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Impact of BMI, heart rhythm, and heart rate on photon-counting detector virtual coronary calcium scoring
Judith Becker1, Josua A Decker1, Stefanie Bette1
1Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
Insights
Virtual non-contrast (VNC) series from photon-counting detector CT angiography reliably estimate coronary artery calcium scoring (CACS) in most patients. However, underestimation may occur with higher BMI and heart rates, potentially impacting treatment decisions.
Area of Science:
- Medical Imaging
- Cardiovascular Imaging
- Radiology
Background:
- Coronary artery calcium scoring (CACS) is crucial for cardiovascular risk assessment.
- Photon-counting detector (PCD) computed tomography angiography (CTA) offers advanced imaging capabilities.
- Virtual non-contrast (VNC) series aim to reduce radiation dose by reconstructing non-contrast images from contrast-enhanced CTA data.
Purpose of the Study:
- To evaluate the accuracy of CACS derived from VNC series compared to true non-contrast (TNC) series using PCD-CT.
- To assess the influence of body mass index (BMI), heart rate, and heart rhythm on the accuracy of VNC-derived CACS.
- To determine the clinical implications of potential discrepancies in CACS categorization.
Main Methods:
- Retrospective analysis of 88 patients who underwent cardiac imaging with both TNC and CTA on a PCD-CT scanner.
- Comparison of Agatston scores and CACS risk categories derived from TNC and VNC images.
- Statistical analysis to assess differences, correlations, and the impact of BMI and heart rate.
Main Results:
- VNC-derived CACS showed a median underestimation of 11% compared to TNC (median VNC: 449 vs. TNC: 542, p<0.001).
- High linear correlation (r²=0.95) was observed, with 80% of cases categorized equivalently.
- Misclassification potentially affecting treatment decisions occurred in approximately 11% of patients, particularly those with BMI >28 kg/m² and heart rate >69 bpm.
Conclusions:
- VNC reconstructions from PCD-CT provide reliable CACS estimation for patients with BMI ≤28 kg/m² and heart rate ≤69 bpm.
- A potential underestimation of CACS risk, especially in patients with elevated BMI and heart rate, must be considered in clinical practice.
- VNC imaging shows promise for dose reduction in cardiac CT while maintaining diagnostic accuracy for CACS in select patient groups.
Abstract:
The study evaluates the impact of body mass index (BMI), heart rate and rhythm on coronary artery calcium scoring (CACS) derived from calcium-sensitive virtual non-contrast (VNC) series of photon-counting detector (PCD) computed tomography angiography (CTA) compared to true non-contrast (TNC) series. Patients who underwent cardiac imaging with TNC and CTA on a PCD-CT were included. Agatston scores from TNC and VNC images were used to assign CACS risk category. Analyses considered BMI, heart rhythm and heart rate. Distributions were tested for differences between TNC and VNC derived scores and their correlation was assessed. The final cohort included 88 patients. CACS on VNC showed an underestimation of TNC derived values on median Agatston score TNC = 542 (IQR 200-1294), on median Agatston score VNC = 449 (IQR 130-1183), p < 0.001, percentage difference - 11%. However, linear correlation coefficient was high (r2 = 0.95), and the CAC severity was categorized equivalent in 80%. In approximately 11% of the study cohort, the misclassification of CAC severity could have potentially led to inappropriate treatment following established guidelines. An impact on the significance and extent of the difference in CACS for BMI > 28 kg/m2 and heart rate groups > 69 bpm was found. VNC reconstructions from PCD-CT reliably estimates TNC CACS for BMI ≤ 28 kg/m2 and heart rate ≤ 69 bpm in patients with severe coronary artery disease. Potential underestimation of risk category, especially with increased BMI and heart rate, must be considered for clinical decision making.
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