Increased diagnostic accuracy and better morphology characterization of unruptured intracranial aneurysm by ultra-high-resolution photon-counting detector CT angiography

作者：Naying He, Haiying Lyu, Youmin Zhang, Robert K.Y. Li, Zhihan Xu, E. Mark Haacke, Ying Cui, Jiqiang Li, Haipeng Dong, Wentao Han, Rui Chang, Zhen Hu, Chengcheng Zhu, Zhangsheng Yu, Yong Lü, H. X. Jiang, Fuhua Yan · 发表于：Journal of NeuroInterventional Surgery · 年份：2025 · DOI：10.1136/jnis-2025-023094 · 被引用次数：6 · 研究领域：Intracranial Aneurysms: Treatment and Complications、Advanced X-ray and CT Imaging、Digital Image Processing Techniques

BACKGROUND: Accurate detection and morphology evaluation of unruptured intracranial aneurysms (UIAs) are essential for patient management. This study aimed to assess the efficacy of ultra-high-resolution (UHR) photon-counting detector-CT angiography (PCD-CTA) in detecting UIAs and characterizing their morphological features. METHODS: This prospective study recruited consecutive participants suspected of cerebral vascular diseases who underwent PCD-CTA and subsequent digital subtraction angiography (DSA) within 1 month from September 2023 to May 2024. Performance of UIA diagnosis using UHR PCD-CTA images (slice thickness 0.2 mm) and standard resolution (SR, reflecting clinical protocols) reconstructed images were compared with DSA as reference on a per-participant, per-vessel, and per-aneurysm basis. The inter-rater agreement for UIA detection and aneurysm morphology characterization using UHR/SR PCD-CTA was also evaluated. RESULTS: Among 95 participants, 50 UIAs were confirmed in 42 participants using DSA. The inter-rater agreement for UIA detection was: kappa 0.95 for UHR and 0.89 for SR (p<0.05). On a per-aneurysm basis, the sensitivity, specificity, and diagnostic accuracy of UHR (98.0%, 96.7%, 97.3%) were all significantly higher than SR (72.0%, 86.7%, 80.0%) (p<0.05). UHR PCD-CTA accurately identified 13 of the 14 aneurysms (93%) missed by SR PCD-CTA, including 3 cases (21%) larger than 3 mm. Furthermore, UHR identified more aneurysm irregularity (18/50, 36%) than SR (5/...