title: Stenosis quantification of coronary arteries in coronary vessel phantoms with second-generation dual-source CT: influence of measurement parameters and limitations.
abstract: OBJECTIVE
  The purpose of this study was to use second-generation dual-source CT to assess the influence of size, degree of stenosis, luminal contrast attenuation, and plaque geometry on stenosis quantification in a coronary artery phantom.
  
  
  METHODS
  Six vessel phantoms with three outer diameters (2, 3, and 4 mm), each containing three radiolucent plaques (72.2 HU) that simulated eccentric and concentric 43.8%, 75%, and 93.8% stenoses were made with a 3D printer system. These phantoms were filled with an iodine-saline solution mixture at luminal attenuations of 150, 200, 250, 300, and 350 HU and were attached to a cardiac motion simulator. Dual-source CT was performed with a standardized ECG-gated protocol (120 kV, 360 mAs per rotation) at a simulated heart rate of 70 beats/min. Two independent readers quantified the degree of stenosis using area-based measurements.
  
  
  RESULTS
  All measurements were highly reproducible (intraclass correlation, ≥ 0.791; p < 0.001). The mean measured degree of stenosis for a phantom with a 3-mm outer diameter at 250-HU luminal attenuation was 49.0% ± 10.0% for 43.8% stenosis, 71.7% ± 9.6% for 75.0% stenosis, and 85.4% ± 5.9% for 93.8% stenosis. With decreasing phantom size, measurement error increased for all degrees of stenosis. The absolute error increased for measurements at a low luminal attenuation of 150 HU (p < 0.001) and for low-grade stenoses compared with medium-and high-grade stenoses (p < 0.001).
  
  
  CONCLUSIONS
  The results are an overview of factors that influence stenosis quantification in simulated coronary arteries. Dual-source CT is highly reproducible and accurate for quantification of low-density stenosis in vessels with a diameter of 3 mm and attenuation of at least 200 HU for different degrees of stenosis and plaque geometry.
authors.affiliation: Department of Radiology, Medical University of Vienna, Vienna General Hospital, 18-20 Waehringer Guertel, Vienna, 1090 Austria. michael.toepker@meduniwien.ac.at
authors.forename: Michael
authors.initials: M
authors.lastname: Toepker
authors.forename: Gordon
authors.initials: G
authors.lastname: Euller
authors.forename: Ewald
authors.initials: E
authors.lastname: Unger
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.forename: Daniela
authors.initials: D
authors.lastname: Kienzl
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Herold
authors.forename: Helmut
authors.initials: H
authors.lastname: Ringl
mesh_terms: D000704:Analysis of Variance; D055424:Cardiac-Gated Imaging Techniques; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D004867:Equipment Design; D006801:Humans; D019047:Phantoms, Imaging; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*