Virtual Monochromatic Imaging in Patients with Intermediate to High Likelihood of Coronary Artery Disease: Impact of Coronary Calcification.
We sought to explore the image quality and diagnostic performance of virtual monochromatic imaging derived from dual-energy computed tomography coronary angiography (DE-CTCA) in patients with intermediate to high likelihood of coronary artery disease (CAD) and the influence of calcification.



Consecutive symptomatic patients with suspected CAD referred for invasive coronary angiography who underwent DE-CTCA and a coronary artery calcium scoring before the invasive procedure comprised the study population.



Sixty-seven patients were included. Image quality was significantly lower at 45 keV reconstructions (mean Likert score 45 keV 3.57 ± 0.6, 65 keV 4.07 ± 0.5, and 85 keV 4.09 ± 0.6; P < .0001). Patients with moderate calcification showed a trend toward a significant improvement in the diagnostic performance with 65 keV vs 45 keV reconstructions (45 keV, area under the curve 0.92 [95% confidence interval 0.89-0.95] vs 65 keV, area under the curve 0.96 [95% confidence interval 0.93-0.98], P = .06). The diagnostic performance of DE-CTCA was significantly lower in segments with higher coronary artery calcium scoring compared to segments with none or mild calcification, independent of the energy level applied.



In patients with intermediate to high likelihood of CAD, DE-CTCA had a good diagnostic performance, although significantly lower in segments with severe calcification.
Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina. Electronic address: patriciacarrascosa@diagnosticomaipu.com.ar.
Patricia
P
Carrascosa
Medical Imaging, St. Paul's Hospital, Vancouver, BC, Canada.
Jonathon A
JA
Leipsic
Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina.
Alejandro
A
Deviggiano
Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina.
Carlos
C
Capunay
Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina.
Javier
J
Vallejos
Department of Interventional Cardiology, Sanatorio Guemes, Buenos Aires, Argentina.
Alejandro
A
Goldsmit
Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina.
Macarena C
MC
De Zan
Department of Cardiovascular Imaging, Diagnóstico Maipú, Av Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina.
Gaston A
GA
Rodriguez-Granillo
D000368:Aged; D019540:Area Under Curve; D000072226:Computed Tomography Angiography / Q000379:methods* / Q000592:standards; D017023:Coronary Angiography / Q000379:methods* / Q000592:standards; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011336:Probability; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D061205:Vascular Calcification / Q000000981:diagnostic imaging*
Spectral; angiogram; imaging; kilovolt; specificity