Computed Tomography Coronary Angiography on a Detector-Based Spectral Computed Tomography Platform: Evaluation of Patients With Coronary Artery Disease Reporting and Data System Score of 3 and Higher

Abstract

Purpose Computed tomography (CT) coronary angiography performed on a detector-based spectral scanner helps more closely approximate severity of stenosis with nuclear medicine and cardiac catheterization tests compared with single-energy CT (SECT) in patients with an original CAD-RADS score of 3 and higher. Methods This retrospective trial was conducted between January 2017 and December 2019 and included 52 patients with a CAD-RADS score of 3 and higher. Two reading sessions were performed 6 weeks apart. The first reading session was performed using only conventional images and the second reading session was performed using spectral results. Detector-based spectral CT CAD-RADS scores were compared with cardiac stress test and/or cardiac catheterization results for final characterization of stenosis in 41 segments from 32 patients. The mean CAD-RADS score was calculated for both the conventional images and spectral images. Results The CAD-RADS score for SECT and the score for spectral CT for the 41 segments were compared. Available associated stress test and/or cardiac catheterization results were also compared with CAD-RADS scores. In 51% (21/41), a diagnosis concordant with best practices results was achieved with the help of spectral CT results. A mean CAD-RADS score of 3.56 was obtained using spectral results, compared with 3.93 using conventional images. A 2-tailed paired t test determined the difference to be significant with a P value of 0.007. Conclusions Computed tomography coronary angiography is feasible on a detector-based spectral CT scanner and can improve diagnostic confidence over SECT angiography in patients with an original CAD-RADS score of 3 and higher.