Advertisement

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
Cardiac

Abstract

Objectives

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).

Methods

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.

Results

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).

Conclusions

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.

Keywords

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

Abbreviations

AUC

Area under the receiver-operating characteristic curve

CAD

Coronary artery disease

CCTA

Coronary computed tomography angiography

CT

Computed tomography

ICA

Invasive coronary angiography

MD

Material density

MDCTA

Multi-detector-row computed tomography angiography

QCA

Quantitative coronary angiography

ROC

Receiver-operating characteristic

ssDECT

Single-detector single-source dual-energy computed tomography

VM

Virtual monochromatic

Notes

Acknowledgements

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.

References

  1. 1.
    Cordeiro MA, Miller JM, Schmidt A et al (2006) Non-invasive half millimetre 32 detector row computed tomography angiography accurately excludes significant stenoses in patients with advanced coronary artery disease and high calcium scores. Heart 92:589–597CrossRefPubMedGoogle Scholar
  2. 2.
    Hamon M, Morello R, Riddell JW, Hamon M (2007) Coronary arteries: diagnostic performance of 16- versus 64-section spiral CT compared with invasive coronary angiography—meta-analysis. Radiology 245:720–731CrossRefPubMedGoogle Scholar
  3. 3.
    Meijboom WB, Meijs MF, Schuijf JD et al (2008) Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol 52:2135–2144CrossRefPubMedGoogle Scholar
  4. 4.
    Zheng M, Wei M, Wen D et al (2015) Transluminal attenuation gradient in coronary computed tomography angiography for determining stenosis severity of calcified coronary artery: a primary study with dual-source CT. Eur Radiol 25:1219–1228CrossRefPubMedGoogle Scholar
  5. 5.
    Zhang S, Levin DC, Halpern EJ, Fischman D, Savage M, Walinsky P (2008) Accuracy of MDCT in assessing the degree of stenosis caused by calcified coronary artery plaques. AJR Am J Roentgenol 191:1676–1683CrossRefPubMedGoogle Scholar
  6. 6.
    Budoff MJ, Dowe D, Jollis JG et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 52:1724–1732CrossRefPubMedGoogle Scholar
  7. 7.
    Ong TK, Chin SP, Liew CK et al (2006) Accuracy of 64-row multidetector computed tomography in detecting coronary artery disease in 134 symptomatic patients: influence of calcification. Am Heart J 151:e1–e6Google Scholar
  8. 8.
    Gottlieb I, Miller JM, Arbab-Zadeh A et al (2010) The absence of coronary calcification does not exclude obstructive coronary artery disease or the need for revascularization in patients referred for conventional coronary angiography. J Am Coll Cardiol 55:627–634CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Arbab-Zadeh A, Miller JM, Rochitte CE et al (2012) Diagnostic accuracy of computed tomography coronary angiography according to pre-test probability of coronary artery disease and severity of coronary arterial calcification. The CORE-64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography) International Multicenter Study. J Am Coll Cardiol 59:379–387CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Vavere AL, Arbab-Zadeh A, Rochitte CE et al (2011) Coronary artery stenoses: accuracy of 64-detector row CT angiography in segments with mild, moderate, or severe calcification—a subanalysis of the CORE-64 trial. Radiology 261:100–108CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Yan RT, Miller JM, Rochitte CE et al (2013) Predictors of inaccurate coronary arterial stenosis assessment by CT angiography. J Am Coll Cardiol Img 6:963–972CrossRefGoogle Scholar
  12. 12.
    Tanaka R, Yoshioka K, Muranaka K et al (2013) Improved evaluation of calcified segments on coronary CT angiography: a feasibility study of coronary calcium subtraction. Int J Cardiovasc Imaging 29:75–81CrossRefPubMedGoogle Scholar
  13. 13.
    Danad I, Fayad ZA, Willemink MJ, Min JK (2015) New applications of cardiac computed tomography: dual energy, spectral, and molecular CT imaging. J Am Coll Cardiol Img 8:710–723Google Scholar
  14. 14.
    Vilades Medel D, Leta R, Alomar Serralach X, Carreras Costa F, Pons-Llado G (2016) Reliability of a new method for coronary artery calcium or metal subtraction by 320-row cardiac CT. Eur Radiol 26:3208–3214CrossRefPubMedGoogle Scholar
  15. 15.
    Alvarez RE, Macovski A (1976) Energy-selective reconstructions in X-ray computerized tomography. Phys Med Biol 21:733–744Google Scholar
  16. 16.
    Silva AC, Morse BG, Hara AK, Paden RG, Hongo N, Pavlicek W (2011) Dual-energy (spectral) CT: applications in abdominal imaging. Radiographics 31:1031–1046CrossRefPubMedGoogle Scholar
  17. 17.
    Pessis E, Campagna R, Sverzut JM et al (2013) Virtual monochromatic spectral imaging with fast kilovoltage switching: reduction of metal artifacts at CT. Radiographics 33:573–583CrossRefPubMedGoogle Scholar
  18. 18.
    Hoffmann U, Kwait DC, Handwerker J, Chan R, Lamuraglia G, Brady TJ (2003) Vascular calcification in ex vivo carotid specimens: precision and accuracy of measurements with multi-detector row CT. Radiology 229:375–381CrossRefPubMedGoogle Scholar
  19. 19.
    Matsumoto K, Jinzaki M, Tanami Y, Ueno A, Yamada M, Kuribayashi S (2011) Virtual monochromatic spectral imaging with fast kilovoltage switching: improved image quality as compared with that obtained with conventional 120-kVp CT. Radiology 259:257–262CrossRefPubMedGoogle Scholar
  20. 20.
    Scheske JA, O'Brien JM, Earls JP et al (2013) Coronary artery imaging with single-source rapid kilovolt peak-switching dual-energy CT. Radiology 268:702–709CrossRefPubMedGoogle Scholar
  21. 21.
    Leipsic J, Abbara S, Achenbach S et al (2014) SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 8:342–358CrossRefPubMedGoogle Scholar
  22. 22.
    Hausleiter J, Meyer T, Hermann F et al (2009) Estimated radiation dose associated with cardiac CT angiography. JAMA 301:500–507CrossRefPubMedGoogle Scholar
  23. 23.
    Zou KH, O'Malley AJ, Mauri L (2007) Receiver-operating characteristic analysis for evaluating diagnostic tests and predictive models. Circulation 115:654–657CrossRefPubMedGoogle Scholar
  24. 24.
    Leisenring W, Alonzo T, Pepe MS (2000) Comparisons of predictive values of binary medical diagnostic tests for paired designs. Biometrics 56:345–351CrossRefPubMedGoogle Scholar
  25. 25.
    DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845CrossRefPubMedGoogle Scholar
  26. 26.
    Andreini D, Pontone G, Mushtaq S et al (2015) Diagnostic accuracy of rapid kilovolt peak-switching dual-energy CT coronary angiography in patients with a high calcium score. J Am Coll Cardiol Img 8:746–748CrossRefGoogle Scholar
  27. 27.
    Fishbein GA, Micheletti RG, Currier JS, Singer E, Fishbein MC (2008) Atherosclerotic oxalosis in coronary arteries. Cardiovasc Pathol 17:117–123CrossRefPubMedGoogle Scholar
  28. 28.
    Mannelli L, MacDonald L, Mancini M et al (2015) Dual energy computed tomography quantification of carotid plaques calcification: comparison between monochromatic and polychromatic energies with pathology correlation. Eur Radiol 25:1238–1246CrossRefPubMedGoogle Scholar

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

Personalised recommendations