Effect of energy difference in the evaluation of calcification size and luminal diameter in calcified coronary artery plaque using spectral CT

Yunaga, Hiroto; Ohta, Yoshiji; Kishimoto, Junichi; Kitao, Shinichiro; Ishibashi, Mana; Fujii, Shinya

doi:10.1007/s11604-020-01027-y

Cited by 5 publications

(4 citation statements)

References 23 publications

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“…The appearance of severe coronary stenosis is frequently exacerbated on CCTA due to partial volume averaging, impeding the accuracy of consequent lumen assessment (8)(9)(10). The limitations of CCTA in diagnosing calcified plaques have been addressed and overcome to some extent via several methods, such as dual-energy CT (11), image subtraction algorithms (12)(13)(14), iterative reconstruction (15,16), high-definition CT (17)(18)(19), and deep learning (DL) approaches (20)(21)(22)(23)(24). Of these methods, using DL seems to be a promising strategy to improve diagnostic value of CCTA in assessing calcified plaques, however, incorporation of coronary angle measurements into routine coronary lumen assessment could be a simple and convenient approach, according to this and other reports (2)(3)(4)(5)(6)(7)25,26).…”

Section: Discussionmentioning

confidence: 99%

Coronary computed tomography angiography assessment of relationship between right coronary artery-aorta angle and the development of coronary artery disease

Geerlings-Batt¹,

Sun²

2023

Quant Imaging Med Surg

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Whilst a correlation has been established between wide left main coronary artery bifurcation[left anterior descending-left circumflex (LAD-LCx)] angle (>80°) and the development of coronary artery disease (CAD), this retrospective, causal-comparative pilot study aimed to explore whether a relationship exists between right coronary artery (RCA)-aorta angle and CAD. Thirty normal cases were identified via radiology reports and selected as the control group with coronary computed tomography angiography (CCTA) scans performed on a 320-slice computed tomography (CT) scanner. Thirty CAD cases were selected with invasive coronary angiography performed to confirm the degree of stenosis, and CCTA performed on dual source and 320-slice CT scanners. An independent sample t-test was used to compare the differences in coronary angles between the normal and CAD group, and analysis of variance (ANOVA) was used to assess for significant differences between coronary angles in normal and CAD subgroups. Coronary angle measurements were conducted by two independent assessors with high intraclass correlation (r=0.971-0.998, P<0.001). RCA-aorta angle measurements were significantly larger in the normal group [87.47°, 95% confidence interval (CI): 79.31° to 95.78°] compared to the CAD group (76.82°, 95% CI: 67.82° to 85.61°, P=0.05). No significant difference was found between RCA-aorta angle and degree of coronary stenosis (P=0.75). This study suggests a relationship between narrow RCA-aorta angle and CAD.

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Section: Discussionmentioning

confidence: 99%

Coronary computed tomography angiography assessment of relationship between right coronary artery-aorta angle and the development of coronary artery disease

Geerlings-Batt¹,

Sun²

2023

Quant Imaging Med Surg

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“…The use of image postprocessing algorithms in highly calcified plaques has addressed this issue to some extent, with promising results reported in the literature [ 8 , 9 , 10 , 11 , 12 ]. These methods include IR, image subtraction, or sharpening algorithms.…”

Section: Discussionmentioning

confidence: 99%

“…However, the main challenge of CCTA lies in the assessment of heavily calcified plaques in the coronary arteries because extensive calcification produces blooming artifacts that result in high false positive rates, thus significantly reducing the specificity and positive predictive value (PPV) [ 4 , 5 , 6 , 7 ]. To address this issue, different strategies have been proposed and these include uses of image post-processing algorithms, dual-energy CT, iterative reconstruction (IR), and so on for suppressing the blooming artifacts with improved specificity and PPV, to some extent [ 8 , 9 , 10 , 11 , 12 ]. A recently developed vendor-specific deblooming algorithm has been shown to improve the diagnostic performance of CCTA, with specificity and PPV increased from 45.8% and 69.8% to 75% and 83.3%, respectively.…”

Section: Introductionmentioning

confidence: 99%

3D-Printed Coronary Plaques to Simulate High Calcification in the Coronary Arteries for Investigation of Blooming Artifacts

Sun

Wong

et al. 2021

Biomolecules

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The diagnostic value of coronary computed tomography angiography (CCTA) is significantly affected by high calcification in the coronary arteries owing to blooming artifacts limiting its accuracy in assessing the calcified plaques. This study aimed to simulate highly calcified plaques in 3D-printed coronary models. A combination of silicone + 32.8% calcium carbonate was found to produce 800 HU, representing extensive calcification. Six patient-specific coronary artery models were printed using the photosensitive polyurethane resin and a total of 22 calcified plaques with diameters ranging from 1 to 4 mm were inserted into different segments of these 3D-printed coronary models. The coronary models were scanned on a 192-slice CT scanner with 70 kV, pitch of 1.4, and slice thickness of 1 mm. Plaque attenuation was measured between 1100 and 1400 HU. Both maximum-intensity projection (MIP) and volume rendering (VR) images (wide and narrow window widths) were generated for measuring the diameters of these calcified plaques. An overestimation of plaque diameters was noticed on both MIP and VR images, with measurements on the MIP images close to those of the actual plaque sizes (<10% deviation), and a large measurement discrepancy observed on the VR images (up to 50% overestimation). This study proves the feasibility of simulating extensive calcification in coronary arteries using a 3D printing technique to develop calcified plaques and generate 3D-printed coronary models.

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“…For example, virtual non-contrast imaging shows the calcified regions in iodine contrast-enhanced CT or CTA images, enabling calcium scoring (Song et al 2016). In CTA, 50 keV virtual monochromatic images (VMIs) have been shown to provide equivalent or improved visualization of coronary arteries with halved iodine contrast agent dose (Yunaga et al 2020).…”

Section: Introductionmentioning

confidence: 99%

Virtual monochromatic imaging reduces beam hardening artefacts in cardiac interior photon counting computed tomography: a phantom study with cadaveric specimens

Inkinen

Juntunen

Ketola

et al. 2021

Biomed. Phys. Eng. Express

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In interior cardiac computed tomography (CT) imaging, the x-ray beam is collimated to a limited field-of-view covering the heart volume, which decreases the radiation exposure to surrounding tissues. Spectral CT enables the creation of virtual monochromatic images (VMIs) through a computational material decomposition process. This study investigates the utility of VMIs for beam hardening (BH) reduction in interior cardiac CT, and further, the suitability of VMIs for coronary artery calcium (CAC) scoring and volume assessment is studied using spectral photon counting detector CT (PCD-CT). Ex vivo coronary artery samples (N=18) were inserted in an epoxy rod phantom. The rod was scanned in the conventional CT geometry, and subsequently, the rod was positioned in a torso phantom and re-measured in the interior PCD-CT geometry. The total energy (TE) 10-100 keV reconstructions from PCD-CT were used as a reference. The low energy 10-60 keV and high energy 60-100 keV data were used to perform projection domain material decomposition to polymethyl methacrylate and calcium hydroxylapatite basis. The truncated basis-material sinograms were extended using the adaptive detruncation method. VMIs from 30-180 keV range were computed from the detruncated virtual monochromatic sinograms using filtered back projection. Detrending was applied as a post-processing method prior to CAC scoring. The results showed that BH artefacts from the exterior structures can be suppressed with high (≥100 keV) VMIs. With appropriate selection of the monoenergy (46 keV), the underestimation trend of CAC scores and volumes shown in Bland-Altman (BA) plots for TE interior PCD-CT was mitigated, as the BA slope values were -0.02 for the 46 keV VMI compared to -0.21 the conventional TE image. To conclude, spectral PCD-CT imaging using VMIs could be applied to reduce BH artefacts interior CT geometry, and further, optimal selection of VMI may improve the accuracy of CAC scoring assessment in interior PCD-CT.

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Effect of energy difference in the evaluation of calcification size and luminal diameter in calcified coronary artery plaque using spectral CT

Cited by 5 publications

References 23 publications

Coronary computed tomography angiography assessment of relationship between right coronary artery-aorta angle and the development of coronary artery disease

Coronary computed tomography angiography assessment of relationship between right coronary artery-aorta angle and the development of coronary artery disease

3D-Printed Coronary Plaques to Simulate High Calcification in the Coronary Arteries for Investigation of Blooming Artifacts

Virtual monochromatic imaging reduces beam hardening artefacts in cardiac interior photon counting computed tomography: a phantom study with cadaveric specimens

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