Accurate quantification of vessel cross-sectional area using CT angiography: a simulation study

Molloi, Sabee; Johnson, T; Ding, Huanjun; Lipinski, Jerry

doi:10.1007/s10554-016-1007-9

Cited by 7 publications

(8 citation statements)

References 21 publications

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“…As previously reported, 11 the integrated Hounsfield technique assumes that although the partial volume effect influences the HU of a particular voxel, the total integrated HU within an ROI is conserved. This study addresses the issue of non-detectable CAC by adjusting the integrated HU technique for use in CAC scoring, calling it integrated calcium mass.…”

Section: Methodsmentioning

confidence: 93%

“…An integrated intensity or Hounsfield unit (HU) technique recently demonstrated the ability to accurately assess coronary artery cross-sectional area near the threshold of detectability. 11 A similar approach based on volume fractions of two materials within a voxel can be used for calcium mass quantification. These techniques have not previously been used for calcium mass quantification.…”

Section: Introductionmentioning

confidence: 99%

“…A more quantitative calcium mass calculation would likewise help improve risk stratification and diagnosis of coronary heart disease. An integrated intensity or Hounsfield unit (HU) technique recently demonstrated the ability to accurately assess coronary artery cross-sectional area near the threshold of detectability 11 . A similar approach based on volume fractions of two materials within a voxel can be used for calcium mass quantification.…”

Section: Introductionmentioning

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: Methodsmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2023

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“…The cross‐sectional area equation (Equation ()), originally proposed by Molloi et al 14 . can be adapted for use in three‐dimensional regions (Equation ()) and applied to calcium mass quantification (Equation ()).…”

Section: Methodsmentioning

confidence: 99%

Integrated intensity‐based technique for coronary artery calcium mass measurement: A phantom study

2023

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BackgroundAgatston scoring, the traditional method for measuring coronary artery calcium, is limited in its ability to accurately quantify low‐density calcifications, among other things. The inaccuracy of Agatston scoring is likely due partly to the arbitrary thresholding requirement of Agatston scoring.PurposeA calcium quantification technique that removes the need for arbitrary thresholding and is more accurate, sensitive, reproducible, and robust is needed. Improvements to calcium scoring will likely improve patient risk stratification and outcome.MethodsThe integrated Hounsfield technique was adapted for calcium scoring (integrated calcium mass). Integrated calcium mass requires no thresholding and includes all calcium information within an image. This study utilized phantom images acquired by G van Praagh et al., with calcium hydroxyapatite (HA) densities in the range of 200–800 mgHAcm−3 to measure calcium according to integrated calcium mass and Agatston scoring. The calcium mass was known, which allowed for accuracy, reproducibility, sensitivity, and robustness comparisons between integrated calcium mass and Agatston scoring. Multiple CT vendors (Canon, GE, Philips, Siemens) were used during the image acquisition phase, which provided a more robust comparison between the two calcium scoring techniques. Three calcification inserts of different diameters (1, 3, and 5 mm) and different HA densities (200, 400, and 800 mgHAcm−3) were placed within the phantom. The effect of motion was also analyzed using a dynamic phantom. All dynamic phantom calcium inserts were 5.0 ± 0.1 mm in diameter with a length of 10.0 ± 0.1 mm. The four different densities were 196 ± 3, 380 ± 2, 408 ± 2, and 800 ± 2 mgHAcm−3.ResultsIntegrated calcium mass was more accurate than Agatston scoring for stationary scans (, ) and motion affected scans (, ). On average, integrated calcium mass was more reproducible than Agatston scoring for two of the CT vendors. The percentage of false‐negative and false‐positive calcium scores were lower for integrated calcium mass (15.00%, 0.00%) than Agatston scoring (28.33%, 6.67%). Integrated calcium mass was more robust to changes in scan parameters than Agatston scoring.ConclusionsThe results of this study indicate that integrated calcium mass is more accurate, reproducible, and sensitive than Agatston scoring on a variety of different CT vendors. The substantial reduction in false‐negative scores for integrated calcium mass is likely to improve risk‐stratification for patients undergoing calcium scoring and their potential outcome.

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“…We have previously reported the results of a computer simulation study using an integrated HU technique for accurate measurement of vessel lumen area [14]. In this paper we have validated the integrated HU technique in physical phantoms with stenosis and calcification where the lumen area is known in order to explore its efficacy.…”

Section: Introductionmentioning

confidence: 99%

A phantom based evaluation of vessel lumen area quantification for coronary CT angiography

Molloi

Johnson

Lipinski

et al. 2018

Int J Cardiovasc Imaging

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Coronary computed tomography (CT) angiography is a noninvasive method for visualizing coronary artery disease. However, coronary CT angiography is limited in assessment of stenosis severity by the partial volume effect and calcification. Therefore, an accurate method for assessment of stenosis severity is needed. A 10 cm diameter cylindrical Lucite phantom with holes in the range of 0.4-4.5 mm diameter was fitted in a chest phantom. The holes were filled with an iodine solution of 8 mg/mL. To simulate coronary artery disease, different levels of stenosis were created by inserting Lucite rods into the holes with diameter range of 2-4.5 mm. The resulting lumen cross sectional areas ranged from 1.4 to 12.3 mm. To simulate arterial calcification, calcium hydroxyapatite rods were inserted into the holes with diameter range of 2-4.5 mm. Images of the phantoms were acquired at 100 kVp using a 320-slice CT scanner. A maual and a semi-automated technique based on integrated Hounsfield units was used to calculate vessel cross-sectional area. There was an excellent correlation between the measured and the known cross-sectional area for both normal and stenotic vessels using the manual and the semi-automated techniques. However, the overall measurement error for the manual method was more than twice as compared with the integrated HU technique. Determination of vessel lumen area using the semi-automated integrated Hounsfield unit technique yields more than a factor of two improvement in precision and accuracy as compared to the existing manual technique for vessels with and without stenosis. This technique can also be used to accurately measure arterial cross-sectional area in the presence of coronary calcification.

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Accurate quantification of vessel cross-sectional area using CT angiography: a simulation study

Cited by 7 publications

References 21 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

Integrated intensity‐based technique for coronary artery calcium mass measurement: A phantom study

A phantom based evaluation of vessel lumen area quantification for coronary CT angiography

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