Systematic assessment of coronary calcium detectability and quantification on four generations of CT reconstruction techniques: a patient and phantom study

Dobrolińska, Magdalena; Praagh, Gijs D van; Oostveen, Luuk J.; Poelhekken, Keris; Greuter, Marcel J W; Fleischmann, Dominik; Willemink, Martin J.; Lange, Frank de; Slart, Riemer H. J. A.; Leiner, Tim; Werf, Niels R van der

doi:10.1007/s10554-022-02703-y

Cited by 6 publications

(4 citation statements)

References 30 publications

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“…Although many parameters were considered in the simulation, only one type of reconstruction was utilized, which prevented us from addressing the effect that reconstruction type has on these calcium scoring techniques. Previous studies have shown good agreement between Agatston scores based on filtered back-projection, hybrid iterative reconstruction, and deep learning-based reconstruction 28 …”

Section: Discussionmentioning

confidence: 85%

“…Previous studies have shown good agreement between Agatston scores based on filtered back-projection, hybrid iterative reconstruction, and deep learning-based reconstruction. 28 Slice thickness plays an important role in calcium scoring, and traditional Agatston scoring is only defined at a slice thickness of 3 mm. Recent studies have shown that the accuracy and sensitivity of Agatston scoring are improved when slice thickness is decreased.…”

Section: Discussionmentioning

confidence: 99%

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Coronary artery calcium mass measurement based on integrated intensity and volume fraction techniques

2023

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Agatston scoring does not detect all the calcium present in computed tomography scans of the heart. A technique that removes the need for thresholding and quantifies calcium mass more accurately and reproducibly is needed.Approach: Integrated intensity and volume fraction techniques were evaluated for accurate quantification of calcium mass. Integrated intensity calcium mass, volume fraction calcium mass, Agatston scoring, and spatially weighted calcium scoring were compared with known calcium mass in simulated and physical phantoms. The simulation was created to match a 320-slice CT scanner. Fat rings were added to the simulated phantoms, which resulted in small (30 × 20 cm 2 ), medium (35 × 25 cm 2 ), and large (40 × 30 cm 2 ) phantoms. Three calcification inserts of different diameters and hydroxyapatite densities were placed within the phantoms. All the calcium mass measurements were repeated across different beam energies, patient sizes, insert sizes, and densities. Physical phantom images from a previously reported study were then used to evaluate the accuracy and reproducibility of the techniques.Results: Both integrated intensity calcium mass and volume fraction calcium mass yielded lower root mean squared error (RMSE) and deviation (RMSD) values than Agatston scoring in all the measurements in the simulated phantoms. Specifically, integrated calcium mass (RMSE: 0.49 mg, RMSD: 0.49 mg) and volume fraction calcium mass (RMSE: 0.58 mg, RMSD: 0.57 mg) were more accurate for the low-density stationary calcium measurements than Agatston scoring (RMSE: 3.70 mg, RMSD: 2.30 mg). Similarly, integrated calcium mass (15.74%) and volume fraction calcium mass (20.37%) had fewer false-negative (CAC = 0) measurements than Agatston scoring (75.00%) and spatially weighted calcium scoring (26.85%), on the low-density stationary calcium measurements. Conclusion:The integrated calcium mass and volume fraction calcium mass techniques can potentially improve risk stratification for patients undergoing calcium scoring and further improve risk assessment compared with Agatston scoring.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Coronary artery calcium mass measurement based on integrated intensity and volume fraction techniques

2023

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“…The use of DLR led to a reduction in image noise and a concomitant increase in SNR and CNR compared to FBP [ 104 – 106 ]. However, a phantom study using standard acquisition parameters showed that, compared with other image reconstruction techniques, DLR failed to detect calcifications ≤ 1.2 mm [ 107 ]. While most studies showed Agatston scores being comparable throughout different reconstruction techniques, its values were reduced with increasing DLR strengths compared to FBP [ 104 – 106 ].…”

Section: Translating Ai Concepts Into Cacsmentioning

confidence: 99%

“…While most studies showed Agatston scores being comparable throughout different reconstruction techniques, its values were reduced with increasing DLR strengths compared to FBP [ 104 – 106 ]. This translated into a downward reclassification of risk scores in 2 to 8% of patients [ 104 – 107 ]. The sole study comparing 3 mm FBP-reconstructed ECG-gated images to 1 mm, low-dose, non-gated DLR-reconstructed images showed that the latter underestimated the CACS (94 ± 249 vs. 105 ± 249) and had 90% accuracy in classifying different risk classes (Fig.…”

Section: Translating Ai Concepts Into Cacsmentioning

confidence: 99%

Artificial intelligence in coronary artery calcium score: rationale, different approaches, and outcomes

Gennari,

Rossi,

De Cecco

et al. 2024

Int J Cardiovasc Imaging

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Almost 35 years after its introduction, coronary artery calcium score (CACS) not only survived technological advances but became one of the cornerstones of contemporary cardiovascular imaging. Its simplicity and quantitative nature established it as one of the most robust approaches for atherosclerotic cardiovascular disease risk stratification in primary prevention and a powerful tool to guide therapeutic choices. Groundbreaking advances in computational models and computer power translated into a surge of artificial intelligence (AI)-based approaches directly or indirectly linked to CACS analysis. This review aims to provide essential knowledge on the AI-based techniques currently applied to CACS, setting the stage for a holistic analysis of the use of these techniques in coronary artery calcium imaging. While the focus of the review will be detailing the evidence, strengths, and limitations of end-to-end CACS algorithms in electrocardiography-gated and non-gated scans, the current role of deep-learning image reconstructions, segmentation techniques, and combined applications such as simultaneous coronary artery calcium and pulmonary nodule segmentation, will also be discussed.

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Feasibility of virtual non-iodine coronary calcium scoring on dual source photon-counting coronary CT angiography: a dynamic phantom study

Dobrolinska,

Koetzier,

Greuter

et al. 2024

Eur Radiol

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Background The aim of our current systematic dynamic phantom study was first, to optimize reconstruction parameters of coronary CTA (CCTA) acquired on photon counting CT (PCCT) for coronary artery calcium (CAC) scoring, and second, to assess the feasibility of calculating CAC scores from CCTA, in comparison to reference calcium scoring CT (CSCT) scans. Methods In this phantom study, an artificial coronary artery was translated at velocities corresponding to 0, < 60, and 60–75 beats per minute (bpm) within an anthropomorphic phantom. The density of calcifications was 100 (very low), 200 (low), 400 (medium), and 800 (high) mgHA/cm3, respectively. CCTA was reconstructed with the following parameters: virtual non-iodine (VNI), with and without iterative reconstruction (QIR level 2, QIR off, respectively); kernels Qr36 and Qr44f; slice thickness/increment 3.0/1.5 mm and 0.4/0.2 mm. The agreement in risk group classification between CACCCTA and CACCSCT scoring was measured using Cohen weighted linear κ with 95% CI. Results For CCTA reconstructed with 0.4 mm slice thickness, calcium detectability was perfect (100%). At < 60 bpm, CACCCTA of low, and medium density calcification was underestimated by 53%, and 15%, respectively. However, CACCCTA was not significantly different from CACCSCT of very low, and high-density calcifications. The best risk agreement was achieved when CCTA was reconstructed with QIR off, Qr44f, and 0.4 mm slice thickness (κ = 0.762, 95% CI 0.671–0.853). Conclusion In this dynamic phantom study, the detection of calcifications with different densities was excellent with CCTA on PCCT using thin-slice VNI reconstruction. Agatston scores were underestimated compared to CSCT but agreement in risk classification was substantial. Clinical relevance statement Photon counting CT may enable the implementation of coronary artery calcium scoring from coronary CTA in daily clinical practice. Key Points Photon-counting CTA allows for excellent detectability of low-density calcifications at all heart rates. Coronary artery calcium scoring from coronary CTA acquired on photon counting CT is feasible, although improvement is needed. Adoption of the standard acquisition and reconstruction protocol for calcium scoring is needed for improved quantification of coronary artery calcium to fully employ the potential of photon counting CT.

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Systematic assessment of coronary calcium detectability and quantification on four generations of CT reconstruction techniques: a patient and phantom study

Cited by 6 publications

References 30 publications

Coronary artery calcium mass measurement based on integrated intensity and volume fraction techniques

Coronary artery calcium mass measurement based on integrated intensity and volume fraction techniques

Artificial intelligence in coronary artery calcium score: rationale, different approaches, and outcomes

Feasibility of virtual non-iodine coronary calcium scoring on dual source photon-counting coronary CT angiography: a dynamic phantom study

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