Photon Counting Detector CT-Based Virtual Noniodine Reconstruction Algorithm for In Vitro and In Vivo Coronary Artery Calcium Scoring: Impact of Virtual Monoenergetic and Quantum Iterative Reconstructions
Abstract
OBJECTIVES: The aim of this study was to evaluate the impact of virtual monoenergetic imaging (VMI) and quantum iterative reconstruction (QIR) on the accuracy of coronary artery calcium scoring (CACS) using a virtual noniodine (VNI) reconstruction algorithm on a first-generation, clinical, photon counting detector computed tomography system. MATERIALS AND METHODS: Coronary artery calcium scoring was evaluated in an anthropomorphic chest phantom simulating 3 different patient sizes by using 2 extension rings (small: 300 × 200 mm, medium: 350 × 250 mm, large: 400 × 300 mm) and in patients (n = 61; final analyses only in patients with coronary calcifications [n = 34; 65.4 ± 10.0 years; 73.5% male]), who underwent nonenhanced and contrast-enhanced, electrocardiogram-gated, cardiac computed tomography on a photon counting detector system. Phantom and patient data were reconstructed using a VNI reconstruction algorithm at different VMI (55-80 keV) and QIR (strength 1-4) levels (CACS VNI ). True noncontrast (TNC) scans at 70 keV and QIR "off" were used as reference for phantom and patient studies (CACS TNC ). RESULTS: In vitro and in vivo CACS VNI showed strong correlation ( r > 0.9, P 0.9 for all) with CACS TNC at all investigated VMI and QIR levels. Phantom and patient CACS VNI significantly increased with decreasing keV levels (in vitro: from 475.2 ± 26.3 at 80 keV up to 652.5 ± 42.2 at 55 keV; in vivo: from 142.5 [7.4/737.7] at 80 keV up to 248.1 [31.2/1144] at 55 keV; P <…
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