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Updated: Jul 11, 2025
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary artery stenosis quantification in patients with dense calcifications using ultra-high-resolution
Emily K Koons1, Prabhakar Shantha Rajiah2, Jamison E Thorne2
1Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA; Department of Biomedical Engineering and Physiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Background:
To quantify differences in coronary artery stenosis severity in patients with calcified lesions between conventional energy-integrating detector (EID) CT and ultra-high-resolution (UHR) photon-counting-detector (PCD) CT.
Methods:
Patients undergoing clinically indicated coronary CT angiography were prospectively recruited and scanned first on an EID-CT (SOMATOM Force, Siemens Healthineers) and then a PCD-CT (NAEOTOM Alpha, Siemens Healthineers) on the same day. EID-CT was performed with standard mode (192 × 0.6 mm detector collimation) following our clinical protocol. PCD-CT scans were performed under UHR mode (120 × 0.2 mm detector collimation). For each patient, left main, left anterior descending, right coronary artery, and circumflex were reviewed and the most severe stenosis from dense calcification for each coronary was quantified using commercial software. Additionally, each measured stenosis was assigned a severity category based on percent diameter stenosis, and changes in severity category across EID-CT and PCD-CT were assessed.
Results:
A total of 23 patients were enrolled, with 34 coronary artery stenoses analyzed. Stenosis was significantly reduced in PCD-CT compared to EID-CT (p < 0.001), resulting in an average of 11% (SD = 11%) reduction in percent diameter stenosis. Among the 34 lesions, 15 changed in stenosis severity category: 3 went from moderate to minimal, 1 from moderate to mild, 9 from mild to minimal, and 2 from minimal to mild with the use of PCD-CT compared to EID-CT.
Conclusion:
Use of UHR PCD-CT decreased percent diameter stenosis by an average of 11% relative to EID-CT, resulting in 13 of 34 stenoses being downgraded in stenosis severity category, potentially sparing patients from unnecessary intervention.
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