PHOTON-COUNTING detector computed tomography (PCD-CT) has demonstrated superior diagnostic accuracy and clinical impact compared to conventional energy-integrating detector computed tomography (EID-CT) for detecting obstructive coronary artery disease (CAD).
This retrospective study evaluated 7,833 patients who underwent coronary computed tomography angiography (CCTA) at a single centre from 2022 to 2023. Of these, 3,876 underwent PCD-CT, while 3,957 received EID-CT imaging. The study assessed the diagnostic performance of both modalities using quantitative coronary angiography as the reference standard and analysed clinical outcomes, including referral rates for invasive coronary angiography (ICA) and subsequent revascularisation procedures. The findings revealed that PCD-CT offers enhanced specificity, positive predictive value, and overall diagnostic accuracy, which may impact clinical decision-making.
Patients undergoing PCD-CT were less likely to require referral for ICA (9.9% vs 13.1%; P < 0.001) compared to those who had EID-CT. Among those referred for ICA, revascularisation was more frequently performed following PCD-CT (43.4% vs 35.5%; P = 0.02). Vessel-level analysis highlighted a significant improvement in specificity (98.0% vs 93.0%; P < 0.001), positive predictive value (83.3% vs 63.0%; P = 0.002), and diagnostic accuracy (97.2% vs 92.8%; P < 0.001) with PCD-CT, while sensitivity (90.9% vs 90.7%; P = 0.95) and negative predictive value (98.9% vs 98.7%; P = 0.83) were comparable between the two modalities.
In conclusion, PCD-CT provides significant advancements in the diagnosis of obstructive CAD, reducing unnecessary ICA referrals while improving the likelihood of therapeutic revascularisation for those referred. This technology holds promise for refining clinical pathways in cardiovascular care, enhancing both diagnostic precision and patient outcomes. Future studies should explore its broader application in diverse clinical settings and long-term cost-effectiveness to guide implementation in routine practice.
Katrina Thornber, EMJ
Reference
Sakai K et al. Diagnostic performance and clinical impact of photon-counting detector computed tomography in coronary artery disease. JACC. 2025;85(4):339-48.
