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Improved coronary calcification quantification using photon-counting-detector CT: an ex vivo study in cadaveric specimens

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To compare the accuracy of coronary calcium quantification of cadaveric specimens imaged from a photon-counting detector (PCD)-CT and an energy-integrating detector (EID)-CT.

Methods

Excised coronary specimens were scanned on a PCD-CT scanner, using both the PCD and EID subsystems. The scanning and reconstruction parameters for EID-CT and PCD-CT were matched: 120 kV, 9.3–9.4 mGy CTDIvol, and a quantitative kernel (D50). PCD-CT images were also reconstructed using a sharper kernel (D60). Scanning the same specimens using micro-CT served as a reference standard for calcified volumes. Calcifications were segmented with a half-maximum thresholding technique. Segmented calcified volume differences were analyzed using the Friedman test and post hoc pairwise Wilcoxon signed rank test with the Bonferroni correction. Image noise measurements were compared between EID-CT and PCD-CT with a repeated-measures ANOVA test and post hoc pairwise comparison with the Bonferroni correction. A p < 0.05 was considered statistically significant.

Results

The volume measurements in 12/13 calcifications followed a similar trend: EID-D50 > PCD-D50 > PCD-D60 > micro-CT. The median calcified volumes in EID-D50, PCD-D50, PCD-D60, and micro-CT were 22.1 (IQR 10.2–64.8), 21.0 (IQR 9.0–56.5), 18.2 (IQR 8.3–49.3), and 14.6 (IQR 5.1–42.4) mm3, respectively (p < 0.05 for all pairwise comparisons). The average image noise in EID-D50, PCD-D50, and PCD-D60 was 60.4 (± 3.5), 56.0 (± 4.2), and 113.6 (± 8.5) HU, respectively (p < 0.01 for all pairwise comparisons).

Conclusion

The PCT-CT system quantified coronary calcifications more accurately than EID-CT, and a sharp PCD-CT kernel further improved the accuracy. The PCD-CT images exhibited lower noise than the EID-CT images.

Key Points

• High spatial resolution offered by PCD-CT reduces partial volume averaging and consequently leads to better morphological depiction of coronary calcifications.

• Improved quantitative accuracy for coronary calcification volumes could be achieved using high-resolution PCD-CT compared to conventional EID-CT.

• PCD-CT images exhibit lower image noise than conventional EID-CT at matched radiation dose and reconstruction kernel.

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Abbreviations

CAC:

Coronary artery calcifications

CAD:

Coronary artery disease

CBA:

Calcium blooming artifacts

CCC:

Lin’s concordance correlation coefficient

CCTA:

Coronary computed tomography angiography

CI:

Confidence interval

CNR:

Contrast-to-noise ratio

CSCT:

Calcium scoring computed tomography

CT :

Computed tomography

CTDIvol :

Volume CT dose index

CV:

Cardiovascular

EID :

Energy-integrating detector

FOV:

Field of view

HMT:

Half-maximum threshold

HU:

Hounsfield Units

IQR:

Interquartile ranges

MMA:

Methyl methacrylate

NCCT:

Non-contrast, non-gated chest CT

PCD :

Photon-counting detector

PVA :

Partial volume averaging

ROI:

Region of interest

SD:

Standard deviation

UHR:

Ultra-high resolution

WFBP:

Weighted filtered back projection

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Acknowledgements

The authors would also like to thank Mats Fredriksson, Department of Occupational and Environmental Medicine, Linköping University, who provided statistical advice. The authors thank Kristina Nunez, Mayo Clinic, for her assistance in manuscript preparation.

Funding

The research reported in this work was supported by the National Institutes of Health under awards R01 EB016966 and C06 RR018898. This work was supported in part by the Mayo Clinic X-ray Imaging Research Core. This research project was also supported by the Mayo Clinic-Karolinska Institutet Collaboration platform and by ALF grants, Region Östergötland.

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Authors and Affiliations

  1. Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden

    Mårten Sandstedt & Anders Persson

  2. Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden

    Mårten Sandstedt & Anders Persson

  3. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Jeffrey Marsh Jr., Kishore Rajendran, Hao Gong, Shengzhen Tao, Shuai Leng & Cynthia McCollough

  4. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

    Anders Persson

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  1. Mårten Sandstedt
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Correspondence to Kishore Rajendran.

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Guarantor

The scientific guarantor of this publication is Anders Persson, MD, Ph.D.

Conflict of interest

Research support for this work was provided, in part, to the Mayo Clinic from Siemens Healthcare GmbH. The research CT system used in this work was provided by Siemens Healthcare GmbH; it is not commercially available.

Statistics and biometry

Mats Fredriksson, Department of Occupational and Environmental Medicine, Linköping University

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Not applicable, since no human subjects are involved.

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Institutional Review Board approval was not required since no human subjects were involved.

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Sandstedt, M., Marsh, J., Rajendran, K. et al. Improved coronary calcification quantification using photon-counting-detector CT: an ex vivo study in cadaveric specimens. Eur Radiol 31, 6621–6630 (2021). https://doi.org/10.1007/s00330-021-07780-6

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