SCCT: Should Photon-Counting CT Be the New Standard for Assessing CAD Prior to TAVR?
For patients having CT angiography prior to TAVR procedures, researchers found that photon-counting detector CT (PCD-CT) offered higher specificity and PPV for detecting significant coronary artery disease (CAD), according to study findings to be presented at the Society of Cardiovascular Computed Tomography (SCCT) conference.
New research to be presented at the Society of Cardiovascular Computed Tomography (SCCT) conference emphasizes the merits of photon-counting detector computed tomography (PCD-CT) over conventional CT in the assessment of patients for transcatheter aortic valve replacement (TAVR) procedures.
For the retrospective study, researchers compared the use of PCD-CT in 546 patients and energy-integrating detector CT (EID-CT) in 581 patients for detecting significant coronary artery disease (CAD). All patients in the cohort (average age of 74.3) were candidates for TAVR procedures who had pre-procedural CT angiography (CTA) and invasive coronary angiography (ICA), according to the study. The study authors noted that 208 patients in the PCD-CT cohort had standard resolution scans and 338 patients had ultra-high resolution (UHR) scans.
The researchers found that PCD-CT offered comparable sensitivity and negative predictive value (NPV) to EID-CT for detection of significant CAD but higher diagnostic accuracy (91.2 percent vs. 83.3 percent), specificity (91.2 percent vs. 82.3 percent) and positive predictive value (PPV) (59.2 percent vs. 40.5 percent).
The study authors pointed out that UDH PCD-CT, in particular, provided a 93.9 percent accuracy rate for detecting significant CAD along with a 94.6 percent specificity rate and a 72.9 percent PPV.
“PCD-CT improves diagnostic accuracy for detection of significant CAD in patients undergoing CTA for TAVR planning, primarily driven by the improved specificity and PPV of UHR acquisition,” noted lead study author Jose Osoria-Velasquez, MD, a research fellow of cardiovascular imaging in the Department of Radiology and Radiological Sciences at the Medical University of South Carolina, and colleagues.
Emphasizing the differences in specificity between PCD-CT and EID-CT, the study authors said the impetus behind the study was the questionable specificity of EID-CT for identifying significant CAD in potential TAVR candidates.
“ … The limited specificity of conventional energy-integrating detector (EID)-CT for coronary artery disease (CAD) assessment has restricted its use as a gatekeeper to invasive coronary angiography (ICA),” noted Osoria-Velasquez and colleagues.
Reference
- Osoria-Velasquez J, Halfmann MC, Hagar MT, et al. Photon-counting vs. energy-integrating detector CT: diagnostic performance for detecting significant coronary artery disease before TAVR. Presented at the Society of Cardiovascular Computed Tomography (SCCT) conference, July 9-12, 2026, San Diego. Available at:
https://cattendee.abstractsonline.com/meeting/21508/presentation/908
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