Evaluation of Silicon-Based Photon-Counting CT for Coronary Stenosis Quantification with Realistic Coronary Artery Phantoms

Abstract

Objective: To quantify the impact of high-resolution deep silicon photon-counting CT (dSi-PCCT) on coronary stenosis quantification in anatomically realistic calcified coronary artery phantoms using Micro-CT as ground truth. Methods: Twelve vessel sections representing four calcification geometries (Type I-IV) and three luminal iodine concentrations (10, 15, and 20 mg/mL) were scanned under static conditions using energy-integrating detector CT (EID-CT), dSi-PCCT, and Micro-CT. Images were registered to Micro-CT and segmented using an automated threshold-based pipeline. The primary analysis compared longitudinal profiles of Micro-CT-referenced percent area stenosis and segmented vessel area. A secondary analysis evaluated ellipse-derived percent area stenosis and percent vessel-area deviation at the maximum-calcification cross-section. Results: dSi-PCCT reduced whole-profile mean absolute error in Micro-CT-referenced percent area stenosis from 3.10% with EID-CT to 1.62% (p=0.027) and reduced segmented vessel-area error from 0.55 to 0.31 mm2 (p=0.001). In the secondary analysis, absolute deviations in ellipse-derived percent area stenosis ranged from 0.1% to 6.5% for dSi-PCCT and from 0.8% to 24.2% for EID-CT (p<0.001). Mean absolute differences in percent vessel-area deviation from Micro-CT were also lower with dSi-PCCT than with EID-CT (15.0% vs 26.6%, p<0.001). Conclusion: Under static, resolution-optimized conditions, dSi-PCCT improved task-based coronary stenosis quantification and vessel delineation relative to EID-CT, supporting further evaluation in dynamic phantoms and clinical CCTA.