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. 2024 Feb 22:11:1367463.
doi: 10.3389/fcvm.2024.1367463. eCollection 2024.

Virtual calcium removal in calcified coronary arteries with photon-counting detector CT-first in-vivo experience

Victor Mergen  1 , Stéphane Rusek  2 , Filippo Civaia  2 , Philippe Rossi  2 , Rengarajan Rajagopal  1   3 , Eduardo Bättig  1   4 , Robert Manka  1   5 , Alessandro Candreva  5 , Matthias Eberhard  1   6 , Hatem Alkadhi  1
Affiliations

Virtual calcium removal in calcified coronary arteries with photon-counting detector CT-first in-vivo experience

Victor Mergen et al. Front Cardiovasc Med. .

Abstract

Purpose: To evaluate the feasibility and accuracy of quantification of calcified coronary stenoses using virtual non-calcium (VNCa) images in coronary CT angiography (CCTA) with photon-counting detector (PCD) CT compared with quantitative coronary angiography (QCA).

Materials and methods: This retrospective, institutional-review board approved study included consecutive patients with calcified coronary artery plaques undergoing CCTA with PCD-CT and invasive coronary angiography between July and December 2022. Virtual monoenergetic images (VMI) and VNCa images were reconstructed. Diameter stenoses were quantified on VMI and VNCa images by two readers. 3D-QCA served as the standard of reference. Measurements were compared using Bland-Altman analyses, Wilcoxon tests, and intraclass correlation coefficients (ICC).

Results: Thirty patients [mean age, 64 years ± 8 (standard deviation); 26 men] with 81 coronary stenoses from calcified plaques were included. Ten of the 81 stenoses (12%) had to be excluded because of erroneous plaque subtraction on VNCa images. Median diameter stenosis determined on 3D-QCA was 22% (interquartile range, 11%-35%; total range, 4%-88%). As compared with 3D-QCA, VMI overestimated diameter stenoses (mean differences -10%, p < .001, ICC: .87 and -7%, p < .001, ICC: .84 for reader 1 and 2, respectively), whereas VNCa images showed similar diameter stenoses (mean differences 0%, p = .68, ICC: .94 and 1%, p = .07, ICC: .93 for reader 1 and 2, respectively).

Conclusion: First experience in mainly minimal to moderate stenoses suggests that virtual calcium removal in CCTA with PCD-CT, when feasible, has the potential to improve the quantification of calcified stenoses.

Keywords: calcified plaque; coronary CT angiography (CCTA); coronary artery disease; photon-counting detector CT (PCD-CT); spectral imaging; virtual non-calcium imaging.

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Conflict of interest statement

The department of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland receives institutional grants from Bayer, Canon, Guerbet and Siemens. Speaker's bureau Siemens: HA and ME. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study. PCD-CT, photon-counting detector CT; ICA, invasive coronary angiography.
Figure 2
Figure 2
Flowchart detailing the scan protocol. ECG, electrocardiography; IQ, image quality.
Figure 3
Figure 3
Bland–Altman plots comparing diameter stenosis determined by quantitative coronary angiography (reference standard) with coronary CT angiography using conventional virtual monoenergetic images (VMI) and virtual non-calcium (VNCa) images for reader 1 and reader 2, respectively. The dotted line indicates the mean difference; the dashed lines indicate the upper and lower limits of agreement (LoA).
Figure 4
Figure 4
Sixty three-year-old male patient with chronic coronary syndrome. Curved planar reformations of conventional (A) and virtual non-calcium (VNCa) images (B) show calcified and subtracted calcified plaques, respectively, in the proximal left anterior descending artery (LAD). Corresponding axial images show the calcified plaque (C) and the vessel lumen after subtraction (arrow) (D) invasive coronary angiography (E) confirmed the presence of a moderate stenosis in the proximal LAD.
Figure 5
Figure 5
Fifty nine-year-old male patient with suspected coronary artery disease. Straightened multiplanar reformations of conventional (A) and virtual non-calcium (VNCa) images (B) show calcified and subtracted calcified plaques, respectively, in the mid left anterior descending artery (LAD). Corresponding axial images show the calcified plaque (C) and the vessel lumen after subtraction (arrow) (D) invasive coronary angiography (E) confirmed the presence of a mild stenosis in the proximal LAD.
Figure 6
Figure 6
Diagram illustrating the concordance and discordance of stenosis classification according to CAD-RADS determined on quantitative coronary angiography (reference standard), virtual monoenergetic, and virtual non-calcium images. QCA, quantitative coronary angiography; VMI, virtual monoenergetic images; VNCa, virtual non-calcium.
See this image and copyright information in PMC

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