title: Diagnostic performance of calcification-suppressed coronary CT angiography using rapid kilovolt-switching dual-energy CT.
abstract: OBJECTIVE
  Multi-detector-row computed tomography angiography (MDCTA) plays an important role in the assessment of patients with suspected coronary artery disease. However, MDCTA tends to overestimate stenosis in calcified coronary artery lesions. The aim of our study was to evaluate the diagnostic performance of calcification-suppressed material density (MD) images produced by using a single-detector single-source dual-energy computed tomography (ssDECT).
  
  
  METHODS
  We enrolled 67 patients with suspected or known coronary artery disease who underwent ssDECT with rapid kilovolt-switching (80 and 140 kVp). Coronary artery stenosis was evaluated on the basis of MD images and virtual monochromatic (VM) images. The diagnostic performance of the two methods for detecting coronary artery disease was compared with that of invasive coronary angiography as a reference standard.
  
  
  RESULTS
  We evaluated 239 calcified segments. In all the segments, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detecting significant stenosis were respectively 88%, 88%, 75%, 95% and 88% for the MD images, 91%, 71%, 56%, 95% and 77% for the VM images. PPV was significantly higher on the MD images than on the VM images (P < 0.0001).
  
  
  CONCLUSIONS
  Calcification-suppressed MD images improved PPV and diagnostic performance for calcified coronary artery lesions.
  
  
  CONCLUSIONS
  • Computed tomography angiography tends to overestimate stenosis in calcified coronary artery. • Dual-energy CT enables us to suppress calcification of coronary artery lesions. • Calcification-suppressed material density imaging reduces false-positive diagnosis of calcified lesion.
authors.affiliation: Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago City, Tottori, 683-8504, Japan. yunagahiroto@gmail.com.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Yunaga
authors.affiliation: Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago City, Tottori, 683-8504, Japan.
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Ohta
authors.affiliation: Department of Cardiology, Kakogawa Higashi Hospital, Kakogawa, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kaetsu
authors.affiliation: Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago City, Tottori, 683-8504, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Kitao
authors.affiliation: Division of Cardiology, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Division of Cardiology, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Furuse
authors.affiliation: Division of Cardiology, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago City, Tottori, 683-8504, Japan.
authors.forename: Toshihide
authors.initials: T
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D000072226:Computed Tomography Angiography / Q000592:standards*; D017023:Coronary Angiography / Q000592:standards*; D023921:Coronary Stenosis / Q000175:diagnosis*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000592:standards*; D015900:Radiography, Dual-Energy Scanned Projection / Q000592:standards*; D012015:Reference Standards; D015203:Reproducibility of Results; D061205:Vascular Calcification / Q000175:diagnosis*
keywords: Coronary angiography; Coronary vessels; Radiography, dual-energy scanned projection; Tomography, X-ray computed; Vascular calcification