Evaluation of low-dose chest scans for coronary artery calcium scoring using photon-counting computed tomography with different slice thicknesses and iterative reconstruction levels
Abstract
Background Coronary artery calcium scoring (CACS) is a noninvasive method for quantifying coronary artery calcification plaque burden. Although low-dose chest computed tomography (LD-CT) scans with energy-integrating detector CT can be used for CACS, its clinical utility is constrained by higher mean differences and wider limits of agreement. In contrast, photon-counting CT offers significantly enhanced image quality compared to energy-integrating detector CT, making it a more promising tool for accurate CACS. This study investigated the difference in CACS obtained from LD-CT using photon-counting detector CT as compared to standard CACS CT (CAC-CT). Methods This prospective study included 105 patients (mean age 64.6±11.5 years) who underwent both CAC-CT and LD-CT scans on the same day using photon-counting detector CT. CAC-CT served as a reference standard. Ten groups generated by LD-CT were reconstructed using different strength levels of quantum iterative reconstruction (QIR; 0–4) and slice thickness (3 and 1.5 mm), with the LD3mm-QIR0 to LD1.5 mm-QIR4 groups being designated. The accuracy of CACS detection via LD-CT was evaluated using the intraclass correlation coefficient (ICC; >0.9: excellent) with two-way mixed effects and absolute agreement, Bland-Altman analysis, and weighted kappa (excellent: >0.8) being used for risk categorization agreement. The Wilcoxon signed-rank test was used to compare the radiation doses between CAC-CT and LD-CT. P<0.05 was considered to…
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