title: Improved evaluation of calcified segments on coronary CT angiography: a feasibility study of coronary calcium subtraction.
abstract: We explore the feasibility of coronary calcium subtraction computed tomography angiography (CCTA) in patients with high calcium scores using invasive coronary angiography as the gold standard. Eleven patients with calcium scores of >400 underwent CCTA using a subtraction protocol followed by invasive coronary angiography. In addition to standard reconstructions, subtracted images were obtained using a dedicated subtraction algorithm. A total of 55 calcified segments were evaluated for image quality [using a 4-point scale ranging from 1 (uninterpretable) to 4 (good)] and the presence of significant (≥ 50 %) luminal stenosis. Conventional and subtracted CCTA were compared using quantitative coronary angiography (QCA) as the gold standard. The average image quality of conventional CCTA was 2.5 ± 0.6 versus 3.1 ± 0.6 on subtraction CCTA (P < 0.001). The percentage of segments with a score 1 or 2 was reduced from 41.8 to 12.7 % after coronary calcium subtraction (P = 0.002). On QCA, significant stenosis was observed in 16 segments. The area under the receiver operating characteristics curve to detect ≥ 50 % stenosis on QCA increased from 0.741 [95 % confidence interval (CI) 0.598-0.885] for conventional CCTA to 0.905 (95 % CI 0.791-1.000) for subtraction CCTA (P = 0.003). In patients with extensive calcifications undergoing CCTA, coronary calcium subtraction may improve the evaluation of calcified segments.
authors.affiliation: Department of Radiology, Iwate Medical University, 19-1, Uchimaru, Morioka, Iwate, 020-8505, Japan, rtanaka@iwate-med.ac.jp.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Tanaka
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Yoshioka
authors.forename: Kenta
authors.initials: K
authors.lastname: Muranaka
authors.forename: Takuya
authors.initials: T
authors.lastname: Chiba
authors.forename: Takanori
authors.initials: T
authors.lastname: Ueda
authors.forename: Tadashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fusazaki
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ehara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015901:Angiography, Digital Subtraction / Q000379:methods*; D019540:Area Under Curve; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging*