Improved coronary CT angiography image quality using photon-counting detector CT in SCAPIS reexamination: scan protocol and comparative analysis

Objectives:The Swedish CArdioPulmonary bioImage Study reexamination (SCAPIS reexamination) is the first population-based study to employ coronary CT angiography (CCTA) using photon-counting detector CT (PCD-CT).It includes 15,000 participants from SCAPIS baseline.This work aims to describe the PCD-CT protocol in SCAPIS reexamination, compare diagnostic image quality with energy-integrating detector CT (EID-CT) at SCAPIS baseline, and assess the comparability of Agatston scores and degree of stenosis between the studies. Methods:The PCD-CT protocol in SCAPIS reexamination is provided.CCTA data from 1,147 participants in SCAPIS reexamination (51% women, age 65 [IQR 61-69]) and 29,554 participants in SCAPIS (52% women, age 58 [54-61]) were analyzed.The image quality in eleven proximal or middle coronary segments was compared, stratified by Agatston score.Agatston scores and stenosis degree were compared in age-and sex-matched samples. Results:Full diagnostic image quality was more frequent in SCAPIS reexamination (1,036/1,147, 90%) compared with SCAPIS baseline (20,468/26,188, 78%), p<0.001, despite a higher calcium burden (Agatston score 8 [0-106] vs. 0 [0-20]).Of participants with Agatston score >400, 89/116, 77%, and 246/945, 26%, had full diagnostic image quality, respectively, p<0.001.Agatston score distributions and stenosis 50% were similar in matched samples (p=0.51 and p=0.08).Of those with 50% stenosis at SCAPIS baseline, 30% (12/40) were reclassified to <50% in SCAPIS reexamination. Conclusion:The optimized PCD-CT protocol in SCAPIS reexamination provided high image quality, irrespective of Agatston scores, outperforming the EID-CT protocol used at SCAPIS baseline.Agatston scores were comparable, but potential differences in stenosis grading warrant further investigation.