European Radiology

, Volume 27, Issue 7, pp 2794–2801 | Cite as

Diagnostic performance of calcification-suppressed coronary CT angiography using rapid kilovolt-switching dual-energy CT

  • Hiroto Yunaga
  • Yasutoshi Ohta
  • Yasuhiro Kaetsu
  • Shinichiro Kitao
  • Tomomi Watanabe
  • Yoshiyuki Furuse
  • Kazuhiro Yamamoto
  • Toshihide Ogawa



Multi-detector-row computed tomography angiography (MDCTA) plays an important role in the assessment of patients with suspected coronary artery disease. However, MDCTA tends to overestimate stenosis in calcified coronary artery lesions. The aim of our study was to evaluate the diagnostic performance of calcification-suppressed material density (MD) images produced by using a single-detector single-source dual-energy computed tomography (ssDECT).


We enrolled 67 patients with suspected or known coronary artery disease who underwent ssDECT with rapid kilovolt-switching (80 and 140 kVp). Coronary artery stenosis was evaluated on the basis of MD images and virtual monochromatic (VM) images. The diagnostic performance of the two methods for detecting coronary artery disease was compared with that of invasive coronary angiography as a reference standard.


We evaluated 239 calcified segments. In all the segments, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detecting significant stenosis were respectively 88%, 88%, 75%, 95% and 88% for the MD images, 91%, 71%, 56%, 95% and 77% for the VM images. PPV was significantly higher on the MD images than on the VM images (P < 0.0001).


Calcification-suppressed MD images improved PPV and diagnostic performance for calcified coronary artery lesions.

Key Points

Computed tomography angiography tends to overestimate stenosis in calcified coronary artery.

Dual-energy CT enables us to suppress calcification of coronary artery lesions.

Calcification-suppressed material density imaging reduces false-positive diagnosis of calcified lesion.


Coronary vessels Vascular calcification Radiography, dual-energy scanned projection Tomography, X-ray computed Coronary angiography 



Area under the receiver-operating characteristic curve


Coronary artery disease


Coronary computed tomography angiography


Computed tomography


Invasive coronary angiography


Material density


Multi-detector-row computed tomography angiography


Quantitative coronary angiography


Receiver-operating characteristic


Single-detector single-source dual-energy computed tomography


Virtual monochromatic



The scientific guarantor of this publication is Toshihide Ogawa. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Hiroto Yunaga
    • 1
  • Yasutoshi Ohta
    • 1
  • Yasuhiro Kaetsu
    • 2
  • Shinichiro Kitao
    • 1
  • Tomomi Watanabe
    • 3
  • Yoshiyuki Furuse
    • 3
  • Kazuhiro Yamamoto
    • 3
  • Toshihide Ogawa
    • 1
  1. 1.Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of MedicineTottori UniversityYonago CityJapan
  2. 2.Department of CardiologyKakogawa Higashi HospitalKakogawaJapan
  3. 3.Division of Cardiology, Department of Molecular Medicine and Therapeutics, Faculty of MedicineTottori UniversityYonagoJapan

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