A prospective study included 26 patients at high risk of coronary artery disease (CAD) with 28 identified stenoses. Coronary CT angiography (CCTA) was performed using both spectral photon-counting CT (SPCCT) in ultra-high-resolution (UHR) mode and dual-energy double-layer CT (DECT). SPCCT at 40 keV achieved the best image quality scores and exhibited less variability in stenosis measurement compared to SPCCT at 70 keV and both 40 keV and 70 keV DECT. These findings highlight the superiority of 40 keV SPCCT over 40 keV and 70 keV DECT in the evaluation of CAD in high-risk patients.
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