Clinical photon-counting CT in living patients detects intraplaque haemorrhage and thrombus in carotid plaques

Abstract In this study of human carotid endarterectomy plaques (using 1128 regions of interest in a total of 10 plaques), we found that photon counting computed tomography (PCCT) can differentiate between attenuation and the spectral patterns of calcium, intra-plaque haemorrhage, thrombus, fibrosis, necrosis and lipid core. This is the first study to show the potential of PCCT in living patients using clinical routine acquisition settings, with many energy levels to detect atherosclerotic plaque features relevant for plaque rupture (which underlies most strokes and myocardial infarctions). Deepened knowledge of the atherosclerotic plaque features using non-invasive, high-resolution techniques as the recent PCCT is a crucial step towards detecting rupture-prone plaques and, thus, improve risk stratification for diagnosis, prevention or monitoring of therapeutic interventions.