Coronary Artery Calcium Scoring With Multislice Computed Tomography

Thomas, Christoph; Mühlenbruch, Georg; Wildberger, Joachim E.; Hohl, C.; Das, Marco; Günther, Rolf W.; Mahnken, Andreas H.

doi:10.1097/01.rli.0000233324.09603.dd

Cited by 55 publications

(45 citation statements)

References 32 publications

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“…It has been shown that lower tube voltages considerably reduce the radiation dose of CT examinations [11,36,37]. For CS, this relevant dose reduction is possible without compromising the reproducibility and accuracy of the method.…”

Section: Discussionmentioning

confidence: 99%

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Radiation dose values for various coronary calcium scoring protocols in dual-source CT

Stolzmann

Leschka

Betschart

et al. 2008

Int J Cardiovasc Imaging

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Purpose The purpose of this study was to assess the radiation dose and associated image noise of previously suggested calcium scoring protocols using dual-source CT. Methods One hundred consecutive patients underwent coronary calcium scoring using dual-source CT. Patients were randomly assigned to five different protocols: retrospective ECG-gating and tube current reduction to 4% outside the pulsing window at 120 (protocol A) and 100 kV (B), prospective ECG-triggering at 120 (C) and 100 kV (D), and prospective ECG-triggering at 100 kV with attenuation-based tube current modulation (E). Radiation dose parameters and image noise were determined and compared. Results Protocol A resulted in an effective dose of 1.3 ± 0.2 mSv, protocol B in 0.8 ± 0.2 mSv, protocol C in 1.0 ± 0.2 mSv, protocol D in 0.6 ± 0.1 mSv, and protocol E in 0.7 ± 0.1 mSv. Effective doses were significantly lower (P \ 0.001) with 100 kV when compared to 120 kV protocols, and were significantly lower (P \ 0.001) for prospective versus retrospective ECG-gating. No significant difference was found between protocol D and E. Significant negative correlations were found between the CTDI vol and heart rate for both retrospective ECGgating protocols (protocol A: r = -0.98, P \ 0.001; protocol B: r = -0.83, P \ 0.001). The mean image noise was 29.0 ± 6.7 HU, with no significant differences between the five protocols. The image noise was significantly correlated with the body weight (r = 0.21, P \ 0.05) and BMI (r = 0.31, P \ 0.01). Conclusions Effective dose of calcium scoring using dual-source CT ranges from 0.6 to 1.3 mSv. Prospective triggering and lower tube voltage significantly reduces the radiation but yield similar image noise.

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Section: Discussionmentioning

confidence: 99%

“…For CS, this relevant dose reduction is possible without compromising the reproducibility and accuracy of the method. At lower tube voltages, however, the detection threshold needs to be increased because of the increasing attenuation of calcium at lower photon energy levels [37].…”

Section: Discussionmentioning

confidence: 99%

Radiation dose values for various coronary calcium scoring protocols in dual-source CT

Stolzmann

Leschka

Betschart

et al. 2008

Int J Cardiovasc Imaging

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“…Known limitations of the classical volume measure are its dependency on the plaque density [6], the reconstruction kernel [23,24], and the tube voltage [25], and its high variability [8,17]. Lower tube voltages result in higher attenuation coefficients for hydroxyapatite [26] and therefore increase the blurring by the line-spread function, which in turn causes an overestimation of the plaque volume.…”

Section: Discussionmentioning

confidence: 99%

“…Lower tube voltages result in higher attenuation coefficients for hydroxyapatite [26] and therefore increase the blurring by the line-spread function, which in turn causes an overestimation of the plaque volume. Thomas et al [25] showed the impact of two different tube voltages on the intensity values of a calcium insert. As the volume score is defined through a fixed 130 HU threshold, different HU values have a direct influence on its outcome.…”

Section: Discussionmentioning

confidence: 99%

ACCURATUM: improved calcium volume scoring using a mesh-based algorithm—a phantom study

et al. 2008

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To overcome the limitations of the classical volume scoring method for quantifying coronary calcifications, including accuracy, variability between examinations, and dependency on plaque density and acquisition parameters, a mesh-based volume measurement method has been developed. It was evaluated and compared with the classical volume scoring method for accuracy, i.e., the normalized volume (measured volume/ ground-truthed volume), and for variability between examinations (standard deviation of accuracy). A cardiac computed-tomography (CT) phantom containing various cylindrical calcifications was scanned using different tube voltages and reconstruction kernels, at various positions and orientations on the CT table and using different slice thicknesses. Mean accuracy for all plaques was significantly higher (p<0.0001) for the proposed method (1.220±0.507) than for the classical volume score (1.896± 1.095). In contrast to the classical volume score, plaque density (p=0.84), reconstruction kernel (p= 0.19), and tube voltage (p=0.27) had no impact on the accuracy of the developed method. In conclusion, the method presented herein is more accurate than classical calcium scoring and is less dependent on tube voltage, reconstruction kernel, and plaque density.

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“…However, there are concerns regarding the reproducibility of CT 11 and the X-ray exposure of sequential scanning, for example, to follow the effects of therapeutic interventions. [12][13][14][15] Vibroacoustography is a new ultrasound-based method to detect vascular calcifications. [16][17][18] This technique uses acoustic radiation pressure produced by 2 intersecting ultrasound beams at slightly different frequencies to induce a vibration (kHz range) of the object from a distance.…”

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confidence: 99%

In Vivo Vibroacoustography of Large Peripheral Arteries

Pislaru¹,

Kantor²,

Kinnick³

et al. 2008

Investigative Radiology

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Objective-Vibroacoustography allows imaging of objects on the basis of their acoustic signal emitted during low-frequency (kHz) vibrations produced by 2 intersecting ultrasound beams at slightly different frequencies. This study tested the feasibility of using vibroacoustography to distinguish between normal and calcified femoral arteries in a pig model. Materials and Methods-Thirteen normal porcine femoral arteries, 7 with experimentally induced arterial calcifications, and 1 control artery injected with saline only were scanned in vivo. Images were obtained at 45 kHz using a 3 MHz confocal transducer. The acoustic emission signal was detected with a hydrophone placed on the animal's limb. Images were reconstructed on the basis of the amplitude of the acoustic emission signal. Vessel patency, vessel dimensions, and the extent of calcified plaques were confirmed in vivo by angiography and conventional ultrasound. Excised arteries were reexamined with vibroacoustography, X-ray radiography, and histology.Results-In vivo, vibroacoustography produced high-resolution, speckle-free images with a high level of anatomic detail. Measurements of femoral artery diameter were similar by vibroacoustography and conventional ultrasound (mean difference ± SD, 0.1 ± 0.4 mm). Calcified plaque area measured by different methods was comparable (vibroacoustography, in vivo: 1.0 ± 0.9 cm 2 ; vibroacoustography in vitro: 1.1 ± 0.6 cm 2 ; X-ray radiography: 0.9 ± 0.6 cm 2 ). The reproducibility of measurements was high. Sensitivity and specificity for detecting calcifications were 100% and 86%, respectively, and positive and negative predictive values were 77% and 100%, respectively. Computed tomography (CT) is currently the most widely used noninvasive imaging modality for the quantitative assessment of total calcium burden on the cardiovascular system. However, there are concerns regarding the reproducibility of CT 11 and the X-ray exposure of sequential scanning, for example, to follow the effects of therapeutic interventions. 12-15 Conclusions-VibroacoustographyVibroacoustography is a new ultrasound-based method to detect vascular calcifications. 16-18 This technique uses acoustic radiation pressure produced by 2 intersecting ultrasound beams at slightly different frequencies to induce a vibration (kHz range) of the object from a distance. The image of the object is obtained on the basis of the vibration-induced acoustic emission signal. This signal depends on the stiffness as well as the acoustic properties of the object. 17, 19Vibroacoustography can easily detect calcified deposits in excised tissue specimens scanned in a water bath. The resulting images faithfully resemble X-ray images of specimens. 16-22 However, in vivo, numerous factors could distort the ultrasound and acoustic emission signals.To our knowledge, this is the first in vivo study to test the ability of vibroacoustography to image normal femoral arteries and to detect calcified plaques in femoral arteries of anesthetized swine, an animal model that allows...

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Coronary Artery Calcium Scoring With Multislice Computed Tomography

Abstract: Using an 80-kVp protocol in coronary calcium scoring, a relevant dose reduction is possible without compromising reproducibility and accuracy.

Cited by 55 publications

References 32 publications

Radiation dose values for various coronary calcium scoring protocols in dual-source CT

Radiation dose values for various coronary calcium scoring protocols in dual-source CT

ACCURATUM: improved calcium volume scoring using a mesh-based algorithm—a phantom study

In Vivo Vibroacoustography of Large Peripheral Arteries

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