainz University Medical Center.

“In our study, the innovative CT method shows clear potential to take a further step towards optimized and patient-centered diagnosis and treatment of coronary heart disease and to promote interdisciplinary collaboration between imaging and clinical cardiology experts. However, since our study is a simulation study, further validation of the results in comparative studies is first necessary,” emphasizes Professor Hell, senior physician at the Center for Cardiology – Cardiology I.

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During computer tomography, energetic particles from X-rays penetrate the tissue being examined. The particles lose energy, depending on how dense or permeable the tissue is. A special detector measures the remaining particle energy and converts it into electrical signals from which an image of the tissue is calculated. Previous detectors require an additional conversion step to generate this electrical signal from the measured energy. The standard detectors combine the energy of several particles and detailed information is lost. The new photon counting detector, on the other hand, can convert the individual particle energy directly into an electrical signal. This converts each signal so that the CT images have a higher spatial resolution and better quality.

Originalpublikation: M.C. Halfmann, S. Bockius, T. Emrich, M. Hell, U.J. Schoepf, G. S. Laux, L. Kavermann, D. Graafen, T. Gori, Y. Yang, R. Klöckner, P. Maurovich-Horvat, J. Ricke, L. Müller, A. Varga-Szemes, N. Fink, Ultra-High-Spatial-Resolution Photon-counting Detector CT Angiography of Coronary Artery Disease for Stenosis Assessment. Radiology, 2024, 310(2):e231956.

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About the University Medicine at Johannes Gutenberg University Mainz
The University Medical Center at Johannes Gutenberg University Mainz is the only medical facility offering supramaximal care in Rhineland-Palatinate and an internationally recognized scientific location. It includes more than 60 clinics, institutes and departments that work together across disciplines and provide inpatient and outpatient care to more than 345,000 people every year. Highly specialized patient care, research and teaching form an inseparable unit at Mainz University Medical Center. More than 3,500 medical and dental students as well as around 670 specialists in a wide range of health professions, commercial and technical professions are trained here. With around 8,700 employees, Mainz University Medical Center is also one of the largest employers in the region and an important driver of growth and innovation. Further information on the Internet at www.unimedizin-mainz.de.
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