Comparison of Photon-Counting Ct Angiography With Energy-Integrating Ct Angiography in Coronary Artery Stenosis: A Systematic Review and Meta-Analysis Publisher Pubmed



Kiani I ; Mohebbi A ; Jannatdoust P ; Darmiani K ; Mohammadzdeh S ; Mohammadi A ; Gholamrezanezhead A
Source: BMC Medical Imaging Published:2025

Abstract

Purpose: To perform CT-angiography of coronary arteries, energy-integrating detector computed tomography (EID-CT) is widely used but it has several limitations, especially in overestimation of size of calcium plaques. Photon-counting detector computed tomography (PCD-CT) promises better image quality and lower radiation. This study compares the efficacy, radiation dose, and image quality of EID-CT and PCD-CT for coronary artery disease (CAD) diagnosis. Materials and methods: A systematic review and meta-analysis were conducted per PRISMA guidelines. Four databases were searched for studies directly comparing EID-CT and PCD-CT. Data on coronary artery calcium scores (CACS), radiation dose index (mGy), dose-length product (DLP), and image quality were extracted. Risk of bias was assessed using the QUADAS-C tool. Results: Twelve studies with 213 patients were included. PCD-CT showed a significant reduction in dose index (standardized mean difference (SMD) = -0.62, 95% CI: -0.89 to -0.35, p < 0.001) and DLP (SMD = -0.66, 95% CI: -0.98 to -0.35, p < 0.001) compared to EID-CT. Quantitative data for image quality and artifacts was limited, but qualitative assessments indicated PCD-CT’s superior performance in reducing beam-hardening artifacts and providing clearer images of calcified plaques. No significant difference was found in CACS between the modalities (intraclass correlation coefficient (ICC) = 0.992, 95% CI: 0.981 to 1.000) based on individual patient data. PCD-CT results in reduced percentage and grade of stenosis compared to EID-CT in the available data. Conclusion: PCD-CT has been suggested to offer better image quality and lower radiation dose compared to EID-CT, especially in visualizing calcified plaques. There is some evidence of less overestimation with PCD-CT, which should be confirmed by further studies. Clinical trial number: Not applicable. © The Author(s) 2025.