Comparison of Spectral Photon Counting CT (SPCCT) With Dual Energy CT (DECT) and Magnetic Resonance Imaging (MRI) for Plaque and Lumen Carotid Arteries Evaluation (CAPL)
Primary Purpose
Supra-Aortic Stenosis
Status
Recruiting
Phase
Not Applicable
Locations
France
Study Type
Interventional
Intervention
Spectral Photon Counting Computed Tomography (SPCCT)
Dual Energy CT (DECT)
Sponsored by
About this trial
This is an interventional diagnostic trial for Supra-Aortic Stenosis focused on measuring diagnostic, carotid plaque, SPCCT
Eligibility Criteria
Inclusion Criteria:
- Male or female subjects of any ethnic background, aged > 18 years
- Any of the following known or suspected supra-aortic arterial disease based on : Prior stroke; Transient Ischemic Attack; Amaurosis Fugax; Referred for evaluation of any supra-aortic vessel; Follow-up for a stent in a supra-aortic vessel; Prior imaging ultrasounds study showing > ou = 50 % stenosis of a supra-aortic vessel segment (within 60 days before consent)
- Patient undergoing surgery within one month of carotid plaque evaluation
- Willingness and ability to follow directions and complete all study procedures specified in the protocol
- Pre-menopausal women only : Negative urinary pregnancy test on the day of imaging before the administration of study drug
- Patient has accepted to participate to the study and has signed the written consent
- Patient is affiliated to social security
Exclusion Criteria:
- Contraindication to MRI examinations (e.g. inability to hold breath, severe arrhythmias, very low cardiac output, severe claustrophobia, metallic devices not approved for MRI such as defibrillators, pacemaker, heart valve prostheses, cochlear implants, neuro-stimulators, implanted automated injection device, intraocular metallic foreign bodies, neurosurgical and vascular clips);
- Contraindication to the use of iodine and gadolinium containing contrast media (including subjects with suspicion for/or known to have NSF);- History of severe allergic or anaphylactic reaction to any allergen including drugs and contrast agents (as judged by the investigator, taking into account the intensity of the event);
- Estimated Glomerular Filtration Rate (eGFR) value < 30 mL/min/1.73 m2 derived from a serum creatinine result within 1 month before the imaging;
- Any subject on hemodialysis or peritoneal dialysis (Note: If there are multiple creatinine values, the values obtained prior to and closest to the time of the examination should be used);
- Acute renal insufficiency of any intensity, either due to hepato-renal syndrome or occurring in the per-operative liver transplantation period;
- Known subject history of severe cardiovascular disease (e.g. acute myocardial infarction [< 14 days], unstable angina, congestive heart failure New York Heart Association class IV) or known long QT syndrome;
- Suspected clinical instability or unpredictability of the clinical course during the study period (e.g. due to previous surgery);
- Scheduled or potentially expected for the period between the SPCCT or DECT and MRI: Any procedure that may alter the MRI or CT interpretation; Any interventional or surgical procedure involving the supra-aortic vessels.
- Pregnant or nursing (including pumping for storage and feeding); 11. Patient under guardianship, curators or safeguard of justice.
Sites / Locations
- Louis Pradel cardiovascular HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
Spectral Photon Counting Computed Tomography (SPCCT)
Dual Energy CT (DECT)
Arm Description
The randomized SPCCT patient will have this CT scan and an MRI before surgery. The plaque carotid will be collected for histological analysis
The randomized DECT patient will have this CT scan and an MRI before surgery. The plaque carotid will be collected for histological analysis
Outcomes
Primary Outcome Measures
Lipid Necrotic Core (LNC) in mm² identified with SPCCT
measurement of the height and thickness of surface of the plaque's components
Lipid Necrotic Core (LNC) in mm² identified with DECT
measurement of the height and thickness of surface of the plaque's components
Lipid Necrotic Core (LNC) in mm² identified with histology
measurement of the height and thickness of surface of the plaque's components
Intra Plaque Hemorrhage (IPH) in mm² identified with SPCCT
measurement of the height and thickness of surface of the plaque's components
Intra Plaque Hemorrhage (IPH) in mm² identified with DECT
measurement of the height and thickness of surface of the plaque's components
Intra Plaque Hemorrhage (IPH) identified with histology
measurement of the height and thickness of surface of the plaque's components
Fibrous Cap Ulceration (FCU) in mm² identified with SPCCT
measurement of the height and thickness of surface of the plaque's components
Fibrous Cap Ulceration (FCU) in mm² identified with DECT
measurement of the height and thickness of surface of the plaque's components
Fibrous Cap Ulceration (FCU) in mm² identified with histology
measurement of the height and thickness of surface of the plaque's components
Secondary Outcome Measures
Number of irregularities identified with SPCCT
- Irregularities as defined by < 2 mm indentation, fissure, or erosion on the luminal surface of a plaque, exposing a portion of the inner plaque to direct contact with circulating blood.
Number of irregularities identified with DECT
- Irregularities as defined by < 2 mm indentation, fissure, or erosion on the luminal surface of a plaque, exposing a portion of the inner plaque to direct contact with circulating blood.
Number of irregularities identified with MRI
- Irregularities as defined by < 2 mm indentation, fissure, or erosion on the luminal surface of a plaque, exposing a portion of the inner plaque to direct contact with circulating blood.
Number of ulcerations identified with SPCCT
- Ulceration as defined by > 2 mm indentation, fissure, or erosion on the luminal surface of a plaque, exposing a portion of the inner plaque to direct contact with circulating blood.
Number of ulcerations identified with DECT
- Ulceration as defined by > 2 mm indentation, fissure, or erosion on the luminal surface of a plaque, exposing a portion of the inner plaque to direct contact with circulating blood.
Number of ulcerations identified with MRI
- Ulceration as defined by > 2 mm indentation, fissure, or erosion on the luminal surface of a plaque, exposing a portion of the inner plaque to direct contact with circulating blood.
Assessable vascular segments with lack of image artifacts
It will be assessed by estimating the image quality on scale from 1 to 4 (1 = poor, 2 = moderate, 3 = good, and 4 = excellent)
radiation dose received during SPCCT
radiation dose received during DECT
Tolerance to SPCCT assessed by a tolerance survey
1 to 10, 1= very bad, 10= very good. Survey adapted from Sparrow et al., Journal of magnetic resonance imaging 19:410-416, 2004
Tolerance to DECT assessed by a tolerance survey
1 to 10, 1= very bad, 10= very good. Survey adapted from Sparrow et al., Journal of magnetic resonance imaging 19:410-416, 2004
Tolerance to MRI assessed by a tolerance survey
1 to 10, 1= very bad, 10= very good. Survey adapted from Sparrow et al., Journal of magnetic resonance imaging 19:410-416, 2004
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04466787
Brief Title
Comparison of Spectral Photon Counting CT (SPCCT) With Dual Energy CT (DECT) and Magnetic Resonance Imaging (MRI) for Plaque and Lumen Carotid Arteries Evaluation
Acronym
CAPL
Official Title
Comparison of Spectral Photon Counting CT (SPCCT) With Dual Energy CT (DECT) and Magnetic Resonance Imaging (MRI) for Plaque and Lumen Carotid Arteries Evaluation.
Study Type
Interventional
2. Study Status
Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 20, 2019 (Actual)
Primary Completion Date
May 2024 (Anticipated)
Study Completion Date
June 2024 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Hospices Civils de Lyon
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
In this study, the investigator propose to determine the efficiency of a new and more sophisticated imaging prototype, the Spectral Photon Counting Computed Tomography (SPCCT), at characterizing vulnerable plaques and luminal stenosis in Carotid Atherosclerosis patients compared to DECT (Dual Energy CT) and MRI (Magnetic Resonance Imaging) which are used in current practice
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Supra-Aortic Stenosis
Keywords
diagnostic, carotid plaque, SPCCT
7. Study Design
Primary Purpose
Diagnostic
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Masking Description
The images will be read without knowing the CT scan used
Allocation
Randomized
Enrollment
40 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Spectral Photon Counting Computed Tomography (SPCCT)
Arm Type
Experimental
Arm Description
The randomized SPCCT patient will have this CT scan and an MRI before surgery. The plaque carotid will be collected for histological analysis
Arm Title
Dual Energy CT (DECT)
Arm Type
Active Comparator
Arm Description
The randomized DECT patient will have this CT scan and an MRI before surgery. The plaque carotid will be collected for histological analysis
Intervention Type
Diagnostic Test
Intervention Name(s)
Spectral Photon Counting Computed Tomography (SPCCT)
Intervention Description
The acquisition for the assessment of the brain parenchyma and for the evaluation of the cervical and intracranial arteries will be performed without and with iodine based contrast media, respectively. The same parameters will be used for both conditions but for a large volume, from the aortic arch to the top of the head. The iodinate contrast agent's injection (Iomeron 400, Bracco Imaging France) will be performed at 5mL/s into an 18G catheter, followed by a 20 mL saline flush that will be injected at the same rate. The bolus volume will be determined according to the patient's body weight : 70 mL for patients < 80 kg and 1 mL/kg for patients > 80 kg, with a maximum of 90 mL.
The SPCCT scanner is a prototype spectral photon-counting computed tomography system derived from a modified clinical CT system with a field of View (FOV) of 168 mm in-plane, and a z-coverage of 2 mm.
Intervention Type
Diagnostic Test
Intervention Name(s)
Dual Energy CT (DECT)
Intervention Description
The acquisition for the assessment of the brain parenchyma and for the evaluation of the cervical and intracranial arteries will be performed without and with iodine based contrast media, respectively. The same parameters will be used for both conditions but for a large volume, from the aortic arch to the top of the head. The iodinate contrast agent's injection (Iomeron 400, Bracco Imaging France) will be performed at 5mL/s into an 18G catheter, followed by a 20 mL saline flush that will be injected at the same rate. The bolus volume will be determined according to the patient's body weight : 70 mL for patients < 80 kg and 1 mL/kg for patients > 80 kg, with a maximum of 90 mL.
DECT : IQon, Philips
Primary Outcome Measure Information:
Title
Lipid Necrotic Core (LNC) in mm² identified with SPCCT
Description
measurement of the height and thickness of surface of the plaque's components
Time Frame
1 month
Title
Lipid Necrotic Core (LNC) in mm² identified with DECT
Description
measurement of the height and thickness of surface of the plaque's components
Time Frame
1 month
Title
Lipid Necrotic Core (LNC) in mm² identified with histology
Description
measurement of the height and thickness of surface of the plaque's components
Time Frame
1 month
Title
Intra Plaque Hemorrhage (IPH) in mm² identified with SPCCT
Description
measurement of the height and thickness of surface of the plaque's components
Time Frame
1 month
Title
Intra Plaque Hemorrhage (IPH) in mm² identified with DECT
Description
measurement of the height and thickness of surface of the plaque's components
Time Frame
1 month
Title
Intra Plaque Hemorrhage (IPH) identified with histology
Description
measurement of the height and thickness of surface of the plaque's components
Time Frame
1 month
Title
Fibrous Cap Ulceration (FCU) in mm² identified with SPCCT
Description
measurement of the height and thickness of surface of the plaque's components
Time Frame
1 month
Title
Fibrous Cap Ulceration (FCU) in mm² identified with DECT
Description
measurement of the height and thickness of surface of the plaque's components
Time Frame
1 month
Title
Fibrous Cap Ulceration (FCU) in mm² identified with histology
Description
measurement of the height and thickness of surface of the plaque's components
Time Frame
1 month
Secondary Outcome Measure Information:
Title
Number of irregularities identified with SPCCT
Description
- Irregularities as defined by < 2 mm indentation, fissure, or erosion on the luminal surface of a plaque, exposing a portion of the inner plaque to direct contact with circulating blood.
Time Frame
1 month
Title
Number of irregularities identified with DECT
Description
- Irregularities as defined by < 2 mm indentation, fissure, or erosion on the luminal surface of a plaque, exposing a portion of the inner plaque to direct contact with circulating blood.
Time Frame
1 month
Title
Number of irregularities identified with MRI
Description
- Irregularities as defined by < 2 mm indentation, fissure, or erosion on the luminal surface of a plaque, exposing a portion of the inner plaque to direct contact with circulating blood.
Time Frame
1 month
Title
Number of ulcerations identified with SPCCT
Description
- Ulceration as defined by > 2 mm indentation, fissure, or erosion on the luminal surface of a plaque, exposing a portion of the inner plaque to direct contact with circulating blood.
Time Frame
1 month
Title
Number of ulcerations identified with DECT
Description
- Ulceration as defined by > 2 mm indentation, fissure, or erosion on the luminal surface of a plaque, exposing a portion of the inner plaque to direct contact with circulating blood.
Time Frame
1 month
Title
Number of ulcerations identified with MRI
Description
- Ulceration as defined by > 2 mm indentation, fissure, or erosion on the luminal surface of a plaque, exposing a portion of the inner plaque to direct contact with circulating blood.
Time Frame
1 month
Title
Assessable vascular segments with lack of image artifacts
Description
It will be assessed by estimating the image quality on scale from 1 to 4 (1 = poor, 2 = moderate, 3 = good, and 4 = excellent)
Time Frame
1 month
Title
radiation dose received during SPCCT
Time Frame
1 month
Title
radiation dose received during DECT
Time Frame
1 month
Title
Tolerance to SPCCT assessed by a tolerance survey
Description
1 to 10, 1= very bad, 10= very good. Survey adapted from Sparrow et al., Journal of magnetic resonance imaging 19:410-416, 2004
Time Frame
1 month
Title
Tolerance to DECT assessed by a tolerance survey
Description
1 to 10, 1= very bad, 10= very good. Survey adapted from Sparrow et al., Journal of magnetic resonance imaging 19:410-416, 2004
Time Frame
1 month
Title
Tolerance to MRI assessed by a tolerance survey
Description
1 to 10, 1= very bad, 10= very good. Survey adapted from Sparrow et al., Journal of magnetic resonance imaging 19:410-416, 2004
Time Frame
1 month
10. Eligibility
Sex
All
Gender Based
Yes
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Male or female subjects of any ethnic background, aged > 18 years
Any of the following known or suspected supra-aortic arterial disease based on : Prior stroke; Transient Ischemic Attack; Amaurosis Fugax; Referred for evaluation of any supra-aortic vessel; Follow-up for a stent in a supra-aortic vessel; Prior imaging ultrasounds study showing > ou = 50 % stenosis of a supra-aortic vessel segment (within 60 days before consent)
Patient undergoing surgery within one month of carotid plaque evaluation
Willingness and ability to follow directions and complete all study procedures specified in the protocol
Pre-menopausal women only : Negative urinary pregnancy test on the day of imaging before the administration of study drug
Patient has accepted to participate to the study and has signed the written consent
Patient is affiliated to social security
Exclusion Criteria:
Contraindication to MRI examinations (e.g. inability to hold breath, severe arrhythmias, very low cardiac output, severe claustrophobia, metallic devices not approved for MRI such as defibrillators, pacemaker, heart valve prostheses, cochlear implants, neuro-stimulators, implanted automated injection device, intraocular metallic foreign bodies, neurosurgical and vascular clips);
Contraindication to the use of iodine and gadolinium containing contrast media (including subjects with suspicion for/or known to have NSF);- History of severe allergic or anaphylactic reaction to any allergen including drugs and contrast agents (as judged by the investigator, taking into account the intensity of the event);
Estimated Glomerular Filtration Rate (eGFR) value < 30 mL/min/1.73 m2 derived from a serum creatinine result within 1 month before the imaging;
Any subject on hemodialysis or peritoneal dialysis (Note: If there are multiple creatinine values, the values obtained prior to and closest to the time of the examination should be used);
Acute renal insufficiency of any intensity, either due to hepato-renal syndrome or occurring in the per-operative liver transplantation period;
Known subject history of severe cardiovascular disease (e.g. acute myocardial infarction [< 14 days], unstable angina, congestive heart failure New York Heart Association class IV) or known long QT syndrome;
Suspected clinical instability or unpredictability of the clinical course during the study period (e.g. due to previous surgery);
Scheduled or potentially expected for the period between the SPCCT or DECT and MRI: Any procedure that may alter the MRI or CT interpretation; Any interventional or surgical procedure involving the supra-aortic vessels.
Pregnant or nursing (including pumping for storage and feeding); 11. Patient under guardianship, curators or safeguard of justice.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Philippe DOUEK, Pr
Phone
4 72 07 18 83
Ext
+33
Email
douek@creatis.insa-lyon.fr
First Name & Middle Initial & Last Name or Official Title & Degree
Adeline MANSUY
Phone
4 72 11 51 70
Ext
+33
Email
adeline.mansuy@chu-lyon.fr
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Philippe DOUEK, Pr
Organizational Affiliation
Hospices Civils de Lyon
Official's Role
Principal Investigator
Facility Information:
Facility Name
Louis Pradel cardiovascular Hospital
City
Bron
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Douek Philippe, Pr
Email
douek@creatis.insa-lyon.fr
12. IPD Sharing Statement
Plan to Share IPD
Undecided
Learn more about this trial
Comparison of Spectral Photon Counting CT (SPCCT) With Dual Energy CT (DECT) and Magnetic Resonance Imaging (MRI) for Plaque and Lumen Carotid Arteries Evaluation
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