Background: Deep learning image reconstruction (DLIR) and adaptive statistical iterative reconstruction-V (ASIR-V) has been used for cardiac computed tomography imaging. However, DLIR and ASIR-V may influence the quantification of coronary artery calcification (CAC).Methods: CT images of 96 patients were reconstructed using filtered back projection (FBP), ASIR-V 50%, and three levels of DLIR [low (L), medium (M), and high (H)]. Image noise and the Agatston, volume, and mass scores were compared between the reconstructions. Patients were stratified into six Agatston scorebased risk categories and five CAC percentile risk categories adjusted by Agatston score, age, sex, and race.The number of patients who were switched to another risk stratification group when ASIR-V and DLIR were used was compared. Bland-Altman plots were used to present the agreement of Agatston scores between FBP and the different reconstruction techniques.

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Deep learning image reconstruction (DLIR) and Adaptive Statistical Iterative Reconstruction-V (ASIR-V) has been used for cardiac computed tomography imaging. However, DLIR and ASIR-V may influence the quantification of coronary artery calcification. This study aimed to investigate the effects of DLIR and ASIR-V on coronary calcium quantification compared to traditional filtered back projection (FBP). CT images of 96 patients were reconstructed by FBP, ASIR-V 50%, and three levels of DLIR (low [L], medium [M], and high [H], respectively). Image noise decreased significantly with ASIR-V 50% and increasing DLIR levels from L to H in comparison with FBP (all P < 0.001). There is a significantly decline with ASIR-V 50% and incremental DLIR levels in Agatston calcium score, volume score and mass score as compared to FBP (all P < 0.001). For all CAC score risk categories, Severity classification shows no significant differences among five reconstructions (all P > 0.05). DLIR-L has the minimal effect on coronary calcium quantification as compared to ASIR-V and DLIR at medium and high levels. it may be considered as an alternative to FBP for routine clinical use.