High-pitch dual-source CT for coronary artery calcium scoring: A head-to-head comparison of non-triggered chest versus triggered cardiac acquisition |
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| Authors: | Congying Xia Marleen Vonder Gert Jan Pelgrim Mieneke Rook Xueqian Xie Abdullah Alsurayhi Peter M.A. van Ooijen Jurjen N. van Bolhuis Matthijs Oudkerk Monique Dorrius Pim van der Harst Rozemarijn Vliegenthart |
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| Affiliation: | 1. Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA;2. Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;3. Manchester Heart Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom;4. Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, Netherlands;5. Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, Netherlands;6. Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, Amsterdam, Netherlands;7. Medical Imaging Centre, Semmelweis University, Budapest, Hungary;8. Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, United States;1. Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA;2. Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA;3. Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA;4. Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA |
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| Abstract: | BackgroundTo determine the effect of low-dose, high-pitch non-electrocardiographic (ECG)-triggered chest CT on coronary artery calcium (CAC) detection, quantification and risk stratification, compared to ECG-triggered cardiac CT.MethodsWe selected 1,000 participants from the ImaLife study, 50% with coronary calcification on cardiac CT. All participants underwent non-contrast cardiac CT followed by chest CT using third-generation dual-source technology. Reconstruction settings were equal for both acquisitions. CAC scores were determined by Agatston's method, and divided dichotomously (0, >0), and into risk categories (0, 1–99, 100–399, ≥400). We investigated the influence of heart rate and body mass index (BMI) on risk reclassification.ResultsPositive CAC scores on cardiac CT ranged from 1 to 6926 (median 39). Compared to cardiac CT, chest CT had sensitivity of 0.96 (95%CI 0.94–0.98) and specificity of 0.99 (95%CI 0.97–0.99) for CAC detection (κ = 0.95). In participants with coronary calcification on cardiac CT, CAC score on chest CT was lower than on cardiac CT (median 30 versus 40, p?0.001). Agreement in CAC-based risk strata was excellent (weighted κ = 0.95). Sixty-five cases (6.5%) were reclassified by one risk category in chest CT, with fifty-five (84.6%) shifting downward. Higher BMI resulted in higher reclassification rate (13% for BMI ≥30 versus 5.2% for BMI <30, p = 0.001), but there was no effect of heart rate.ConclusionLow-dose, high-pitch chest CT, using third-generation dual-source technology shows almost perfect agreement with cardiac CT in CAC detection and risk stratification. However, low-dose chest CT mainly underestimates the CAC score as compared to cardiac CT, and results in inaccurate risk categorization in BMI ≥30. |
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| Keywords: | Computed tomography Coronary artery calcium score Dual source High pitch |
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