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Hrabak Paar M, Muršić M, Bremerich J, Heye T. Cardiovascular Aging and Risk Assessment: How Multimodality Imaging Can Help. Diagnostics (Basel) 2024; 14:1947. [PMID: 39272731 PMCID: PMC11393882 DOI: 10.3390/diagnostics14171947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/15/2024] Open
Abstract
Aging affects the cardiovascular system, and this process may be accelerated in individuals with cardiovascular risk factors. The main vascular changes include arterial wall thickening, calcification, and stiffening, together with aortic dilatation and elongation. With aging, we can observe left ventricular hypertrophy with myocardial fibrosis and left atrial dilatation. These changes may lead to heart failure and atrial fibrillation. Using multimodality imaging, including ultrasound, computed tomography (CT), and magnetic resonance imaging, it is possible to detect these changes. Additionally, multimodality imaging, mainly via CT measurements of coronary artery calcium or ultrasound carotid intima-media thickness, enables advanced cardiovascular risk stratification and helps in decision-making about preventive strategies. The focus of this manuscript is to briefly review cardiovascular changes that occur with aging, as well as to describe how multimodality imaging may be used for the assessment of these changes and risk stratification of asymptomatic individuals.
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Affiliation(s)
- Maja Hrabak Paar
- Department of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, Kispaticeva 12, HR-10000 Zagreb, Croatia
| | - Miroslav Muršić
- Department of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, Kispaticeva 12, HR-10000 Zagreb, Croatia
| | - Jens Bremerich
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Tobias Heye
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Petersgraben 4, CH-4031 Basel, Switzerland
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Fink N, Emrich T, Schoepf UJ, Zsarnoczay E, O’Doherty J, Halfmann MC, Griffith JP, Pinos D, Suranyi P, Baruah D, Kabakus IM, Ricke J, Varga-Szemes A. Improved Detection of Small and Low-Density Plaques in Virtual Noncontrast Imaging-based Calcium Scoring at Photon-Counting Detector CT. Radiol Cardiothorac Imaging 2024; 6:e230328. [PMID: 39023373 PMCID: PMC11369658 DOI: 10.1148/ryct.230328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 03/26/2024] [Accepted: 05/30/2024] [Indexed: 07/20/2024]
Abstract
Purpose To investigate the impact of plaque size and density on virtual noncontrast (VNC)-based coronary artery calcium scoring (CACS) using photon-counting detector CT and to provide safety net reconstructions for improved detection of subtle plaques in patients whose VNC-based CACS would otherwise be erroneously zero when compared with true noncontrast (TNC)-based CACS. Materials and Methods In this prospective study, CACS was evaluated in a phantom containing calcifications with different diameters (5, 3, and 1 mm) and densities (800, 400, and 200 mg/cm3) and in participants who underwent TNC and contrast-enhanced cardiac photon-counting detector CT (July 2021-March 2022). VNC images were reconstructed at different virtual monoenergetic imaging (55-80 keV) and quantum iterative reconstruction (QIR) levels (QIR,1-4). TNC scans at 70 keV with QIR off served as the reference standard. In vitro CACS was analyzed using standard settings (3.0-mm sections, kernel Qr36, 130-HU threshold). Calcification detectability and CACS of small and low-density plaques were also evaluated using 1.0-mm sections, kernel Qr44, and 120- or 110-HU thresholds. Safety net reconstructions were defined based on background Agatston scores and evaluated in vivo in TNC plaques initially nondetectable using standard VNC reconstructions. Results The in vivo cohort included 63 participants (57.8 years ± 15.5 [SD]; 37 [59%] male, 26 [41%] female). Correlation and agreement between standard CACSVNC and CACSTNC were higher in large- and medium-sized and high- and medium-density than in low-density plaques (in vitro: intraclass correlation coefficient [ICC] ≥ 0.90; r > 0.9 vs ICC = 0.20-0.48; r = 0.5-0.6). Small plaques were not detectable using standard VNC reconstructions. Calcification detectability was highest using 1.0-mm sections, kernel Qr44, 120- and 110-HU thresholds, and QIR level of 2 or less VNC reconstructions. Compared with standard VNC, using safety net reconstructions (55 keV, QIR 2, 110-HU threshold) for in vivo subtle plaque detection led to higher detection (increased by 89% [50 of 56]) and improved correlation and agreement of CACSVNC with CACSTNC (in vivo: ICC = 0.51-0.61; r = 0.6). Conclusion Compared with TNC-based calcium scoring, VNC-based calcium scoring was limited for small and low-density plaques but improved using safety net reconstructions, which may be particularly useful in patients with low calcium scores who would otherwise be treated based on potentially false-negative results. Keywords: Coronary Artery Calcium CT, Photon-Counting Detector CT, Virtual Noncontrast, Plaque Size, Plaque Density Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Nicola Fink
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Tilman Emrich
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - U. Joseph Schoepf
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Emese Zsarnoczay
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Jim O’Doherty
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Moritz C. Halfmann
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Joseph P. Griffith
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Daniel Pinos
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Pal Suranyi
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Dhiraj Baruah
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Ismail M. Kabakus
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Jens Ricke
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
| | - Akos Varga-Szemes
- From the Department of Radiology and Radiological Science, Division
of Cardiovascular Imaging, Medical University of South Carolina, Ashley River
Tower, 25 Courtenay Dr, MUSC 226, Charleston, SC 29425-2260 (N.F., T.E., U.J.S.,
E.Z., J.O., J.P.G., D.P., P.S., D.B., I.M.K., A.V.S.); Department of Radiology,
University Hospital, LMU Munich, Munich, Germany (N.F., J.R.); Department of
Diagnostic and Interventional Radiology, University Medical Center of Johannes
Gutenberg-University, Mainz, Germany (T.E., M.C.H.); German Centre for
Cardiovascular Research, Mainz, Germany (T.E.); Medical Imaging Center,
Semmelweis University, Budapest, Hungary (E.Z.); and Siemens Medical Solutions,
Malvern, Pa (J.O.)
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Rajiah PS, Rajendran K. Safety Net Reconstruction to Catch Low-Density and Low-Volume Calcifications at Photon-Counting Detector CT Using Virtual Noncontrast Imaging. Radiol Cardiothorac Imaging 2024; 6:e240266. [PMID: 39172033 PMCID: PMC11369647 DOI: 10.1148/ryct.240266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/24/2024] [Accepted: 08/05/2024] [Indexed: 08/23/2024]
Affiliation(s)
| | - Kishore Rajendran
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Black D, Singh T, Molloi S. Coronary artery calcium quantification technique using dual energy material decomposition: a simulation study. Int J Cardiovasc Imaging 2024; 40:1465-1474. [PMID: 38904849 PMCID: PMC11258084 DOI: 10.1007/s10554-024-03124-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/28/2024] [Indexed: 06/22/2024]
Abstract
Coronary artery calcification is a significant predictor of cardiovascular disease, with current detection methods like Agatston scoring having limitations in sensitivity. This study aimed to evaluate the effectiveness of a novel CAC quantification method using dual-energy material decomposition, particularly its ability to detect low-density calcium and microcalcifications. A simulation study was conducted comparing the dual-energy material decomposition technique against the established Agatston scoring method and the newer volume fraction calcium mass technique. Detection accuracy and calcium mass measurement were the primary evaluation metrics. The dual-energy material decomposition technique demonstrated fewer false negatives than both Agatston scoring and volume fraction calcium mass, indicating higher sensitivity. In low-density phantom measurements, material decomposition resulted in only 7.41% false-negative (CAC = 0) measurements compared to 83.95% for Agatston scoring. For high-density phantoms, false negatives were removed (0.0%) compared to 20.99% in Agatston scoring. The dual-energy material decomposition technique presents a more sensitive and reliable method for CAC quantification.
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Affiliation(s)
- Dale Black
- Department of Radiological Sciences, University of California, Medical Sciences I, B-140, Irvine, CA, 92697, USA
| | - Tejus Singh
- Department of Radiological Sciences, University of California, Medical Sciences I, B-140, Irvine, CA, 92697, USA
| | - Sabee Molloi
- Department of Radiological Sciences, University of California, Medical Sciences I, B-140, Irvine, CA, 92697, USA.
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Dobrolinska MM, Koetzier LR, Greuter MJW, Vliegenthart R, van der Bie J, Prakken NHJ, Slart RHJA, Leiner T, Budde RPJ, Mastrodicasa D, Booij R, Fleischmann D, Willemink MJ, van Straten M, van der Werf NR. Feasibility of virtual non-iodine coronary calcium scoring on dual source photon-counting coronary CT angiography: a dynamic phantom study. Eur Radiol 2024:10.1007/s00330-024-10806-4. [PMID: 38789792 DOI: 10.1007/s00330-024-10806-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/23/2024] [Accepted: 04/05/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND The aim of our current systematic dynamic phantom study was first, to optimize reconstruction parameters of coronary CTA (CCTA) acquired on photon counting CT (PCCT) for coronary artery calcium (CAC) scoring, and second, to assess the feasibility of calculating CAC scores from CCTA, in comparison to reference calcium scoring CT (CSCT) scans. METHODS In this phantom study, an artificial coronary artery was translated at velocities corresponding to 0, < 60, and 60-75 beats per minute (bpm) within an anthropomorphic phantom. The density of calcifications was 100 (very low), 200 (low), 400 (medium), and 800 (high) mgHA/cm3, respectively. CCTA was reconstructed with the following parameters: virtual non-iodine (VNI), with and without iterative reconstruction (QIR level 2, QIR off, respectively); kernels Qr36 and Qr44f; slice thickness/increment 3.0/1.5 mm and 0.4/0.2 mm. The agreement in risk group classification between CACCCTA and CACCSCT scoring was measured using Cohen weighted linear κ with 95% CI. RESULTS For CCTA reconstructed with 0.4 mm slice thickness, calcium detectability was perfect (100%). At < 60 bpm, CACCCTA of low, and medium density calcification was underestimated by 53%, and 15%, respectively. However, CACCCTA was not significantly different from CACCSCT of very low, and high-density calcifications. The best risk agreement was achieved when CCTA was reconstructed with QIR off, Qr44f, and 0.4 mm slice thickness (κ = 0.762, 95% CI 0.671-0.853). CONCLUSION In this dynamic phantom study, the detection of calcifications with different densities was excellent with CCTA on PCCT using thin-slice VNI reconstruction. Agatston scores were underestimated compared to CSCT but agreement in risk classification was substantial. CLINICAL RELEVANCE STATEMENT Photon counting CT may enable the implementation of coronary artery calcium scoring from coronary CTA in daily clinical practice. KEY POINTS Photon-counting CTA allows for excellent detectability of low-density calcifications at all heart rates. Coronary artery calcium scoring from coronary CTA acquired on photon counting CT is feasible, although improvement is needed. Adoption of the standard acquisition and reconstruction protocol for calcium scoring is needed for improved quantification of coronary artery calcium to fully employ the potential of photon counting CT.
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Affiliation(s)
- Magdalena M Dobrolinska
- Department of Radiology and Nuclear Medicine Rotterdam, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Medical Imaging Center, Groningen, The Netherlands.
| | - Lennart R Koetzier
- Department of Radiology and Nuclear Medicine Rotterdam, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Radiology Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Marcel J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Medical Imaging Center, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Medical Imaging Center, Groningen, The Netherlands
| | - Judith van der Bie
- Department of Radiology and Nuclear Medicine Rotterdam, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Niek H J Prakken
- Department of Radiology, University of Groningen, University Medical Center Groningen, Medical Imaging Center, Groningen, The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Medical Imaging Center, Groningen, The Netherlands
| | - Tim Leiner
- Department of Radiology Rochester, Mayo Clinic, Rochester, MN, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine Rotterdam, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Domenico Mastrodicasa
- Department of Radiology Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Ronald Booij
- Department of Radiology and Nuclear Medicine Rotterdam, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dominik Fleischmann
- Department of Radiology Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Martin J Willemink
- Department of Radiology Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Marcel van Straten
- Department of Radiology and Nuclear Medicine Rotterdam, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Niels R van der Werf
- Department of Radiology and Nuclear Medicine Rotterdam, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Feldle P, Scheuber M, Grunz JP, Heidenreich JF, Pannenbecker P, Nora C, Huflage H, Bley TA, Petritsch B. Virtual non-iodine photon-counting CT-angiography for aortic valve calcification scoring. Sci Rep 2024; 14:4724. [PMID: 38413684 PMCID: PMC10899655 DOI: 10.1038/s41598-024-54918-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/18/2024] [Indexed: 02/29/2024] Open
Abstract
Photon-counting detector (PCD)-CT allows for reconstruction of virtual non-iodine (VNI) images from contrast-enhanced datasets. This study assesses the diagnostic performance of aortic valve calcification scoring (AVCS) derived from VNI datasets generated with a 1st generation clinical dual-source PCD-CT. AVCS was evaluated in 123 patients (statistical analysis only comprising patients with aortic valve calcifications [n = 56; 63.2 ± 11.6 years]), who underwent contrast enhanced electrocardiogram-gated (either prospective or retrospective or both) cardiac CT on a clinical PCD system. Patient data was reconstructed at 70 keV employing a VNI reconstruction algorithm. True non-contrast (TNC) scans at 70 keV without quantum iterative reconstruction served as reference in all individuals. Subgroup analysis was performed in 17 patients who received both, prospectively and retrospectively gated contrast enhanced scans (n = 8 with aortic valve calcifications). VNI images with prospective/retrospective gating had an overall sensitivity of 69.2%/56.0%, specificity of 100%/100%, accuracy of 85.4%/81.0%, positive predictive value of 100%/100%, and a negative predictive value of 78.2%/75.0%. VNI images with retrospective gating achieved similar results. For both gating approaches, AVCSVNI showed high correlation (r = 0.983, P < 0.001 for prospective; r = 0.986, P < 0.001 for retrospective) with AVCSTNC. Subgroup analyses demonstrated excellent intra-individual correlation between different acquisition modes (r = 0.986, P < 0.001). Thus, VNI images derived from cardiac PCD-CT allow for excellent diagnostic performance in the assessment of AVCS, suggesting potential for the omission of true non-contrast scans in the clinical workup of patients with aortic calcifications.
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Affiliation(s)
- Philipp Feldle
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany.
| | - Marit Scheuber
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Julius F Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Pauline Pannenbecker
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Conrads Nora
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
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Sartoretti T, Mergen V, Dzaferi A, Allmendinger T, Manka R, Alkadhi H, Eberhard M. Effect of temporal resolution on calcium scoring: insights from photon-counting detector CT. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03070-6. [PMID: 38389028 DOI: 10.1007/s10554-024-03070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
To intra-individually investigate the variation of coronary artery calcium (CAC), aortic valve calcium (AVC), and mitral annular calcium (MAC) scores and the presence of blur artifacts as a function of temporal resolution in patients undergoing non-contrast cardiac CT on a dual-source photon counting detector (PCD) CT. This retrospective, IRB-approved study included 70 patients (30 women, 40 men, mean age 78 ± 9 years) who underwent ECG-gated cardiac non-contrast CT with PCD-CT (gantry rotation time 0.25 s) prior to transcatheter aortic valve replacement. Each scan was reconstructed at a temporal resolution of 66 ms using the dual-source information and at 125 ms using the single-source information. Average heart rate and heart rate variability were calculated from the recorded ECG. CAC, AVC, and MAC were quantified according to the Agatston method on images with both temporal resolutions. Two readers assessed blur artifacts using a 4-point visual grading scale. The influence of average heart rate and heart rate variability on calcium quantification and blur artifacts of the respective structures were analyzed by linear regression analysis. Mean heart rate and heart rate variability during data acquisition were 76 ± 17 beats per minute (bpm) and 4 ± 6 bpm, respectively. CAC scores were smaller on 66 ms (median, 511; interquartile range, 220-978) than on 125 ms reconstructions (538; 203-1050, p < 0.001). Median AVC scores [2809 (2009-3952) versus 3177 (2158-4273)] and median MAC scores [226 (0-1284) versus 251 (0-1574)] were also significantly smaller on 66ms than on 125ms reconstructions (p < 0.001). Reclassification of CAC and AVC risk categories occurred in 4% and 11% of cases, respectively, whereby the risk category was always overestimated on 125ms reconstructions. Image blur artifacts were significantly less on 66ms as opposed to 125 ms reconstructions (p < 0.001). Intra-individual analyses indicate that temporal resolution significantly impacts on calcium scoring with cardiac CT, with CAC, MAC, and AVC being overestimated at lower temporal resolution because of increased motion artifacts eventually leading to an overestimation of patient risk.
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Affiliation(s)
- Thomas Sartoretti
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Victor Mergen
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Amina Dzaferi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | | | - Robert Manka
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Matthias Eberhard
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Radiology, Spital Interlaken, Spitäler fmi AG, Unterseen, Switzerland.
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Fink N, Halfmann MC. Artificial intelligence for coronary artery calcium scoring: A new trick for an old dog? Eur J Radiol 2023; 166:110965. [PMID: 37451135 DOI: 10.1016/j.ejrad.2023.110965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA; Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany.
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany; German Centre for Cardiovascular Research, Partner Site Rhine-Main, 55131 Mainz, Germany.
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Otgonbaatar C, Jeon PH, Ryu JK, Shim H, Jeon SH, Ko SM, Kim H. Coronary artery calcium quantification: comparison between filtered-back projection, hybrid iterative reconstruction, and deep learning reconstruction techniques. Acta Radiol 2023; 64:2393-2400. [PMID: 37211615 DOI: 10.1177/02841851231174463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND The reference protocol for the quantification of coronary artery calcium (CAC) should be updated to meet the standards of modern imaging techniques. PURPOSE To assess the influence of filtered-back projection (FBP), hybrid iterative reconstruction (IR), and three levels of deep learning reconstruction (DLR) on CAC quantification on both in vitro and in vivo studies. MATERIAL AND METHODS In vitro study was performed with a multipurpose anthropomorphic chest phantom and small pieces of bones. The real volume of each piece was measured using the water displacement method. In the in vivo study, 100 patients (84 men; mean age = 71.2 ± 8.7 years) underwent CAC scoring with a tube voltage of 120 kVp and image thickness of 3 mm. The image reconstruction was done with FBP, hybrid IR, and three levels of DLR including mild (DLRmild), standard (DLRstd), and strong (DLRstr). RESULTS In the in vitro study, the calcium volume was equivalent (P = 0.949) among FBP, hybrid IR, DLRmild, DLRstd, and DLRstr. In the in vivo study, the image noise was significantly lower in images that used DLRstr-based reconstruction, when compared images other reconstructions (P < 0.001). There were no significant differences in the calcium volume (P = 0.987) and Agatston score (P = 0.991) among FBP, hybrid IR, DLRmild, DLRstd, and DLRstr. The highest overall agreement of Agatston scores was found in the DLR groups (98%) and hybrid IR (95%) when compared to standard FBP reconstruction. CONCLUSION The DLRstr presented the lowest bias of agreement in the Agatston scores and is recommended for the accurate quantification of CAC.
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Affiliation(s)
| | - Pil-Hyun Jeon
- Department of Radiology, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, Wonju, Republic of Korea
| | - Jae-Kyun Ryu
- Medical Imaging AI Research Center, Canon Medical Systems Korea, Seoul, Republic of Korea
| | - Hackjoon Shim
- Medical Imaging AI Research Center, Canon Medical Systems Korea, Seoul, Republic of Korea
- ConnectAI Research Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hyun Jeon
- Department of Radiology, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, Wonju, Republic of Korea
| | - Sung Min Ko
- Department of Radiology, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, Wonju, Republic of Korea
| | - Hyunjung Kim
- Department of Radiology, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, Wonju, Republic of Korea
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Black D, Xiao X, Molloi S. Coronary artery calcium mass measurement based on integrated intensity and volume fraction techniques. J Med Imaging (Bellingham) 2023; 10:043502. [PMID: 37434664 PMCID: PMC10332802 DOI: 10.1117/1.jmi.10.4.043502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/11/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
Purpose Agatston scoring does not detect all the calcium present in computed tomography scans of the heart. A technique that removes the need for thresholding and quantifies calcium mass more accurately and reproducibly is needed. Approach Integrated intensity and volume fraction techniques were evaluated for accurate quantification of calcium mass. Integrated intensity calcium mass, volume fraction calcium mass, Agatston scoring, and spatially weighted calcium scoring were compared with known calcium mass in simulated and physical phantoms. The simulation was created to match a 320-slice CT scanner. Fat rings were added to the simulated phantoms, which resulted in small (30 × 20 cm 2 ), medium (35 × 25 cm 2 ), and large (40 × 30 cm 2 ) phantoms. Three calcification inserts of different diameters and hydroxyapatite densities were placed within the phantoms. All the calcium mass measurements were repeated across different beam energies, patient sizes, insert sizes, and densities. Physical phantom images from a previously reported study were then used to evaluate the accuracy and reproducibility of the techniques. Results Both integrated intensity calcium mass and volume fraction calcium mass yielded lower root mean squared error (RMSE) and deviation (RMSD) values than Agatston scoring in all the measurements in the simulated phantoms. Specifically, integrated calcium mass (RMSE: 0.49 mg, RMSD: 0.49 mg) and volume fraction calcium mass (RMSE: 0.58 mg, RMSD: 0.57 mg) were more accurate for the low-density stationary calcium measurements than Agatston scoring (RMSE: 3.70 mg, RMSD: 2.30 mg). Similarly, integrated calcium mass (15.74%) and volume fraction calcium mass (20.37%) had fewer false-negative (CAC = 0) measurements than Agatston scoring (75.00%) and spatially weighted calcium scoring (26.85%), on the low-density stationary calcium measurements. Conclusion The integrated calcium mass and volume fraction calcium mass techniques can potentially improve risk stratification for patients undergoing calcium scoring and further improve risk assessment compared with Agatston scoring.
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Affiliation(s)
- Dale Black
- University of California, Irvine, Department of Radiological Sciences, Irvine, California, United States
| | - Xingshuo Xiao
- University of California, Irvine, Department of Radiological Sciences, Irvine, California, United States
| | - Sabee Molloi
- University of California, Irvine, Department of Radiological Sciences, Irvine, California, United States
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Fink N, Zsarnoczay E, Schoepf UJ, O'Doherty J, Griffith JP, Pinos D, Tesche C, Ricke J, Willemink MJ, Varga-Szemes A, Emrich T. Radiation Dose Reduction for Coronary Artery Calcium Scoring Using a Virtual Noniodine Algorithm on Photon-Counting Detector Computed-Tomography Phantom Data. Diagnostics (Basel) 2023; 13:diagnostics13091540. [PMID: 37174932 PMCID: PMC10177425 DOI: 10.3390/diagnostics13091540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Background: On the basis of the hypothesis that virtual noniodine (VNI)-based coronary artery calcium scoring (CACS) is feasible at reduced radiation doses, this study assesses the impact of radiation dose reduction on the accuracy of this VNI algorithm on a photon-counting detector (PCD)-CT. Methods: In a systematic in vitro setting, a phantom for CACS simulating three chest sizes was scanned on a clinical PCD-CT. The standard radiation dose was chosen at volumetric CT dose indices (CTDIVol) of 1.5, 3.3, 7.0 mGy for small, medium-sized, and large phantoms, and was gradually reduced by adjusting the tube current resulting in 100, 75, 50, and 25%, respectively. VNI images were reconstructed at 55 keV, quantum iterative reconstruction (QIR)1, and at 60 keV/QIR4, and evaluated regarding image quality (image noise (IN), contrast-to-noise ratio (CNR)), and CACS. All VNI results were compared to true noncontrast (TNC)-based CACS at 70 keV and standard radiation dose (reference). Results: INTNC was significantly higher than INVNI, and INVNI at 55 keV/QIR1 higher than at 60 keV/QIR4 (100% dose: 16.7 ± 1.9 vs. 12.8 ± 1.7 vs. 7.7 ± 0.9; p < 0.001 for every radiation dose). CNRTNC was higher than CNRVNI, but it was better to use 60 keV/QIR4 (p < 0.001). CACSVNI showed strong correlation and agreement at every radiation dose (p < 0.001, r > 0.9, intraclass correlation coefficient > 0.9). The coefficients of the variation in root-mean squared error were less than 10% and thus clinically nonrelevant for the CACSVNI of every radiation dose. Conclusion: This phantom study suggests that CACSVNI is feasible on PCD-CT, even at reduced radiation dose while maintaining image quality and CACS accuracy.
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Affiliation(s)
- Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Medical Imaging Center, Semmelweis University, Korányi Sándor utca 2, 1083 Budapest, Hungary
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Siemens Medical Solutions, 40 Liberty Boulevard, Malvern, PA 19355, USA
| | - Joseph P Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Daniel Pinos
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Martin J Willemink
- Department of Radiology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center of Johannes-Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
- German Centre for Cardiovascular Research, Partner Site Rhine-Main, 55131 Mainz, Germany
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Wolf EV, Halfmann MC, Schoepf UJ, Zsarnoczay E, Fink N, Griffith JP, Aquino GJ, Willemink MJ, O’Doherty J, Hell MM, Suranyi P, Kabakus IM, Baruah D, Varga-Szemes A, Emrich T. Intra-individual comparison of coronary calcium scoring between photon counting detector- and energy integrating detector-CT: Effects on risk reclassification. Front Cardiovasc Med 2023; 9:1053398. [PMID: 36741832 PMCID: PMC9892711 DOI: 10.3389/fcvm.2022.1053398] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose To compare coronary artery calcium volume and score (CACS) between photon-counting detector (PCD) and conventional energy integrating detector (EID) computed tomography (CT) in a phantom and prospective patient study. Methods A commercially available CACS phantom was scanned with a standard CACS protocol (120 kVp, slice thickness/increment 3/1.5 mm, and a quantitative Qr36 kernel), with filtered back projection on the EID-CT, and with monoenergetic reconstruction at 70 keV and quantum iterative reconstruction off on the PCD-CT. The same settings were used to prospectively acquire data in patients (n = 23, 65 ± 12.1 years), who underwent PCD- and EID-CT scans with a median of 5.5 (3.0-12.5) days between the two scans in the period from August 2021 to March 2022. CACS was quantified using a commercially available software solution. A regression formula was obtained from the aforementioned comparison and applied to simulate risk reclassification in a pre-existing cohort of 514 patients who underwent a cardiac EID-CT between January and December 2021. Results Based on the phantom experiment, CACS PCD-CT showed a more accurate measurement of the reference CAC volumes (overestimation of physical volumes: PCD-CT 66.1 ± 1.6% vs. EID-CT: 77.2 ± 0.5%). CACS EID-CT and CACS PCD-CT were strongly correlated, however, the latter measured significantly lower values in the phantom (CACS PCD-CT : 60.5 (30.2-170.3) vs CACS EID-CT 74.7 (34.6-180.8), p = 0.0015, r = 0.99, mean bias -9.7, Limits of Agreement (LoA) -36.6/17.3) and in patients (non-significant) (CACS PCD-CT : 174.3 (11.1-872.7) vs CACS EID-CT 218.2 (18.5-876.4), p = 0.10, r = 0.94, mean bias -41.1, LoA -315.3/232.5). The systematic lower measurements of Agatston score on PCD-CT system led to reclassification of 5.25% of our simulated patient cohort to a lower classification class. Conclusion CACS PCD-CT is feasible and correlates strongly with CACS EID-CT , however, leads to lower CACS values. PCD-CT may provide results that are more accurate for CACS than EID-CT.
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Affiliation(s)
- Elias V. Wolf
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany,Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Moritz C. Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany,German Centre for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany
| | - U. Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States,MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States,Department of Radiology, University Hospital Munich, LMU Munich, Munich, Germany
| | - Joseph P. Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Gilberto J. Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Martin J. Willemink
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States,Segmed, Inc., Palo Alto, CA, United States
| | - Jim O’Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States,Siemens Medical Solutions USA, Inc., Malvern, PA, United States
| | - Michaela M. Hell
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Ismael M. Kabakus
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Dhiraj Baruah
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany,Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States,German Centre for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany,*Correspondence: Tilman Emrich,
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Coronary Computed Tomography Angiography-Based Calcium Scoring: In Vitro and In Vivo Validation of a Novel Virtual Noniodine Reconstruction Algorithm on a Clinical, First-Generation Dual-Source Photon Counting-Detector System. Invest Radiol 2022; 57:536-543. [PMID: 35318969 DOI: 10.1097/rli.0000000000000868] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate coronary computed tomography angiography (CCTA)-based in vitro and in vivo coronary artery calcium scoring (CACS) using a novel virtual noniodine reconstruction (PureCalcium) on a clinical first-generation photon-counting detector-computed tomography system compared with virtual noncontrast (VNC) reconstructions and true noncontrast (TNC) acquisitions. MATERIALS AND METHODS Although CACS and CCTA are well-established techniques for the assessment of coronary artery disease, they are complementary acquisitions, translating into increased scan time and patient radiation dose. Hence, accurate CACS derived from a single CCTA acquisition would be highly desirable. In this study, CACS based on PureCalcium, VNC, and TNC, reconstructions was evaluated in a CACS phantom and in 67 patients (70 [59/80] years, 58.2% male) undergoing CCTA on a first-generation photon counting detector-computed tomography system. Coronary artery calcium scores were quantified for the 3 reconstructions and compared using Wilcoxon test. Agreement was evaluated by Pearson and Spearman correlation and Bland-Altman analysis. Classification of coronary artery calcium score categories (0, 1-10, 11-100, 101-400, and >400) was compared using Cohen κ. RESULTS Phantom studies demonstrated strong agreement between CACSPureCalcium and CACSTNC (60.7 ± 90.6 vs 67.3 ± 88.3, P = 0.01, r = 0.98, intraclass correlation [ICC] = 0.98; mean bias, 6.6; limits of agreement [LoA], -39.8/26.6), whereas CACSVNC showed a significant underestimation (42.4 ± 75.3 vs 67.3 ± 88.3, P < 0.001, r = 0.94, ICC = 0.89; mean bias, 24.9; LoA, -87.1/37.2). In vivo comparison confirmed a high correlation but revealed an underestimation of CACSPureCalcium (169.3 [0.7/969.4] vs 232.2 [26.5/1112.2], P < 0.001, r = 0.97, ICC = 0.98; mean bias, -113.5; LoA, -470.2/243.2). In comparison, CACSVNC showed a similarly high correlation, but a substantially larger underestimation (24.3 [0/272.3] vs 232.2 [26.5/1112.2], P < 0.001, r = 0.97, ICC = 0.54; mean bias, -551.6; LoA, -2037.5/934.4). CACSPureCalcium showed superior agreement of CACS classification (κ = 0.88) than CACSVNC (κ = 0.60). CONCLUSIONS The accuracy of CACS quantification and classification based on PureCalcium reconstructions of CCTA outperforms CACS derived from VNC reconstructions.
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