Improved Detection of Small and Low-Density Plaques in Virtual Noncontrast Imaging-based Calcium Scoring at Photon-Counting Detector CT.
IF 3.8
Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Nicola Fink, Tilman Emrich, U Joseph Schoepf, Emese Zsarnoczay, Jim O'Doherty, Moritz C Halfmann, Joseph P Griffith, Daniel Pinos, Pal Suranyi, Dhiraj Baruah, Ismail M Kabakus, Jens Ricke, Akos Varga-Szemes
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Abstract
Purpose To investigate the impact of plaque size and density on virtual noncontrast (VNC)-based coronary artery calcium scoring (CACS) using photon-counting detector CT and to provide safety net reconstructions for improved detection of subtle plaques in patients whose VNC-based CACS would otherwise be erroneously zero when compared with true noncontrast (TNC)-based CACS. Materials and Methods In this prospective study, CACS was evaluated in a phantom containing calcifications with different diameters (5, 3, and 1 mm) and densities (800, 400, and 200 mg/cm3 ) and in participants who underwent TNC and contrast-enhanced cardiac photon-counting detector CT (July 2021-March 2022). VNC images were reconstructed at different virtual monoenergetic imaging (55-80 keV) and quantum iterative reconstruction (QIR) levels (QIR,1-4). TNC scans at 70 keV with QIR off served as the reference standard. In vitro CACS was analyzed using standard settings (3.0-mm sections, kernel Qr36, 130-HU threshold). Calcification detectability and CACS of small and low-density plaques were also evaluated using 1.0-mm sections, kernel Qr44, and 120- or 110-HU thresholds. Safety net reconstructions were defined based on background Agatston scores and evaluated in vivo in TNC plaques initially nondetectable using standard VNC reconstructions. Results The in vivo cohort included 63 participants (57.8 years ± 15.5 [SD]; 37 [59%] male, 26 [41%] female). Correlation and agreement between standard CACSVNC and CACSTNC were higher in large- and medium-sized and high- and medium-density than in low-density plaques (in vitro: intraclass correlation coefficient [ICC] ≥ 0.90; r > 0.9 vs ICC = 0.20-0.48; r = 0.5-0.6). Small plaques were not detectable using standard VNC reconstructions. Calcification detectability was highest using 1.0-mm sections, kernel Qr44, 120- and 110-HU thresholds, and QIR level of 2 or less VNC reconstructions. Compared with standard VNC, using safety net reconstructions (55 keV, QIR 2, 110-HU threshold) for in vivo subtle plaque detection led to higher detection (increased by 89% [50 of 56]) and improved correlation and agreement of CACSVNC with CACSTNC (in vivo: ICC = 0.51-0.61; r = 0.6). Conclusion Compared with TNC-based calcium scoring, VNC-based calcium scoring was limited for small and low-density plaques but improved using safety net reconstructions, which may be particularly useful in patients with low calcium scores who would otherwise be treated based on potentially false-negative results. Keywords: Coronary Artery Calcium CT, Photon-Counting Detector CT, Virtual Noncontrast, Plaque Size, Plaque Density Supplemental material is available for this article. © RSNA, 2024.
在光子计数探测器 CT 上基于虚拟非对比成像的钙化评分中改进对小斑块和低密度斑块的检测。
目的 研究斑块大小和密度对使用光子计数探测器 CT 进行的基于虚拟非对比(VNC)的冠状动脉钙化评分(CACS)的影响,并提供安全网重建,以改进对患者微小斑块的检测,否则与基于真实非对比(TNC)的 CACS 相比,基于 VNC 的 CACS 将错误地为零。材料与方法 在这项前瞻性研究中,CACS 在一个包含不同直径(5、3 和 1 毫米)和密度(800、400 和 200 毫克/立方厘米)钙化的模型中进行了评估,并在接受 TNC 和对比度增强型心脏光子计数探测器 CT 的参与者中进行了评估(2021 年 7 月至 2022 年 3 月)。VNC 图像在不同的虚拟单能成像(55-80 keV)和量子迭代重建(QIR)级别(QIR,1-4)下重建。以关闭 QIR 的 70 keV TNC 扫描作为参考标准。体外 CACS 分析采用标准设置(3.0 毫米切片、Qr36 内核、130-HU 阈值)。此外,还使用 1.0 毫米切片、Qr44 内核、120 或 110-HU 阈值对小型和低密度斑块的钙化可探测性和 CACS 进行了评估。安全网重建是根据背景 Agatston 评分定义的,并在体内对最初使用标准 VNC 重建无法检测到的 TNC 斑块进行评估。结果 体内队列包括 63 名参与者(57.8 岁 ± 15.5 [SD];37 [59%] 男性,26 [41%] 女性)。与低密度斑块相比,标准 CACSVNC 与 CACSTNC 在大、中、高密度斑块中的相关性和一致性更高(体外:类内相关系数 [ICC] ≥ 0.90;r > 0.9 vs ICC = 0.20-0.48;r = 0.5-0.6)。使用标准 VNC 重建无法检测到小斑块。使用 1.0 毫米切片、内核 Qr44、120 和 110-HU 阈值以及 QIR 级别为 2 或更低的 VNC 重建,钙化的可检测性最高。与标准 VNC 相比,使用安全网重建(55 keV、QIR 2、110-HU 阈值)进行体内微小斑块检测可提高检测率(提高 89% [56 例中的 50 例]),并改善 CACSVNC 与 CACSTNC 的相关性和一致性(体内:ICC = 0.51-0.61; r = 0.6)。结论 与基于TNC的钙评分相比,基于VNC的钙评分对小斑块和低密度斑块的影响有限,但使用安全网重建后,情况有所改善,这对钙评分较低的患者可能特别有用,否则这些患者可能会根据潜在的假阴性结果接受治疗。关键词:冠状动脉钙化冠状动脉钙化 CT 光子计数探测器 CT 虚拟非对比斑块大小 斑块密度 本文有补充材料。© RSNA, 2024.
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