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Infrapopliteal Segments on Lower-Extremity CTA: Prospective Intraindividual Comparison of Energy-Integrating Detector CT and Photon-Counting Detector CT.

Background: The higher spatial resolution and image contrast for iodine-containing tissues of photon-counting detector (PCD) CT may address challenges in evaluating small, calcified vessels when performing lower-extremity CTA by energy-integrating detector (EID) CTA. Purpose: To compare the evaluation of infrapopliteal vasculature between lower-extremity CTA performed using EID CT and PCD CT. Methods: This prospective study included 32 patients (mean age 69.5±8.3 years; 27 men, 5 women) who underwent clinically indicated lower-extremity EID CTA between April 2021 and March 2022; participants underwent investigational lower-extremity PCD CTA later in the same day as EID CTA using a reduced IV contrast media dose. Two radiologists independently reviewed examinations in two sessions, each containing a random combination of EID-CT and PCD-CT examinations, assessing the number of visualized fibular perforators, characteristics of stenoses at 11 infrapopliteal segmental levels, and subjective arterial sharpness. Results: Mean IV contrast media dose was 60.0±11.0 ml for PCD CTA versus 139.6±11.8 ml for EID CTA (p<.001). Number of identified fibular perforators per lower extremity was significantly higher for PCD CTA than for EID CTA for reader 1 (6.4±3.2 vs 4.2±2.4, p<.001) and reader 2 (8.8±3.4 vs 7.6±3.3, p=.04). Reader confidence for assessing stenosis was significantly higher for PCD CTA than for EID CTA for reader 1 (82.3±20.3 vs 78.0±20.2; p<.001), but not reader 2 (89.8±16.7 vs 90.6±7.1; p=.24). Number of segments per lower extremity with total occlusion was significantly lower for PCD CTA than for EID CTA for reader 2 (0.5±1.3 vs 0.9±1.7; p=.04) but not reader 1 (0.6±1.3 vs 1.0±1.5; p=.07). Number of segments per lower extremity with clinically significant nonocclusive stenosis was significantly higher for PCD CTA than for EID CTA for reader 1 (2.2±2.2 vs 1.6±1.7; p=.01) but not reader 2 (1.1±2.0 vs 1.1±1.4; p=.89). Arterial sharpness was significantly greater for PCD CTA than for EID CTA for reader 1 (3.2±0.5 vs 1.8±0.5; p<.001) and reader 2 (3.2±0.4 vs 1.7±0.8; p<.001). Conclusion: PCD CTA yielded multiple advantages relative to EID CTA for visualizing small infrapopliteal vessels and characterizing associated plaque. Clinical Impact: Use of PCD CTA may improve vascular evaluation in patients with peripheral arterial disease.

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