Ultra-high-resolution Photon-Counting CT for Leaflet-Specific Evaluation of Fibrosis and Calcification in Aortic Stenosis
- 1Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53115 Bonn, Germany
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.
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BibTeX
@misc{bahaaeldin2026ultrahighresolution,
title = {{Ultra-high-resolution Photon-Counting CT for Leaflet-Specific Evaluation of Fibrosis and Calcification in Aortic Stenosis}},
author = {M. Bahaaeldin and J. Shamekhi and B. S. Franklin and S. Nowak and A. M. C. Bohner and D. Kravchenko and J. Wrobel and R. Phinicarides and L. Pennig and J. P. Janssen and C. Gietzen and S. Zimmer and S. Baldus and M. Kelm and G. Nickenig and T. Zeus and V. Mauri and J. A. Luetkens},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.27.26366483},
url = {https://www.medrxiv.org/content/10.64898/2026.10.27.26366483v1},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Ultra-high-resolution Photon-Counting CT for Leaflet-Specific Evaluation of Fibrosis and Calcification in Aortic Stenosis
AU - M. Bahaaeldin
AU - J. Shamekhi
AU - B. S. Franklin
AU - S. Nowak
AU - A. M. C. Bohner
AU - D. Kravchenko
AU - J. Wrobel
AU - R. Phinicarides
AU - L. Pennig
AU - J. P. Janssen
AU - C. Gietzen
AU - S. Zimmer
AU - S. Baldus
AU - M. Kelm
AU - G. Nickenig
AU - T. Zeus
AU - V. Mauri
AU - J. A. Luetkens
PY - 2026
DA - 2026/10/27
PB - medRxiv
DO - 10.64898/2026.10.27.26366483
UR - https://www.medrxiv.org/content/10.64898/2026.10.27.26366483v1
AB - 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.
ER -