Heavily calcified coronary arteries advanced calcium subtraction improves luminal visualization and diagnostic confidence in dual-energy coronary computed tomography angiography

Domenico De Santis, Kwang Nam Jin, U. Joseph Schoepf, Katharine L. Grant, Carlo N. De Cecco, John W. Nance, Thomas J. Vogl, Andrea Laghi, Moritz H. Albrecht

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Objectives: The aim of this study was to evaluate a prototype dual-energy computed tomography calcium subtraction algorithm and its impact on luminal visualization in patients with heavily calcified coronary arteries. Materials and Methods: Twenty-nine patients (62% male; mean age, 64 ± 7 years) who had undergone dual-energy coronary computed tomography angiography were retrospectively included in this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study. Linearly blended (M0.6) and calcium-subtracted images were reconstructed. Two independent observers assessed luminal visualization of the coronary arteries in a segmentbased analysis, subjective image quality, and diagnostic confidence using 5-point Likert scales. Contrast-to-noise ratios for both data sets were calculated. Wilcoxon testing and Cohen's? were used for statistical comparisons. Results: Calcium-subtracted image series showed improved lumen visualization of the coronary arteries (P = 0.008), with excellent interreader agreement (mean score, 3.3; = 0.82), compared with M-0.6 series (mean score, 2.9; = 0.77). The calcium subtraction algorithm improved diagnostic confidence compared with the M-0.6 reconstructions (mean scores, 4.0 and 3.1, respectively; all P = 0.002). The image quality analysis showed no significant differences between calcium-subtracted and M-0.6 data sets (subjectively: mean scores, 4.1 and 4.2, respectively, P = 0.442; objectively: mean contrast-to-noise ratio, 37.0 and 38.2, respectively, P = 0.733). Conclusions: A prototype algorithm for calcium subtraction improves coronary lumen visualization and diagnostic confidence in patients with heavy coronary calcifications without differences in conventional subjective and objective measures of image quality.

Original languageEnglish (US)
Pages (from-to)103-109
Number of pages7
JournalInvestigative Radiology
Volume53
Issue number2
DOIs
StatePublished - 2018

Keywords

  • Calcified plaque
  • Calcium subtraction
  • Coronary artery disease
  • Diagnostic confidence
  • Dual-energy CT
  • Luminal visualization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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