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

  • 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
  • Erich Sorantin
  • Christian Tesche
Cardiac
  • 89 Downloads

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.

Keywords

Computed tomography Coronary artery calcium Tin filtration High-pitch Radiation dose 

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

Notes

Compliance with ethical standards

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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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Georg Apfaltrer
    • 1
    • 2
  • Moritz H. Albrecht
    • 1
    • 3
  • U. Joseph Schoepf
    • 1
    • 4
    • 5
  • Taylor M. Duguay
    • 1
  • Carlo N. De Cecco
    • 1
  • John W. Nance
    • 1
  • Domenico De Santis
    • 1
    • 6
  • Paul Apfaltrer
    • 1
    • 7
  • Marwen H. Eid
    • 1
  • Chelsea D. Eason
    • 1
  • Zachary M. Thompson
    • 1
  • Maximilian J. Bauer
    • 1
  • Akos Varga-Szemes
    • 1
  • Brian E. Jacobs
    • 1
  • Erich Sorantin
    • 2
  • Christian Tesche
    • 1
    • 8
  1. 1.Division of Cardiovascular Imaging, Department of Radiology and Radiological ScienceMedical University of South CarolinaCharlestonUSA
  2. 2.Division of Paediatric Radiology, Department of RadiologyMedical University of GrazGrazAustria
  3. 3.Department of Diagnostic and Interventional RadiologyUniversity Hospital FrankfurtFrankfurtGermany
  4. 4.Division of CardiologyMedical University of South CarolinaCharlestonUSA
  5. 5.Heart and Vascular CenterMedical University of South CarolinaCharlestonUSA
  6. 6.Department of Radiological Sciences, Oncology and PathologyUniversity of Rome “Sapienza”RomeItaly
  7. 7.Department of Biomedical Imaging and Image-guided TherapyMedical University of ViennaViennaAustria
  8. 8.Department of Cardiology and Intensive Care MedicineHeart Center Munich-BogenhausenMunichGermany

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