Computed tomography (CT) has deeply affected the approach to diagnosis in medical practice and is heavily relied on for numerous therapeutic decisions. Meanwhile, diagnostic imaging and CT in particular remains at the core of medical innovation, not least due to remarkable developments on the imaging chain. After three decades of conventional CT – intrinsically disregarding energy-dependency of X-ray attenuation – spectral CT became available clinically, fostering research and improvement of patient management. Spectral CT is regarded as a disruptive technology that can affect workflow, patient safety, and diagnostic accuracy but needs validation. With this in mind, we sought to explore the potential benefits of spectral CT for evaluating cardiovascular disease.
To provide a thorough assessment of spectral CT in evaluating vascular lumen and wall, we designed several phantom experiments to assess the feasibility of dedicated tasks and expanded our research to clinical studies for validation. To this end, we used both clinically available dual-energy CT (DECT) and pre-clinical multi-energy (spectral photon-counting detector CT [SPCCT]) platforms.
We confirmed that DECT can save radiation dose thanks to virtual non-contrast reconstructions, reduce iodine doses considerably for coronary artery imaging, and task-oriented material decomposition reconstructions improve aortic wall conspicuity, notably in aortic intramural hematoma. We also showed that SPCCT coronary angiography outperforms DECT in terms of noise, spatial resolution, and diagnostic performance. These findings advance both patient safety and the clinical value of spectral CT in cardiovascular imaging.