CT coronary calcium scoring with tin filtration using iterative beam-hardening calcium correction reconstruction

To investigate the diagnostic accuracy of CT coronary artery calcium scoring (CACS) with tin pre-filtration (Sn100kVp) using iterative beam-hardening correction (IBHC) calcium material reconstruction compared to the standard 120kVp acquisition.

Third generation dual-source CT (DSCT) CACS with Sn100kVp acquisition allows significant dose reduction. However, the Sn100kVp spectrum is harder with lower contrast compared to 120kVp, resulting in lower calcium score values. Sn100kVp spectral correction using IBHC-based calcium material reconstruction may restore comparable calcium values.

Image data of 62 patients (56% male, age 63.9±9.2years) who underwent a clinically-indicated CACS acquisition using the standard 120kVp protocol and an additional Sn100kVp CACS scan as part of a research study were retrospectively analyzed. Datasets of the Sn100kVp scans were reconstructed using a dedicated spectral IBHC CACS reconstruction to restore the spectral response of 120kVp spectra. Agatston scores were derived from 120kVp and IBHC reconstructed Sn100kVp studies. Pearson's correlation coefficient was assessed and Agatston score categories and percentile-based risk categorization were compared.

Median Agatston scores derived from IBHC Sn100kVp scans and 120kVp acquisition were 31.7 and 34.1, respectively (p=0.057). Pearson's correlation coefficient showed excellent correlation between the acquisitions (r=0.99, p<0.0001). Agatston score categories and percentile-based cardiac risk categories showed excellent agreement (ĸ=1.00 and ĸ=0.99), resulting in a low cardiac risk reclassification of 1.6% with the use of IBHC CACS reconstruction. Image noise was 24.9±3.6HU in IBHC Sn100kVp and 17.1±3.9HU in 120kVp scans (p<0.0001). The dose-length-product was 13.2±3.4mGycm with IBHC Sn100kVp and 59.1±22.9mGycm with 120kVp scans (p<0.0001), resulting in a significantly lower effective radiation dose (0.19±0.07mSv vs. 0.83±0.33mSv, p<0.0001) for IBHC Sn100kVp scans.

Low voltage CACS with tin filtration using a dedicated IBHC CACS material reconstruction algorithm shows excellent correlation and agreement with the standard 120kVp acquisition regarding Agatston score and cardiac risk categorization, while radiation dose is significantly reduced by 75% to the level of a chest x-ray.