Coronary stent imaging with dual-source CT: assessment of lumen visibility using different convolution kernels and postprocessing filters

Abstract

Background

Assesment of the coronary arteries after stent placement using coronary computed tomography angiography (CCTA) currently requires reconstruction of images with soft kernels for the assessment of atherosclerotic plaques and dedicated edge enhancing kernels for the evaluation of the stent lumen.

Purpose

To evaluate a two-dimensional filter tool that provides instant postprocessing of images reconstructed with soft kernels into edge-enhanced images and vice versa and thus may eliminate the need for two separate reconstrcutions for the assessment of coronary artery stents using CCTA.

Material and Methods

Twenty stents with a diameter of 3.0 mm placed in a vascular phantom were scanned with a dual-source CT using standard parameters. Images were reconstructed with a soft B30f and an edge-enhancing B46f kernel and postprocessed with the corresponding filter algorithm (F30 for B30f images; F46 for B46f images). The resulting four data-sets were evaluated for lumen visibility, intraluminal attenuation, and image noise by two independent readers. Results were validated in vivo against invasive coronary angiography in data-sets from patients with coronary artery stents.

Results

Average intraluminal attenuation was 552.6 HU, 527.3 HU, 207.9 HU, and 267.5 HU for B30f, F30, B46f, and F46 images, respectively (P < 0.0001). Average image noise was 11.3, 10.6, 19.2, and 15.0 HU, respectively (P < 0.0001). The visible stent diameter was significantly higher in the B46f (59.6%) and F46 images (54%) compared to the B30f (48.3%) and F30 (51.5%) images (P < 0.0001). In the patient study, lumen assessability was significantly better in B46f images than in F46 images. Sensitivity for stenosis detection was best in the original B46f images with a sensitivity of 67% and a specificity of 94%.

Conclusion

The postprocessing filter reduces image noise, however currently it does not offer an alternative to image reconstruction using the edge-enhancing kernels for the evaluation of the stent lumen.

Keywords

Coronary CT angiography cardiac CT image noise image reconstruction stent

Get full access to this article

View all access options for this article.

References

Roger

Lloyd-Jones

. Heart disease and stroke statistics—2011. Circulation 2011; 123: e18–e209.

Di Lorenzo

Sauro

Varricchio

. Benefits of drug-eluting stents as compared to bare metal stent in ST-segment elevation myocardial infarction: Four year results of the Paclitaxel or Sirolimus-Eluting stent vs bare metal stent in primary angioplasty (PASEO) randomized trial. Am Heart J 2009; 158: e43–e50.

Farb

Sangiorgi

Carter

. Pathology of acute and chronic coronary stenting in humans. Circulation 1999; 99: 44–52.

Stone

Ellis

Cox

. A polymer-based, Paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 2004; 350: 221–231.

DeFrances

Lucas

Buie

. 2006 National hospital discharge survey. National health statistics reports; no5 , Hyatsville, MD: National Center for Health Statistics, 2008.

Mowatt

Cook

Hillis

. 64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart 2008; 94: 1386–1393.

Maintz

Seifarth

Flohr

. Improved coronary artery stent visualization and in-stent stenosis detection using 16-slice computed-tomography and dedicated image reconstruction technique. Invest Radiol 2003; 38: 790–795.

Hoffmann

MHK

Shi

Schmitz

. Noninvasive coronary angiography with multislice computed tomography. JAMA 2005; 293: 2471–2478.

Maintz

Grude

Fallenberg

. Assessment of coronary arterial stents by multislice-CT angiography. Acta Radiol 2003; 44: 597–603.

10.

Andreini

Pontone

Mushtaq

. Multidetector computed tomography coronary angiography for the assessment of coronary in-stent restenosis. Am J Cardiol 2010; 105: 645–655.

11.

Seifarth

Özgün

Raupach

. 64- versus 16-slice CT angiography for coronary artery stent assessment: in-vitro experience. Invest Radiol 2006; 41: 22–27.

12.

Pugliese

Cademartiri

van Mieghem

. Multidetector CT for visualization of coronary stents. Radiographics 2006; 26: 887–904.

13.

Cademartiri

La Grutta

Runza

. Influence of convolution filtering on coronary plaque attenuation values: observations in an ex vivo model of multislice computed tomography coronary angiography. Eur Radiol 2007; 17: 1842–1849.

14.

Achenbach

Anders

Kalender

. Dual-source cardiac computed tomography: image quality and dose considerations. Eur Radiol 2008; 18: 1188–1198.

15.

Seifarth

Raupach

Schaller

. Assessment of coronary artery stents using 16-slice MDCT angiography: evaluation of a dedicated reconstruction kernel and a noise reduction filter. Eur Radiol 2005; 15: 721–726.

16.

Maintz

Burg

Seifarth

. Update on multidetector coronary CT angiography of coronary stents: in-vitro evaluation of 29 different stent types with dual-source CT. Eur Radiol 2009; 19: 42–49.

17.

Haraldsdottir

Gudnason

Sigurdsson

. Diagnostic accuracy of 64-slice multidetector CT for detection of in-stent restenosis in an unselected, consecutive patient population. Eur J Radiol 2010; 76: 188–194.

18.

Pugliese

Mollet

Hunink

MGM

. Diagnostic performance of coronary CT angiography by using different generations of multisection scanners: Single-center experience. Radiology 2008; 246: 384–393.

19.

Lell

Panknin

Saleh

. Evaluation of coronary stents and stenoses at different heart rates with dual source spiral CT (DSCT). Invest Rad 2007; 42: 536–541.