Cardiac CT with Precise IQ Engine (PIQE) 1024 Matrix in Clinical Practice Dr. Marcus Chen Prof. Mickaël Ohana National Heart, Lung & Blood Institute National Institutes of Health, USA Nouvel Hopital Civil, Strasbourg University Hospital, France Introduction Cardiovascular disease is the leading cause of death worldwide1. Early diagnosis of cardiovascular disease is important for improved life expectancy and effective treatment planning. Cardiac CT Angiography (CCTA) is a non-invasive test to diagnose coronary artery disease (CAD). A multi-center international study has shown that cardiac CTA accurately identifies the presence and severity of obstructive coronary artery disease and subsequent revascularization in symptomatic patients2. Recently both the US and European guidelines for the diagnosis of patients with chest pain have been updated. In the European guidelines cardiac CTA is recommended to exclude acute coronary syndrome in patients with low to intermediate likelihood of CAD3. In the US guidelines cardiac CTA is recommended as a frontline test for the Dr. Fuminari Tatsugami Hiroshima University, Japan evaluation of patients with stable and acute chest pain who have no history of CAD4. In both guidelines cardiac CTA has a Class 1 Level A designation which is the strongest recommendation indicating high quality evidence from clinical trials that CTA is beneficial, useful and safe3,4. The Coronary Artery Disease Reporting and Data System (CAD-RADS) provides a standardized reporting framework for coronary CT angiography and was updated in 2022. The classification system provides an assessment of stenosis and plaque burden and a guide to possible next steps in patient management5 (Figure 1). Precise IQ Engine (PIQE) is a Super Resolution Deep Learning Reconstruction* that brings together extraordinary spatial resolution and reduced noise, within a single-rotation scan for confident diagnosis of small coronary vessels, plaques, stents and fine cardiac structures (Figure 2). Figure 2: Single rotation cardiac CTA reconstructed with PIQE 1024 Figure 1: CAD-RADS Scoring system for coronary CTA. From https://radiologyassistant.nl/cardiovascular/cad-rads/coronaryartery-disease-reporting-and-data-system * In clinical practice, the use of PIQE may increase spatial resolution (super resolution), depending on the clinical task, patient size, anatomical location, and clinical practice.

The PIQE Deep Learning Reconstruction algorithm is trained using Ultra-High Resolution data with twice the resolution of conventional CT acquired on the commercially available Aquilion Precision CT system, which features UHR 0.25 mm detectors in routine clinical practice. Datasets reconstructed with PIQE empower the clinician with twice the high contrast signal definition, as well as reduced noise, in all three dimensions, relative to conventional hybrid iterative reconstruction. These benefits maintain low contrast detectability, without additional radiation dose to the patient6 (Figure 3)....

PIQE 1024 Matrix training principles The PIQE reconstruction algorithm features a next generation, three-dimensional neural network trained to identify and preserve signal features, both in-plane and longitudinally, throughout the cardiac volume dataset. Trained on high quality cardiac cases acquired on clinically operating Aquilion Precision systems, PIQE optimizes spatial resolution for clinically relevant tasks and realistic Training Data Preparation High Resolution CT Acquisition Model Aquilion Precision Anatomical Model Scanner Model field-of-views. PIQE’s three-dimensional learning also...

Stenosis in the right coronary artery (RCA) Dr. Tatsugami, Hiroshima University, Japan Patient History This 73-year-old man presented with typical angina pectoris and a heart rate of 60 bpm. A coronary CTA was requested. A mild stenosis of CAD-RADs 2 (25-49%) is seen in the proximal segment of the right coronary artery. Non-calcified plaque is identified at the stenotic site. A small calcification is seen immediately distal to the stenosis. Clinical Benefit The spotty calcification are described as high risk plaque features. PIQE 1024 may provide identification of micro calcifications beyond...

Vulnerable plaque in the left circumflex artery (LCx) Dr. Chen, National Institutes of Health, USA Patient History This 60-year-old man with BMI 29.4 and a history of an RCA stent presented with recent onset of chest pain. A Coronary CTA was requested. In the LCx there is a non-calcified severe (>70%) stenosis with outward/positive remodeling of the mid vessel. This stenosis is approximately 10 mm before the first obtuse marginal branch. There is a small, calcified plaque at the origin of the first obtuse marginal vessel. Clinical Benefit The positive remodeling and non-calcified plaque can be...

Left anterior descending artery (LAD) non-calcified plaque and correlation with invasive coronary angiogram Prof. Ohana, Strasbourg University Hospital, France Patient History This 67-year-old woman with a BMI 28 and a heart rate of 76 bpm presented with a history of angina. The Calcium Score scan was within normal range with an Agatston score of 68. A CTA was requested to investigate the cause of angina. Invasive coronary angiogram In the mid LAD there is a non-calcified plaque with positive remodeling. The residual lumen can be seen better with the PIQE 1024 reconstruction. With the DLR reconstruction,...

Napkin-Ring Sign in the first diagonal vessel Dr. Tatsugami, Hiroshima University, Japan Patient History This 60-year-old man with a BMI 29 and heart rate of 61 bpm had a history of acute myocardial infarction and a previous revascularization procedure. As a follow-up, CT was performed for coronary artery evaluation. Global Illumination Rendering with PIQE 1024

lumen low attenuation core non-calcified plaque high attenuation peripheral rim Global Illumination Rendering with PIQE 1024 The D1 shows a non-calcified plaque causing a stenosis scored as CAD-RADs 3 (50-69% stenosis). It is very challenging to confirm whether there is a napkin-ring sign in the DLR and PIQE 512 images. However, the PIQE 1024 images clearly shows a napkin-ring sign. Clinical Benefit The unique combination of high resolution, low contrast detectability and low noise enabled by PIQE 1024 makes it possible to identify vulnerable plaques with the napkin-ring sign. Therefore, PIQE...