Is coronary stent assessment improved with spectral analysis of dual energy CT?
OBJECTIVE
The aims of this study were to distinguish stents from iodinated contrast on the basis of spectral characteristics on dual-energy computed tomographic (DECT) imaging and to determine whether DECT imaging might provide a more accurate measurement of true stent lumen.


METHODS
Three stainless steel stents and one cobalt chromium stent were scanned using a multidetector, single-source DECT scanner. Stents 2.5, 3.5, and 4.0 mm in diameter were filled with iodinated contrast, submerged in water, and scanned. Spectral analysis was performed to assess the separation of stents from iodinated contrast. Two independent reviewers measured stent lumen diameter and strut thickness on low-energy (L(0)), high-energy (L(1)), and combined-energy (L(c)) images. Dual-energy full-width half-maximum edge detection analysis was used to provide an independent assessment of stent luminal diameter and strut thickness.


RESULTS
Two-dimensional graphical plots of computed tomographic attenuation for the L(0) and L(1) images did not demonstrate a sharp separation between the absorption characteristics of stents and iodinated contrast material. Stent lumens were underestimated by approximately 50% on L(c) images. Observer measurements on L(1) images demonstrated a 24% decrease in strut thickness and a 25% increase in stent luminal diameter compared to L(0) images (P < .0001). Full-width half-maximum measurements did not demonstrate significant changes in stent luminal diameters or strut thicknesses between L(0) and L(1) images.


CONCLUSIONS
Spectral analysis did not clearly distinguish stents from iodinated contrast with the DECT system used in this study. The larger stent lumens visualized by the high-energy components of the x-ray spectrum were not related to improved computed tomographic delineation of stent thickness.
Halpern
Ethan J
EJ
Department of Radiology, Thomas Jefferson University, 132S 10th Street, Philadelphia, PA 19107-5244, USA. ethan.halpern@jefferson.edu
Halpern
David J
DJ
Yanof
Jeffrey H
JH
Amin-Spector
Sigal
S
Fischman
David
D
Aviram
Galit
G
Sosna
Jacob
J
D015502:Absorptiometry, Photon / Q000379:methods*; D001807:Blood Vessel Prosthesis; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D019544:Equipment Failure Analysis / Q000379:methods; D006801:Humans; D019047:Phantoms, Imaging; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods*