title: Sensitivity to detect small coronary artery calcium lesions with varying slice thickness using electron beam tomography.
abstract: OBJECTIVE
  To estimate the sensitivity to find small coronary artery calcium lesions with use of different slice widths with electron beam tomography.
  
  
  METHODS
  Two studies were performed. Study 1 utilized double scanning of a stationary cork phantom with three different slice thickness (1.5, 3, and 6 mm). Fifty different calcific lesions (all <20 mm2 in area) fitted in 10 cork coronary arteries were utilized. The calcium foci area, peak value and score were measured and compared. In group 2, 30 patients underwent coronary artery calcium (CAC) screen studies. Each patient was scanned with both 3-mm and 6-mm scan widths in a same study time. Lesions with < 20 mm2 of area of CAC were measured on both 3-mm and 6-mm images. The mean and peak Hounsfield unit measure, and Agatston score were compared between both images.
  
  
  RESULTS
  In the cork study, the sensitivity to detect small calcium foci were 96% (48/50), 82% (41/50), and 34% (17/50) in images with 1.5-, 3-, and 6-mm slice thickness, respectively. There is a smaller value in mass, and calcium volume in 6-mm images than 1.5-mm and 3-mm images ( P< 0.001). There was no significant difference between the true value and measured value from 1.5-mm and 3-mm images. In the human study, 18 (30%) of 60 CAC lesions with an area < 20 mm2 defined on 3 mm images were not visible on 6-mm images. Sensitivity of small lesions (P< 5 mm2) was 48% using 6-mm slices. There was a smaller value in CAC area, mean and peak Hounsfield units and score measured from 6-mm images, as compared with 3 mm slices ( P< 0.05).
  
  
  CONCLUSIONS
  Thinner slice imaging has a higher sensitivity to detect small calcium focus. There was no significant change in score between 3 mm and 1.5 mm on the cork phantom study. However, the use of 6-mm slices should be discouraged, as this protocol both underestimates calcific mass and misses a significant number of calcific lesions in both a phantom and human study.
authors.affiliation: Division of Cardiology, Harbor-UCLA Research and Education Institute, Torrance, California. dagger From the Department of Radiology, XiJing Hospital, Xi'an, China.
authors.forename: Songshou
authors.initials: S
authors.lastname: Mao
authors.forename: Janis
authors.initials: J
authors.lastname: Child
authors.forename: Sivi
authors.initials: S
authors.lastname: Carson
authors.forename: Steve C K
authors.initials: SC
authors.lastname: Liu
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Oudiz
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
mesh_terms: D002114:Calcinosis / Q000000981:diagnostic imaging*; D002138:Calibration; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D019047:Phantoms, Imaging; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*