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Updated: Mar 15, 2026
Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
Correction Factors for CT Coronary Artery Calcium Scoring Using Advanced Modeled Iterative Reconstruction Instead of
Damiano Caruso1, Carlo N De Cecco2, U Joseph Schoepf3
1Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC 29425; Department of Radiological Sciences, Oncological and Pathological Sciences University of Rome "Sapienza", Latina, Italy.
Rationale And Objectives:
Iterative reconstruction (IR) computed tomography (CT) techniques allow for radiation dose reduction while maintaining image quality. However, CT coronary artery calcium (CAC) scores may be influenced by certain IR algorithms. The aim of our study is to identify suitable correction factors to ensure consistency between IR and filtered back projection (FBP)-based CAC scoring.
Material And Methods:
A phantom study was performed to derive suitable correction factors for CAC scores and volume (VOL) values with advanced modeled iterative reconstruction (or ADMIRE) strength level 3 (ADM3) and 5 (ADM5) vs FBP. CT data from 40 patients were retrospectively analyzed, and CAC score and VOL values were obtained following reconstruction with FBP, ADM3, and ADM5. Linear regression analysis was performed to obtain correction factors. Results with and without application of the correction factors were compared. Inter-reader agreement for risk class stratification was analyzed.
Results:
Phantom experiments determined a correction factor of 1.14 for ADM3 and 1.25 for ADM5. FBP-based CAC scores (897 ± 1413) were significantly higher than uncorrected scores with ADM3 (746 ± 1184, P ≤ .001) and ADM5 (640 ± 1036, P ≤ .001). After application of correction factors, no significant differences were found for CAC scores based on FBP (897 ± 1413) and ADM3 (853 ± 1353, P = .07). The inter-reader agreement for risk stratification was excellent (k = 0.91).
Conclusion:
ADM3 can be applied to CAC scoring with use of a correction factor. When applying a correction factor of 1.14, excellent agreement with standard FBP for both CAC score and VOL can be achieved.
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