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Improved evaluation of calcified segments on coronary CT angiography: a feasibility study of coronary calcium subtraction

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Abstract

We explore the feasibility of coronary calcium subtraction computed tomography angiography (CCTA) in patients with high calcium scores using invasive coronary angiography as the gold standard. Eleven patients with calcium scores of >400 underwent CCTA using a subtraction protocol followed by invasive coronary angiography. In addition to standard reconstructions, subtracted images were obtained using a dedicated subtraction algorithm. A total of 55 calcified segments were evaluated for image quality [using a 4-point scale ranging from 1 (uninterpretable) to 4 (good)] and the presence of significant (≥50 %) luminal stenosis. Conventional and subtracted CCTA were compared using quantitative coronary angiography (QCA) as the gold standard. The average image quality of conventional CCTA was 2.5 ± 0.6 versus 3.1 ± 0.6 on subtraction CCTA (P < 0.001). The percentage of segments with a score 1 or 2 was reduced from 41.8 to 12.7 % after coronary calcium subtraction (P = 0.002). On QCA, significant stenosis was observed in 16 segments. The area under the receiver operating characteristics curve to detect ≥50 % stenosis on QCA increased from 0.741 [95 % confidence interval (CI) 0.598–0.885] for conventional CCTA to 0.905 (95 % CI 0.791–1.000) for subtraction CCTA (P = 0.003). In patients with extensive calcifications undergoing CCTA, coronary calcium subtraction may improve the evaluation of calcified segments.

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Abbreviations

CCTA:

Coronary computed tomography angiography

cMPR:

Curved multiplanar reconstructions

QCA:

Quantitative coronary angiography

AIDR 3D:

Adaptive iterative dose reduction 3D

BW:

Body weight

AUC:

Area under the curve

ROC:

Receiver operating characteristic

DLP:

Dose-length product

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Acknowledgments

Mr. Kazumasa Arakita and Dr. Joanne Schuijf from Toshiba Medical Systems gave support and suggestions in writing and technical subjects, especially for the dedicated subtraction algorithms.

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None.

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Authors and Affiliations

  1. Department of Radiology, Iwate Medical University, 19-1, Uchimaru, Morioka, Iwate, 020-8505, Japan

    Ryoichi Tanaka, Kunihiro Yoshioka, Kenta Muranaka, Takuya Chiba, Takanori Ueda, Tadashi Sasaki & Shigeru Ehara

  2. Department of Cardiovascular Medicine, Iwate Medical University, 19-1, Uchimaru, Morioka, Iwate, 020-8505, Japan

    Tetsuya Fusazaki

Authors
  1. Ryoichi Tanaka
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  2. Kunihiro Yoshioka
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  3. Kenta Muranaka
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  5. Takanori Ueda
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  8. Shigeru Ehara
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Correspondence to Ryoichi Tanaka.

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Tanaka, R., Yoshioka, K., Muranaka, K. et al. Improved evaluation of calcified segments on coronary CT angiography: a feasibility study of coronary calcium subtraction. Int J Cardiovasc Imaging 29 (Suppl 2), 75–81 (2013). https://doi.org/10.1007/s10554-013-0316-5

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  • DOI: https://doi.org/10.1007/s10554-013-0316-5

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