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Coronary artery calcium quantification from contrast enhanced CT using gemstone spectral imaging and material decomposition

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Abstract

To explore the feasibility of coronary artery calcium (CAC) measurement from low-dose contrast enhanced coronary CT angiography (CCTA) as this may obviate the need for an unenhanced CT scan. 52 patients underwent unenhanced cardiac CT and prospectively ECG triggered contrast enhanced CCTA (Discovery HD 750, GE Healthcare, Milwaukee, WI, USA). The latter was acquired in single-source dual-energy mode [gemstone spectral imaging (GSI)]. Virtual unenhanced images were generated from GSI CCTA by monochromatic image reconstruction of 70 keV allowing selective iodine material suppression. CAC scores from virtual unenhanced CT were compared to standard unenhanced CT including a linear regression model. After iodine subtraction from the contrast enhanced CCTA the attenuation in the ascending aorta decreased significantly from 359 ± 61 to 54 ± 8 HU (P < 0.001), the latter comparing well to the value of 64 ± 55 HU found in the standard unenhanced CT (P = ns) confirming successful iodine subtraction. After introducing linear regression formula the mean values for Agatston, Volume and Mass scores of virtual unenhanced CT were 187 ± 321, 72 ± 114 mm3, and 27 ± 46 mg/cm3, comparing well to the values from standard unenhanced CT (187 ± 309, 72 ± 110 mm3, and 27 ± 45 mg/cm3) yielding an excellent correlation (r = 0.96, r = 0.96, r = 0.92; P < 0.001). Mean estimated radiation dose revealed 0.83 ± 0.02 mSv from the unenhanced CT and 1.70 ± 0.53 mSv from the contrast enhanced CCTA. Single-source dual-energy scanning with GSI allows CAC quantification from low dose contrast enhanced CCTA by virtual iodine contrast subtraction.

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Acknowledgments

The study was supported by grants from the Swiss National Science Foundation (SNSF) to PAK. Furthermore, we thank our cardiac radiographers Ennio Mueller and Gentian Cermjani for their excellent technical support.

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Authors and Affiliations

  1. Cardiac Imaging, Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, NUK C 42, 8091, Zurich, Switzerland

    Tobias A. Fuchs, Julia Stehli, Svetlana Dougoud, Bert-Ram Sah, Sacha Bull, Olivier F. Clerc, Mathias Possner, Ronny R. Buechel, Oliver Gaemperli & Philipp A. Kaufmann

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  1. Tobias A. Fuchs
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  2. Julia Stehli
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  3. Svetlana Dougoud
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  4. Bert-Ram Sah
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  5. Sacha Bull
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  6. Olivier F. Clerc
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  7. Mathias Possner
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  8. Ronny R. Buechel
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  9. Oliver Gaemperli
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  10. Philipp A. Kaufmann
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Correspondence to Philipp A. Kaufmann.

Additional information

Tobias A. Fuchs and Julia Stehli have contributed equally to this work.

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Fuchs, T.A., Stehli, J., Dougoud, S. et al. Coronary artery calcium quantification from contrast enhanced CT using gemstone spectral imaging and material decomposition. Int J Cardiovasc Imaging 30, 1399–1405 (2014). https://doi.org/10.1007/s10554-014-0474-0

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  • DOI: https://doi.org/10.1007/s10554-014-0474-0

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