Original Research

DOI: 10.4244/EIJ-D-25-00257

Photon-counting detector computed tomography for the assessment of coronary stents and in-stent restenosis

Doosup Shin1, MD; Rick H.J.A. Volleberg1,2, MD; Roosha Parikh1,3,4, MD; Christopher Chieh Yang Koo1,5, MBBS; Sarah Malik1,3, MD; Matthew Cannata1, BSc; Emma Caron1, BSc; Yasemin Ciftcikal1, BA; Koshiro Sakai6,7, MD, PhD; J. Jane Cao1,3, MD, MPH; Lu Chen1,3, MD; Fernando Sosa1, MS, MBA; Jonathan Weber1, MPH; Jaffar M. Khan1, MD, PhD; David J. Cohen1,8, MD, MSc; Jeffrey W. Moses1,8, MD; Niels van Royen2, MD, PhD; Carlos Collet6, MD, PhD; Richard A. Shlofmitz1, MD; Evan Shlofmitz1, DO; Allen Jeremias1, MD, MSc; Omar K. Khalique1,3,4, , MD; Ziad A. Ali1,4, MD, DPhil

Abstract

Background: Photon-counting detector computed tomography (PCD-CT) offers enhanced spatial resolution and reduced blooming artefacts, potentially improving the evaluation of stented coronary vessels.

Aims: This study aimed to assess the diagnostic performance of dual-source PCD-CT in detecting obstructive in-stent restenosis (ISR).

Methods: We identified consecutive patients with prior coronary stent implantation who underwent clinically indicated coronary computed tomography angiography (CCTA) with PCD-CT and subsequent invasive coronary angiography within 90 days between 2023 and 2024. Obstructive ISR (≥50% diameter stenosis) was determined by visual assessment of CCTA and invasive quantitative coronary angiography (QCA) in a blinded fashion. The diagnostic performance of CCTA for ISR was compared with that of QCA.

Results: A total of 283 stented lesions from 171 patients were included. Of these, only 3 lesions (1.1%) were deemed indeterminate by PCD-CT. Using invasive QCA as the reference standard, PCD-CT demonstrated a lesion-level sensitivity of 80.0%, specificity of 90.4%, positive predictive value (PPV) of 58.2%, negative predictive value (NPV) of 96.4%, and an overall diagnostic accuracy of 88.9% for detecting obstructive ISR. In a subgroup analysis according to the stent diameter (<3.00 mm [n=83] vs ≥3.00 mm [n=108]), there were no significant differences in sensitivity (87.5% vs 86.7%; p=1.00), specificity (93.3% vs 92.5%; p=1.00), PPV (58.3% vs 65.0%; p=1.00), NPV (98.6% vs 97.7%; p=1.00), or overall diagnostic accuracy (92.8% vs 91.7%; p=1.00), respectively.

Conclusions: PCD-CT demonstrated good diagnostic performance for evaluating obstructive ISR using QCA as the reference standard, regardless of stent diameter.

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Volume 21 Number 19
Oct 6, 2025
Volume 21 Number 19
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