Diagnostic performance of calcification-suppressed coronary CT angiography using rapid kilovolt-switching dual-energy CT
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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.
• 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.
KeywordsCoronary 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
Invasive coronary angiography
Multi-detector-row computed tomography angiography
Quantitative coronary angiography
Single-detector single-source dual-energy computed tomography
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.
- 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.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.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.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
- 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
- 15.Alvarez RE, Macovski A (1976) Energy-selective reconstructions in X-ray computerized tomography. Phys Med Biol 21:733–744Google Scholar