Rationale and Objectives
The study aimed to evaluate in vitro stent lumen visibility of coronary stents in a second- and third-generation dual-source computed tomography (CT) system at 100 and 120 kVp tube potential.
Materials and Methods
Twenty-six coronary stents ranging from 2.25 to 4.0 mm in diameter were implanted in a coronary vessel phantom. Scans were performed at 100 and 120 kVp tube potential. Evaluation was performed using a medium-sharp kernel in both systems (B46f in the second-generation and Bv49 in the third-generation model) and a sharp (Bv59) convolution kernel optimized for vascular imaging in the third-generation CT.
Results
The median visible stent lumen diameter in the second-generation system was higher at 120 kVp with a median of 62.0% compared to 56.3% at 100 kVp ( P < 0.001). The median visible diameter in the third-generation system was significantly higher applying the Bv49 kernel with 66.7% at 120 kVp and 61.1% at 100 kVp (both P < 0.001). When applying the Bv59 kernel, visible stent lumen further increased to 69.3% at 120 kVp and 66.7% at 100 kVp. Additionally, stent lumen was assessed using full width at half maximum, resulting in a comparable increase in luminal diameter at corresponding tube potential.
Conclusions
Third-generation dual-source CT provides superior stent lumen visibility at equivalent tube potential and at reduced tube potential of 100 kVp when compared to 120 kVp in a second-generation system, at least when manually assessed.
Introduction
An estimated 492,000 patients underwent percutaneous coronary intervention in the United States in 2010 . In-stent restenosis is a major limitation of percutaneous coronary intervention, and although its incidence decreased with the advent of drug-eluting stents it remains in the range of 3%–20% . Several thousand coronary angiographies are performed each year to exclude in-stent restenosis, exposing the patient to the minor but definite risks of an invasive procedure. Thus, a noninvasive method for diagnosis or exclusion of in-stent restenosis is desirable.
Yet various stent materials cause different magnitudes of x-ray attenuation, leading to beam hardening and blooming artifacts, and eventually hindering stent lumen assessment. Previous studies have shown that computed tomographic angiography (CTA) might be an appropriate tool for visualization of coronary stents. However, image quality is strongly dependent on the material and architecture of the stents reviewed, as well as the technical capabilities of the computed tomography (CT) system used for evaluation .
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Materials and Methods
Experimental Setup
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Table 1
Stent Characteristics
Number Manufacturer Name Material Coating Diameter (mm) Length (mm) Strut Thickness (mm) 1 Abbott JOSTENT Graftmaster Stainless steel + PTFE None 3.0 16 0.300 (wall thickness) 2 Abbott Multilink Vision Cobalt-chromium alloy None 3.0 23 0.081 3 Abbott Xience Pro Cobalt-chromium alloy Everolimus 3.0 15 0.081 4 Biotronik Orsiro Cobalt-chromium alloy Poly-L-lactic acid (PLLA) polymer, Sirolimus 2.25 18 0.060 5 Biotronik Orsiro Cobalt-chromium alloy Poly-L-lactic acid (PLLA) polymer, Sirolimus 2.5 13 0.060 6 Biotronik Orsiro Cobalt-chromium alloy Poly-L-lactic acid (PLLA) polymer, Sirolimus 2.75 13 0.060 7 Biotronik Orsiro Cobalt-chromium alloy Poly-L-lactic acid (PLLA) polymer, Sirolimus 3.0 18 0.060 8 Biotronik Orsiro Cobalt-chromium alloy Poly-L-lactic acid (PLLA) polymer, Sirolimus 3.5 26 0.060 9 Biotronik Orsiro Cobalt-chromium alloy Poly-L-lactic acid (PLLA) polymer, Sirolimus 4.0 15 0.060 10 Biotronik PRO-Kinetic Energy Cobalt-chromium alloy PROBIO Amorphous Silicon Carbide Coating 3.0 20 0.060 11 Boston Scientific Omega Platinum-chromium alloy None 3.0 16 0.081 12 Boston Scientific TAXUS Liberté Stainless steel None 3.0 38 0.100 13 Braun Coroflex Blue Cobalt-chromium alloy None 3.0 19 0.065 14 Cordis Cypher Stainless steel Sirolimus 3.0 28 0.140 15 Medtronic Resolute RX Cobalt-chromium alloy Zotarolimus 3.0 18 0.091 16 Medtronic Resolute Integrity RX Cobalt-chromium alloy Zotarolimus 3.5 26 0.091 17 Medtronic Resolute Integrity RX Cobalt-chromium alloy Zotarolimus 4.0 34 0.091 18 Medtronic Integrity RX Cobalt-chromium alloy Zotarolimus 2.25 30 0.091 19 Medtronic Integrity BMS Cobalt-chromium alloy None 2.5 26 0.091 20 Medtronic Integrity RX Cobalt-chromium alloy None 2.75 30 0.091 21 Medtronic Integrity RX Cobalt-chromium alloy None 3.0 22 0.091 22 Medtronic Integrity RX Cobalt-chromium alloy None 3.5 26 0.091 23 Medtronic Integrity RX Cobalt-chromium alloy None 4.0 15 0.091 24 OrbusNeich Genous Stainless steel Anti-hCD34 antibody 3.0 18 0.081 25 Terumo Kaname Cobalt-chromium alloy None 3.0 28 0.080 26 Terumo Nobori Stainless steel Poly-L-lactic acid (PLLA) polymer, Biolimus A9 3.0 28 0.120
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CT Scan Protocol
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Data Reconstruction
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Image Analysis
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Statistical Analysis
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Results
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Table 2
Visible Stent Lumen Diameters, In-stent Attenuation, and Noise at 100 and 120 kVp Tube Voltage
SOMATOM Definition Flash SOMATOM Force B46f–100 kVp B46f–120 kVp Bv49–100 kVp Bv49–120 kVp Bv59–100 kVp Bv59–120 kVp Visible diameter (%) 56.3 62.0 61.1 66.7 66.7 69.3 (49.7–60.3; 36–70) (55.9–64.4; 46–77) (55.6–64.5; 40–71) (64.4–71.4; 49–78) (64.4–71.6; 44–80) (66.0–75.6; 50–81) Attenuation (HU) 574 460 575 484 542 457 (552–605; 519–777) (453–490; 442–647) (558–597; 508–697) (471–498; 417–664) (535–569; 475–600) (414–493; 305–550) Noise (HU) 27.5 21.5 34.0 26.0 39.0 35.7 (24.8–29.0; 21–34) (19.8–23.0; 15–26) (32.8–35.0; 26–37) (24.8–27.0; 20–29) (37.8–40.0; 30–42) (28.2–36.7; 26–46)
Values provided as median, interquartile range, and range.
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Manual Measurements
Second-generation Dual-source CT
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Third-generation Dual-source CT
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Semi-automatic Evaluation Using FWHM
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Discussion
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Limitations
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Conclusions
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