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High-pitch low-voltage CT coronary artery calcium scoring with tin filtration: accuracy and radiation dose reduction

  • Cardiac
  • Published:
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Abstract

Objectives

To investigate diagnostic accuracy and radiation dose of high-pitch CT coronary artery calcium scoring (CACS) with tin filtration (Sn100kVp) versus standard 120kVp high-pitch acquisition.

Methods

78 patients (58% male, 61.5±9.1 years) were prospectively enrolled. Subjects underwent clinical 120kVp high-pitch CACS using third-generation dual-source CT followed by additional high-pitch Sn100kVp acquisition. Agatston scores, calcium volume scores, Agatston score categories, percentile-based risk categorization and radiation metrics were compared.

Results

61/78 patients showed coronary calcifications. Median Agatston scores were 34.9 [0.7–197.1] and 41.7 [0.7–207.2] and calcium volume scores were 34.1 [0.7–218.0] for Sn100kVp and 35.7 [1.1–221.0] for 120kVp acquisitions, respectively (both p<0.0001). Bland-Altman analysis revealed underestimated Agatston scores and calcium volume scores with Sn100kVp versus 120kVp acquisitions (mean difference: 16.4 and 11.5). However, Agatston score categories and percentile-based risk categories showed excellent agreement (ĸ=0.98 and ĸ=0.99). Image noise was 25.8±4.4HU and 16.6±2.9HU in Sn100kVp and 120kVp scans, respectively (p<0.0001). Dose-length-product was 9.9±4.8mGy*cm and 40.9±14.4mGy*cm with Sn100kVp and 120kVp scans, respectively (p<0.0001). This resulted in significant effective radiation dose reduction (0.13±0.07mSv vs. 0.57±0.2mSv, p<0.0001) for Sn100kVp acquisitions.

Conclusion

CACS using high-pitch low-voltage tin-filtered acquisitions demonstrates excellent agreement in Agatston score and percentile-based cardiac risk categorization with standard 120kVp high-pitch acquisitions. Furthermore, radiation dose was significantly reduced by 78% while maintaining accurate risk prediction.

Key points

• Coronary artery calcium scoring with tin filtration reduces radiation dose by 78%.

• There is excellent correlation between high-pitch Sn100kVp and standard 120kVp acquisitions.

• Excellent agreement regarding Agatston score categories and percentile-based risk categorization was achieved.

• No cardiac risk reclassifications were observed using Sn100kVp coronary artery calcium scoring.

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Abbreviations

BMI:

Body mass index

CACS:

Coronary artery calcium scoring

CAD:

Coronary artery disease

CCTA:

Coronary CT angiography

CI:

Confidence interval

CT:

Computed tomography

CTDI:

CT dose index

DLP:

Dose length product

DSCT:

Dual-source CT

HU:

Hounsfield units

SD:

Standard deviation

SNR:

Signal-to-noise ratio

ROI:

Region of interest

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA

    Georg Apfaltrer, Moritz H. Albrecht, U. Joseph Schoepf, Taylor M. Duguay, Carlo N. De Cecco, John W. Nance, Domenico De Santis, Paul Apfaltrer, Marwen H. Eid, Chelsea D. Eason, Zachary M. Thompson, Maximilian J. Bauer, Akos Varga-Szemes, Brian E. Jacobs & Christian Tesche

  2. Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria

    Georg Apfaltrer & Erich Sorantin

  3. Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany

    Moritz H. Albrecht

  4. Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA

    U. Joseph Schoepf

  5. Heart and Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA

    U. Joseph Schoepf

  6. Department of Radiological Sciences, Oncology and Pathology, University of Rome “Sapienza”, Rome, Italy

    Domenico De Santis

  7. Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria

    Paul Apfaltrer

  8. Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany

    Christian Tesche

Authors
  1. Georg Apfaltrer
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  2. Moritz H. Albrecht
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  3. U. Joseph Schoepf
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  4. Taylor M. Duguay
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  5. Carlo N. De Cecco
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  6. John W. Nance
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  7. Domenico De Santis
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  8. Paul Apfaltrer
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  9. Marwen H. Eid
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  10. Chelsea D. Eason
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  11. Zachary M. Thompson
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  12. Maximilian J. Bauer
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  13. Akos Varga-Szemes
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  14. Brian E. Jacobs
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  15. Erich Sorantin
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  16. Christian Tesche
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Corresponding author

Correspondence to U. Joseph Schoepf.

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Guarantor

The scientific guarantor of this publication is U. Joseph Schoepf, MD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Dr. Schoepf receives institutional research support from Astellas, Bayer, GE, and Siemens Healthineers. Dr. De Cecco receives institutional research support from Siemens Healthineers. Dr. Schoepf has received consulting fees / honoraria from Bayer, Guerbet, and Siemens. Drs. De Cecco and Varga-Szemes have received consulting fees from Guerbet. Dr. P. Apfaltrer receives institutional research support from Siemens Healthineers. The other authors have no conflicts of interest to disclose.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic study

• performed at one institution

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Apfaltrer, G., Albrecht, M.H., Schoepf, U.J. et al. High-pitch low-voltage CT coronary artery calcium scoring with tin filtration: accuracy and radiation dose reduction. Eur Radiol 28, 3097–3104 (2018). https://doi.org/10.1007/s00330-017-5249-2

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  • DOI: https://doi.org/10.1007/s00330-017-5249-2

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