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

Lidén, Mats ; Nyberg, Gusten ; Aurumskjöld, Marie Louise LU ; Baron, Tomasz ; Bergström, Göran ; Henriksson, Lilian ; Jernberg, Tomas ; Johannesson, Marit ; Lind, David and Löfmark, Henrik , et al. (2026) In European Journal of Radiology 201.
Abstract

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])... (More)

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 and 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.

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type
Contribution to journal
publication status
published
subject
keywords
Cardiac CT, Coronary arteries, Coronary CT angiography, Image quality, Photon-counting detector CT
in
European Journal of Radiology
volume
201
article number
112920
publisher
Elsevier
external identifiers
  • scopus:105038467552
  • pmid:42127646
ISSN
0720-048X
DOI
10.1016/j.ejrad.2026.112920
language
English
LU publication?
yes
id
96a4418d-472d-4e5c-9815-d1cc6cefa248
date added to LUP
2026-08-12 11:34:49
date last changed
2026-08-26 12:33:08
@article{96a4418d-472d-4e5c-9815-d1cc6cefa248,
  abstract     = {{<p>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 and 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 &lt; 0.001, despite a higher calcium burden (Agatston score 8 [0–106] vs. 0 [0–20]). Of participants with Agatston score &gt; 400, 89/116, 77%, and 246/945, 26%, had full diagnostic image quality, respectively, p &lt; 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 &lt; 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.</p>}},
  author       = {{Lidén, Mats and Nyberg, Gusten and Aurumskjöld, Marie Louise and Baron, Tomasz and Bergström, Göran and Henriksson, Lilian and Jernberg, Tomas and Johannesson, Marit and Lind, David and Löfmark, Henrik and Malinovschi, Andrei and Persson, Anders and Nowik, Patrik and Pistea, Adrian and Segelsjö, Monica and Wikner, Franciska and Sandstedt, Mårten and Fagman, Erika}},
  issn         = {{0720-048X}},
  keywords     = {{Cardiac CT; Coronary arteries; Coronary CT angiography; Image quality; Photon-counting detector CT}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Radiology}},
  title        = {{Improved coronary CT angiography image quality using photon-counting detector CT in SCAPIS reexamination : scan protocol and comparative analysis}},
  url          = {{http://dx.doi.org/10.1016/j.ejrad.2026.112920}},
  doi          = {{10.1016/j.ejrad.2026.112920}},
  volume       = {{201}},
  year         = {{2026}},
}