Trial reportEuropean radiology experimental2026
Feasibility of ultra-low flow rate coronary CT angiography using photon-counting detector CT: a prospective randomized trial.
Trial report in European radiology experimental, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
objectiveThis study evaluates the feasibility of photon-counting detector CT (PCD-CT)-based coronary CT angiography (CCTA) using ultra-low flow contrast rate while maintaining diagnostic image quality. MATERIALS AND
methodsIn this prospective trial, 292 patients underwent CCTA assigned to one of three protocols: ultra-low (1.5-1.8 mL/s) or routine (4.0-5.0 mL/s) contrast injection with PCD-CT, or routine injection with EID-CT. All scans utilized a high-pitch prospective electrocardiogram-triggering acquisition. PCD-CT images were reconstructed at 45 keV (ultra-low) or 60 keV (routine). Objective image quality was quantitatively assessed by measuring vessel attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Subjective image quality parameters (vascular contrast, image noise, artifacts, and vessel clarity) were independently evaluated by two blinded readers using a 4-point Likert scale (1: non-diagnostic; 2: adequate; 3: good; 4: excellent).
resultsObjective image quality demonstrated comparable attenuation, CNR, and SNR in proximal coronary segments across all groups (all p > 0.05). The ultra-low PCD-CT protocol significantly lowers attenuation in the distal LAD (373.20 ± 49.58 HU) compared to routine protocols (PCD-CT: 393.52 ± 49.38 HU; EID-CT: 396.72 ± 47.55 HU; p = 0.01). While distal vessel clarity scores were modestly reduced in distal vessel clarity (ultra-low PCD-CT: 2.91 ± 0.81 versus routine PCD-CT: 3.58 ± 0.50 versus routine EID-CT: 3.54 ± 0.50; p < 0.01).
conclusionFor patients with difficulty establishing venous access routes, ultra-low contrast agent flow rates in PCD-CT maintain objective image quality comparable to that of standard protocols, with acceptable diagnostic performance despite slight reductions. RELEVANCE STATEMENT: Photon-counting detector CT (PCD-CT) maintains objective coronary CT angiography image quality comparable to standard protocols even at ultra-low contrast flow rates (1.5-1.8 mL/s), offering a clinically acceptable and safer alternative for patients with challenging venous access. KEY POINTS: First validation of ultra-low flow contrast rate CCTA using photon-counting CT (PCD-CT). Ultra-low flow rates maintain objective image quality (CNR/SNR) versus routine protocols. PCD-CT enables 50% contrast reduction without diagnostic compromise.
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