Impact of Cardiac Motion on coronary artery calcium scoring using a virtual non-iodine algorithm on photon-counting detector CT: a dynamic phantom study

• Published in: The International Journal of Cardiovascular Imaging Vol. 39; no. 10; pp. 2083 - 2092
• Main Authors: Nicola, Fink, Emese, Zsarnoczay, U Joseph, Schoepf, Jim, O'Doherty, Moritz C, Halfmann, Thomas, Allmendinger, Junia, Hagenauer, Joseph P, Griffith, Milán, Vecsey-Nagy, Daniel, Pinos, Ullrich, Ebersberger, Jens, Ricke, Akos, Varga-Szemes, Tilman, Emrich
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Science and Business Media LLC 01.10.2023; Springer Netherlands; Springer Nature B.V
• Subjects: Algorithms; Arteriosclerosis; Attenuation; Blood vessels; Calcification (ectopic); Calcium; Cardiac Imaging; Cardiology; Computed tomography; Coronary artery; Coronary vessels; Heart rate; Image reconstruction; Imaging; Iodine; Medicine; Medicine & Public Health; Original Paper; Photons; Radiology; In-vessel attenuation; Photon-counting detector CT; Coronary artery calcium scoring; Virtual non-contrast algorithm; Cardiac motion; Virtual non-iodine algorithm
• ISSN: 1875-8312; 1569-5794; 1875-8312; 1573-0743
• DOI: 10.1007/s10554-023-02912-z

This study assessed the impact of cardiac motion and in-vessel attenuation on coronary artery calcium (CAC) scoring using virtual non-iodine (VNI) against virtual non-contrast (VNC) reconstructions on photon-counting detector CT. Two artificial vessels containing calcifications and different in-vessel attenuations (500, 800HU) were scanned without (static) and with cardiac motion (60, 80, 100 beats per minute [bpm]). Images were post-processed using a VNC and VNI algorithm at 70 keV and quantum iterative reconstruction (QIR) strength 2. Calcium mass, Agatston scores, cardiac motion susceptibility (CMS)-indices were compared to physical mass, static scores as well as between reconstructions, heart rates and in-vessel attenuations. VNI scores decreased with rising heart rate (p < 0.01) and showed less underestimation than VNC scores (p < 0.001). Only VNI scores were similar to the physical mass at static measurements, and to static scores at 60 bpm. Agatston scores using VNI were similar to static scores at 60 and 80 bpm. Standard deviation of CMS-indices was lower for VNI-based than for VNC-based CAC scoring. VNI scores were higher at 500 than 800HU (p < 0.001) and higher than VNC scores (p < 0.001) with VNI scores at 500 HU showing the lowest deviation from the physical reference. VNI-based CAC quantification is influenced by cardiac motion and in-vessel attenuation, but least when measuring Agatston scores, where it outperforms VNC-based CAC scoring.