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Rofo 2025; 197(05): 509-517
DOI: 10.1055/a-2452-0288
Review

Photon-Counting Detektor CT: Fortschritte und klinische Anwendungen in der kardiovaskulären Bildgebung

Article in several languages: English | deutsch
Muhammad Taha Hagar 
1   Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, United States (Ringgold ID: RIN2345)
2   Department of Diagnostic and Interventional Radiology, University of Freiburg Faculty of Medicine, Freiburg, Germany (Ringgold ID: RIN88751)
,
Christopher L Schlett
2   Department of Diagnostic and Interventional Radiology, University of Freiburg Faculty of Medicine, Freiburg, Germany (Ringgold ID: RIN88751)
,
Tim Oechsner
2   Department of Diagnostic and Interventional Radiology, University of Freiburg Faculty of Medicine, Freiburg, Germany (Ringgold ID: RIN88751)
,
Akos Varga-Szemes
1   Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, United States (Ringgold ID: RIN2345)
,
Tilman Emrich
1   Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, United States (Ringgold ID: RIN2345)
3   Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (Ringgold ID: RIN39068)
,
Xiao Yan Chen
4   Computed Tomography, Siemens Healthineers AG, Forchheim, Germany (Ringgold ID: RIN42406)
,
Dmitrij Kravchenko
1   Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, United States (Ringgold ID: RIN2345)
5   Department of Diagnostic and Interventional Radiology, University of Bonn, Bonn, Germany (Ringgold ID: RIN9374)
,
Giuseppe Tremamunno
1   Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, United States (Ringgold ID: RIN2345)
6   Department of Medical Surgical Sciences and Translational Medicine, University of Rome La Sapienza, Rome, Italy (Ringgold ID: RIN9311)
,
Milán Vecsey-Nagy
1   Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, United States (Ringgold ID: RIN2345)
7   Heart and Vascular Center, Semmelweis University, Budapest, Hungary (Ringgold ID: RIN37637)
,
Moises Felipe Molina-Fuentes
8   Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland (Ringgold ID: RIN27243)
,
Tobias Krauss
2   Department of Diagnostic and Interventional Radiology, University of Freiburg Faculty of Medicine, Freiburg, Germany (Ringgold ID: RIN88751)
,
Jana Taron
2   Department of Diagnostic and Interventional Radiology, University of Freiburg Faculty of Medicine, Freiburg, Germany (Ringgold ID: RIN88751)
,
Christopher Schuppert 
2   Department of Diagnostic and Interventional Radiology, University of Freiburg Faculty of Medicine, Freiburg, Germany (Ringgold ID: RIN88751)
,
Fabian Bamberg
2   Department of Diagnostic and Interventional Radiology, University of Freiburg Faculty of Medicine, Freiburg, Germany (Ringgold ID: RIN88751)
,
Martin Soschynski
2   Department of Diagnostic and Interventional Radiology, University of Freiburg Faculty of Medicine, Freiburg, Germany (Ringgold ID: RIN88751)
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Zusammenfassung

Hintergrund

Seit der Zulassung des ersten Dual-Source Photon-Counting Detektor-CT (PCD-CT) im Herbst 2021 konnten in der Anwendung für die kardiovaskuläre Bildgebung signifikante Erkenntnisse gewonnen werden. Diese Übersicht fokussiert sich darauf, den derzeitigen Wissensstand und die stetig wachsende Forschungsliteratur umfassend darzustellen und dabei innovative Anwendungen und Perspektiven anhand von Fallbeispielen zu illustrieren.

Methode

Wir führten eine strukturierte Literaturrecherche durch, wobei relevante Studien über Google Scholar und PubMed identifiziert wurden. Die Suchbegriffe umfassten „Photon-Counting Detektor“, „kardiovaskuläre CT“, „Herz-CT“ und „ultrahochauflösende CT“. Wir analysierten die Ergebnisse von Publikationen seit Januar 2015. Ergänzend dazu integrierten wir unsere eigenen klinischen Erfahrungen und Fallbeispiele.

Ergebnisse und Schlussfolgerungen

Neben dem bekannten Vorteil der erhöhten zeitlichen Auflösung von Dual-Source-Scannern bietet die Dual-Source PCD-CT drei wesentliche Vorteile: 1) Eine optimierte geometrische Dosiseffizienz mit verbessertem Kontrast-zu-Rausch-Verhältnis, 2) eine intrinsische spektrale Sensitivität und 3) die Möglichkeit zur ultrahochauflösenden CT. Diese Technologie ermöglicht eine verbesserte Bildqualität oder eine Reduktion der Strahlendosis bei etablierten kardiovaskulären Protokollen. Ihr Einsatz bei adipösen Patienten, hoher Plaquelast oder nach Stentimplantation erscheint technisch machbar, wodurch das Anwendungsspektrum der CT erweitert werden könnte. Die spektrale Sensitivität erlaubt zudem eine individuelle Anpassung der Bildakquisition, um Artefakte zu reduzieren und die Kontrastmitteldosis bei Patienten mit Niereninsuffizienz zu senken. Erste Studien und klinische Erfahrungen belegen diese Anwendungsmöglichkeiten der PCD-CT in der kardiovaskulären Diagnostik und weisen auf Optimierungen der klinischen Abläufe hin.

Trotz dieser Vorteile gibt es Herausforderungen wie hohe Kosten, große Datenmengen, etwas längere Rekonstruktionszeiten sowie technische Schwierigkeiten bei der Kombination von spektraler Sensitivität und Ultrahochauflösung. Es fehlen prospektiv randomisierte Studien mit klinischen Endpunkten, die einen klaren Vorteil gegenüber herkömmlichen Scannern belegen könnten. Zukünftige Forschungsprojekte sollten durch endpunktbasierte Studien und fundierte Kosten-Nutzen-Analysen das Potenzial dieser Technologie evaluieren, um eine evidenzbasierte Integration in die klinische Praxis zu ermöglichen.

Kernaussagen

  • Photon-Counting Detektor-CT markiert einen technologischen Fortschritt in der Computertomografie.

  • Die spektrale Sensitivität verstärkt das Jodsignal und minimiert Artefakte.

  • Ultrahochauflösende CT ermöglicht präzise Bildgebung auch bei Stents und fortgeschrittener Sklerose.

  • Die Technologie muss durch endpunktbasierte, randomisierte Studien validiert werden.

Zitierweise

  • Hagar MT, Schlett CL, Oechsner T et al. Photon-Counting Detector CT: Advances and Clinical Applications in Cardiovascular Imaging. Rofo 2025; 197: 509–517



Publication History

Received: 08 September 2024

Accepted after revision: 17 October 2024

Article published online:
20 November 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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