Coronary artery calcium scoring using ECG-gated multidetector CT: effect of individually optimized image-reconstruction windows on image quality and measurement reproducibility

OBJECTIVE: We studied the effect of using individually optimized image-reconstruction windows on image quality and measurement reproducibility in coronary artery calcium scoring using ECG-gated multidetector CT (MDCT). SUBJECTS AND METHODS: In 50 patients, the coronary arteries were investigated twice with ECG-gated MDCT with 500-msec rotation time. Per scan, three sets of images were reconstructed, respectively, at an image-reconstruction window of 40%, 50%, and 60% of the R-R interval. Image quality was assessed, and the optimal image-reconstruction window per scan and per coronary territory was determined. The interscan variability of calcium mass measurements was calculated for different strategies (use of fixed image-reconstruction window 40%, 50%, or 60%] versus individually optimized image-reconstruction window). RESULTS: A significant improvement in image quality was obtained by selecting the best of three reconstructed data sets (mean image quality score, 4.4 vs 3.7; p < 0.001). Even with individually optimized image-reconstruction window values, we obtained high values for interscan variability (mean +/- SD, 27% +/- 22% vs 31% +/- 35% with a fixed image-reconstruction window). CONCLUSION: The use of individually optimized image-reconstruction windows leads to a significant improvement in image quality. However, interscan variability of calcium mass measurements remains high.