High-pitch low-voltage CT coronary artery calcium scoring with tin filtration: accuracy and radiation dose reduction

• Published in: European radiology Vol. 28; no. 7; pp. 3097 - 3104
• Main Authors: Apfaltrer, Georg, Albrecht, Moritz H., Schoepf, U. Joseph, Duguay, Taylor M., De Cecco, Carlo N., Nance, John W., De Santis, Domenico, Apfaltrer, Paul, Eid, Marwen H., Eason, Chelsea D., Thompson, Zachary M., Bauer, Maximilian J., Varga-Szemes, Akos, Jacobs, Brian E., Sorantin, Erich, Tesche, Christian
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2018; Springer Nature B.V
• Subjects: Aged; Arteriosclerosis; Calcification (ectopic); Calcinosis - diagnostic imaging; Calcium; Calcium channels (voltage-gated); Cardiac; Categories; Classification; Computed tomography; Coronary Angiography - methods; Coronary artery; Coronary Artery Disease - diagnostic imaging; Coronary vessels; Diagnostic Radiology; Diagnostic systems; Electric potential; Female; Filtration; Filtration - methods; Health risk assessment; Heart; Heart diseases; Humans; Imaging; Internal Medicine; Interventional Radiology; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Patients; Prognosis; Prospective Studies; Radiation; Radiation Dosage; Radiographic Image Interpretation, Computer-Assisted - methods; Radiology; Reproducibility of Results; Risk; Risk Assessment - methods; Tin; Tomography; Tomography, X-Ray Computed - methods; Ultrasound; Radiation dose; Computed tomography; Coronary artery calcium; High-pitch; Tin filtration
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-017-5249-2

Objectives To investigate diagnostic accuracy and radiation dose of high-pitch CT coronary artery calcium scoring (CACS) with tin filtration (Sn100kVp) versus standard 120kVp high-pitch acquisition. Methods 78 patients (58% male, 61.5±9.1 years) were prospectively enrolled. Subjects underwent clinical 120kVp high-pitch CACS using third-generation dual-source CT followed by additional high-pitch Sn100kVp acquisition. Agatston scores, calcium volume scores, Agatston score categories, percentile-based risk categorization and radiation metrics were compared. Results 61/78 patients showed coronary calcifications. Median Agatston scores were 34.9 [0.7–197.1] and 41.7 [0.7–207.2] and calcium volume scores were 34.1 [0.7–218.0] for Sn100kVp and 35.7 [1.1–221.0] for 120kVp acquisitions, respectively (both p <0.0001). Bland-Altman analysis revealed underestimated Agatston scores and calcium volume scores with Sn100kVp versus 120kVp acquisitions (mean difference: 16.4 and 11.5). However, Agatston score categories and percentile-based risk categories showed excellent agreement (ĸ=0.98 and ĸ=0.99). Image noise was 25.8±4.4HU and 16.6±2.9HU in Sn100kVp and 120kVp scans, respectively ( p <0.0001). Dose-length-product was 9.9±4.8mGy*cm and 40.9±14.4mGy*cm with Sn100kVp and 120kVp scans, respectively ( p <0.0001). This resulted in significant effective radiation dose reduction (0.13±0.07mSv vs. 0.57±0.2mSv, p <0.0001) for Sn100kVp acquisitions. Conclusion CACS using high-pitch low-voltage tin-filtered acquisitions demonstrates excellent agreement in Agatston score and percentile-based cardiac risk categorization with standard 120kVp high-pitch acquisitions. Furthermore, radiation dose was significantly reduced by 78% while maintaining accurate risk prediction. Key points • Coronary artery calcium scoring with tin filtration reduces radiation dose by 78%. • There is excellent correlation between high-pitch Sn100kVp and standard 120kVp acquisitions. • Excellent agreement regarding Agatston score categories and percentile-based risk categorization was achieved. • No cardiac risk reclassifications were observed using Sn100kVp coronary artery calcium scoring.