{
  "abstract": "Objectives: Ultra-high-resolution photon-counting detector (PCD)-CT may enable leaflet-specific analysis of aortic valve fibrosis and calcification, providing insights into early aortic stenosis (AS) disease progression. This study aimed to investigate how PCD-CT leaflet-specific calcific and fibrotic volumes influence cardiovascular magnetic resonance (CMR) leaflet mobility. Materials and methods: Participants with moderate aortic AS prospectively underwent both PCD-CT (n=80) and CMR (n=58). Using PCD-CT, calcific and fibrotic volumes were segmented for right (RCC), left (LCC), and non-coronary cusps (NCC) and indexed to the aortic annulus area (ICV and IFV). CMR-derived leaflet mobility index (LMI) was assessed. Two raters compared image quality using a Likert scale (1=poor to 5=excellent) and distinguishability of individual leaflets in PCD-CT with EID-CT (n=82). Results: PCD-CT analysis showed that calcification was higher in males (e.g., ICVRCC: 15+/-16 vs. 4+/-7 uL/cm^2; p<0.001), while fibrosis was higher in females (e.g., IFVLCC: 47+/-18 vs. 34+/-15 uL/cm^2; p=0.004) across all leaflets. Fibrocalcific ratio was higher in LCC (53+/-276) compared to RCC (19+/-48; p<0.001) and NCC (13.5+/-34; p<0.001). LMI of RCC was higher in females compared to men (0.66+/-0.21 vs. 0.38+/-0.33; p=0.008). LMILCC and LMINCC showed no sex differences. LMIRCC negatively correlated with ICVRCC ({rho}=-0.64 [-0.77, -0.46]; p<0.001) and LMINCC with ICVNCC ({rho}=-0.69 [-0.80, -0.53]; p<0.001), whereas LMILCC negatively correlated with IFVLCC ({rho}=-0.35 [-0.56, -0.10]; p=0.007), particularly in females ({rho}=-0.70 [-0.89, -0.31]; p=0.003). PCD-CT yielded higher image quality (5 [IQR 4-5] vs. 3 [3-4]; p<0.001) and leaflet distinguishability (79/80 [99%] vs. 42/82 [51%]; p<0.001) than EID-CT. Conclusions: Ultra-high-resolution PCD-CT allows for leaflet-specific quantification of indexed fibrotic and calcific volume. These volumes demonstrate sex- and leaflet-specific differences that may distinctly contribute to AS pathophysiology.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53115 Bonn, Germany"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 18,
  "authors": [
    {
      "name": "M. Bahaaeldin"
    },
    {
      "name": "J. Shamekhi"
    },
    {
      "name": "B. S. Franklin"
    },
    {
      "name": "S. Nowak"
    },
    {
      "name": "A. M. C. Bohner"
    },
    {
      "name": "D. Kravchenko"
    },
    {
      "name": "J. Wrobel"
    },
    {
      "name": "R. Phinicarides"
    },
    {
      "name": "L. Pennig"
    },
    {
      "name": "J. P. Janssen"
    },
    {
      "name": "C. Gietzen"
    },
    {
      "name": "S. Zimmer"
    },
    {
      "name": "S. Baldus"
    },
    {
      "name": "M. Kelm"
    },
    {
      "name": "G. Nickenig"
    },
    {
      "name": "T. Zeus"
    },
    {
      "name": "V. Mauri"
    },
    {
      "affs": [
        0
      ],
      "name": "J. A. Luetkens"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6j6vg29jsg7gd.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.27.26366483",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.27.26366483v1.full",
  "id": "6j6vg29jsg7gd",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.27.26366483v1",
  "language": null,
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "cardiovascular medicine"
    ],
    [
      "openalex",
      "2705|Cardiac Valve Diseases and Treatments"
    ]
  ],
  "openalex": "W7224091764",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.27.26366483v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-27",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/6j6vg29jsg7gd.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:57Z",
      "native_id": "10.64898/2026.10.27.26366483",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.27.26366483v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:cardiovascular medicine",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Ultra-high-resolution Photon-Counting CT for Leaflet-Specific Evaluation of Fibrosis and Calcification in Aortic Stenosis",
  "title_text": "Ultra-high-resolution Photon-Counting CT for Leaflet-Specific Evaluation of Fibrosis and Calcification in Aortic Stenosis",
  "type": "preprint",
  "updated_at": "2026-10-30T12:21:57Z",
  "url": "https://research.draconitic.com/paper/6j6vg29jsg7gd",
  "venue": "medRxiv",
  "versions": []
}