Calcium score of small coronary calcifications on multidetector computed tomography: Results from a static phantom study

• Published in: European journal of radiology Vol. 82; no. 2; pp. e58 - e63
• Main Authors: Groen, J.M, Kofoed, K.F, Zacho, M, Vliegenthart, R, Willems, T.P, Greuter, M.J.W
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.02.2013
• Subjects: Algorithms; Calcinosis - complications; Calcinosis - diagnostic imaging; Calcium score; Computed tomography; Coronary Angiography - instrumentation; Coronary Angiography - methods; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary calcium; Equipment Design; Equipment Failure Analysis; Humans; Phantoms, Imaging; Radiographic Image Interpretation, Computer-Assisted - instrumentation; Radiographic Image Interpretation, Computer-Assisted - methods; Radiology; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed - instrumentation; Tomography, X-Ray Computed - methods; Computed tomography; Coronary calcium; Calcium score
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2012.09.018

Abstract Introduction Multi detector computed tomography (MDCT) underestimates the coronary calcium score as compared to electron beam tomography (EBT). Therefore clinical risk stratification based on MDCT calcium scoring may be inaccurate. The aim of this study was to assess the feasibility of a new phantom which enables establishment of a calcium scoring protocol for MDCT that yields a calcium score comparable to the EBT values and to the physical mass. Materials and methods A phantom containing 100 small calcifications ranging from 0.5 to 2.0 mm was scanned on EBT using a standard coronary calcium protocol. In addition, the phantom was scanned on a 320-row MDCT scanner using different scanning, reconstruction and scoring parameters (tube voltage 80–135 kV, slice thickness 0.5–3.0 mm, reconstruction kernel FC11–FC15 and threshold 110–150 HU). The Agatston and mass score of both modalities was compared and the influence of the parameters was assessed. Results On EBT the Agatston and mass scores were between 0 and 20, and 0 and 3 mg, respectively. On MDCT the Agatston and mass scores were between 0 and 20, and 0 and 4 mg, respectively. All parameters showed an influence on the calcium score. The Agatston score on MDCT differed 52% between the 80 and 135 kV, 65% between 0.5 and 3.0 mm and 48% between FC11 and FC15. More calcifications were detected with a lower tube voltage, a smaller slice thickness, a sharper kernel and a lower threshold. Based on these observations an acquisition protocol with a tube voltage of 100 kV and two reconstructions protocols were defined with a FC12 reconstruction kernel; one with a slice thickness of 3.0 mm and a one with a slice thickness of 0.5 mm. This protocol yielded an Agatston score as close to the EBT as possible, but also a mass score as close to the physical phantom value as possible, respectively. Conclusion With the new phantom one acquisition protocol and two reconstruction protocols can be defined which produces Agatston scores comparable to EBT values and to the physical mass.