Influence of Cardiac Motion on Stent Lumen Visibility in Photon-Counting CT Employing a Pulsatile Heart Model

Introduction: Detection of in-stent restenosis by cardiac CT is challenging due to blooming artifacts. The technological progress of CT scanners and especially the recent introduction of photon-counting detectors (PCDs) has led to an improvement in image quality. Several studies have analyzed the lumen visibility of coronary stents, but most studies used models which did not simulate cardiac movement. In this study we use a pulsatile heart model to simulate a heartbeat to analyze the effects of cardiac motion on image quality. Methods: Seventeen different coronary stents with an outer diameter of 3.0 mm were implanted into polyolefin tubes. The tubes were then filled with diluted contrast medium and attached to the pulsatile heart model. The stents were scanned in a third-generation dual-source CT with an energy-integrating detector (EID) and a first-generation PCD CT. Results: In motion, the mean visible stent lumen was reduced from 64.4% to 59.4% in EID CT, from 61.4% to 56.0% in PCD CT using the Bv60 kernel, and from 72.9% to 62.9% in PCD CT using the Bv72 kernel, each in standard resolution mode. Employing the ultra-high-resolution mode (UHR), stent lumen visibility was reduced from 61.3% to 57.9% with the Bv60 kernel and from 71.7% to 61.8% with the Bv72 kernel. The difference between static imaging and motion was significant in each instance (p < 0.001). Conclusions: While PCD CT and the use of sharper kernels improves the image quality in comparison with EID CT and smoother kernels, the impact of cardiac motion on the reduction in stent lumen visibility is substantial. Hence, the best image quality is achieved in patients with a normal and regular heart rate. If this is not possible to achieve, a retrospective acquisition mode should be considered.