Reproducibility of artificial intelligence-enabled plaque measurements between systolic and diastolic phases from coronary computed tomography angiography.

OBJECTIVES: Current coronary CT angiography (CTA) guidelines suggest both end-systolic and mid-diastolic phases of the cardiac cycle can be used for CTA image acquisition. However, whether differences in the phase of the cardiac cycle influence coronary plaque measurements is not known. We aim to explore the potential impact of cardiac phases on quantitative plaque assessment. METHODS: We enrolled 39 consecutive patients (23 male, age 66.2 ± 11.5 years) who underwent CTA with dual-source CT with visually evident coronary atherosclerosis and with good image quality. End-systolic and mid- to late-diastolic phase images were reconstructed from the same CTA scan. Quantitative plaque and stenosis were analyzed in both systolic and diastolic images using artificial intelligence (AI)-enabled plaque analysis software (Autoplaque). RESULTS: Overall, 186 lesions from 39 patients were analyzed. There were excellent agreement and correlation between systolic and diastolic images for all plaque volume measurements (Lin's concordance coefficient ranging from 0.97 to 0.99; R ranging from 0.96 to 0.98). There were no substantial intrascan differences per patient between systolic and diastolic phases (p > 0.05 for all) for total (1017.1 ± 712.9 mm3 vs. 1014.7 ± 696.2 mm3), non-calcified (861.5 ± 553.7 mm3 vs. 856.5 ± 528.7 mm3), calcified (155.7 ± 229.3 mm3 vs. 158.2 ± 232.4 mm3), and low-density non-calcified plaque volume (151.4 ± 106.1 mm3 vs. 151.5 ± 101.5 mm3) and diameter stenosis (42.5 ± 18.4% vs 41.3 ± 15.1%). CONCLUSION: Excellent agreement and no substantial differences were observed in AI-enabled quantitative plaque measurements on CTA in systolic and diastolic images. Following further validation, standardized plaque measurements can be performed from CTA in systolic or diastolic cardiac phase. CLINICAL RELEVANCE STATEMENT: Quantitative plaque assessment using artificial intelligence-enabled plaque analysis software can provide standardized plaque quantification, regardless of cardiac phase. KEY POINTS: • The impact of different cardiac phases on coronary plaque measurements is unknown. • Plaque analysis using artificial intelligence-enabled software on systolic and diastolic CT angiography images shows excellent agreement. • Quantitative coronary artery plaque assessment can be performed regardless of cardiac phase.

Incremental value of diagonal earlobe crease to the Diamond-Forrester classification in estimating the probability of significant coronary artery disease determined by computed tomographic angiography.

The Diamond-Forrester (DF) algorithm overestimates the likelihood of significant coronary artery disease (≥50% stenosis, CAD50). The aim of the present study was to evaluate whether the addition of a diagonal earlobe crease (DELC) enhances the predictive ability of DF to detect CAD50 by coronary computed tomographic angiography (CTA). We evaluated 430 patients referred for CTA for symptoms, cardiovascular risk factors, and CAD50 likelihood using DF. Observers blinded to CTA findings evaluated the presence of DELC. The diagnostic accuracy and relation of DF, DELC, and DF + DELC for predicting CAD50 in patients with chest pain were evaluated using receiver operating characteristics curve (area under curve) analyses and multivariate logistic regression analyses. In 199 patients with chest pain, the sensitivity and specificity for CAD50 were 96% and 20% for DF (AUC 0.59, p = 0.59), 91% and 32% for DELC (AUC 0.62, p = 0.03), and 91% and 41% for DF + DELC (AUC 0.66, p = 0.004). On multivariate analyses DELC was the only independent predictor of CAD50 (odds ratio 3.6, 95% confidence interval 1 to 12.9, p = 0.048). DF + DELC increased the predictive ability to detect CAD50 above cardiovascular risk factors (odds ratio 5.6, 95% confidence interval 1.6 to 19.8, p = 0.007). In patients with chest pain, the presence of DELC is related to CAD50 beyond DF. A combined variable of DF + DELC provides superior discriminatory ability for detecting CAD50 than either method alone.

Low radiation coronary calcium scoring by dual-source CT with tube current optimization based on patient body size.

BACKGROUND: Reducing tube voltage from 120 kV to 100 kV during noncontrast CT for the detection of coronary artery calcium reduces patient radiation exposure. OBJECTIVE: We investigated whether coronary calcium scoring by multidetector row CT can be performed at reduced tube current, resulting in lower radiation dose to the patient. METHODS: Sixty-six outpatients were scanned on the same visit by dual-source CT (DSCT) with a standard protocol (120 kVp, 150 mAs), followed by a scan with reduced tube current: 85 mAs for patients with body mass index (BMI) ≤ 30 kg/m(2) and weight ≤ 85 kg, and 120 mAs for patients with BMI > 30 kg/m(2) or weight > 85 kg. Low-dose scans were scored by an experienced reader blinded to the standard scan. RESULTS: Agatston scores (ASs) and calcium volume for standard versus low-dose scans were 236 ± 581 versus 234 ± 586 (P = 0.65, NS), and 189 ± 460 mm(3) versus 184 ± 455 mm(3) with excellent correlation (r = 1.0, P < 0.0001), and no significant difference (P = 0.14, NS). Effective radiation dose for the low-dose protocol (1.0 ± 0.2 mSv) was significantly lower than for the standard protocol (1.7 ± 0.2 mSv; P < 0.0001). Image noise was higher for the low-dose scan (18.8 ± 5.5 HU vs 15.2 ± 4.8 HU; P < 0.0001), but both were within target limits. CONCLUSION: Noncontrast CT for measurement of coronary artery calcium with lower tube current optimized for patient body size is equivalent to standard methods at 40% lower radiation dose, indicating that radiation dose can be lowered for coronary calcium scanning.

Relation of diagonal ear lobe crease to the presence, extent, and severity of coronary artery disease determined by coronary computed tomography angiography.

Controversy exists concerning the relation between diagonal ear lobe crease (DELC) and coronary artery disease (CAD). We examined whether DELC is associated with CAD using coronary computed tomography (CT) angiography. We studied 430 consecutive patients without a history of coronary artery intervention who underwent CT angiography on a dual-source scanner. Presence of DELC was agreed by 2 blinded observers. Two blinded readers evaluated CT angiography images for presence of CAD and for significant CAD (≥50% stenosis). Chi-square and t tests were used to assess demographic differences between subgroups with and without DELC and the relation of DELC to 4 measurements of CAD: any CAD, significant CAD, multivessel disease (cutoff ≥2), and number of segments with plaque (cutoff ≥3). Multivariable logistic regression was performed to adjust for CAD confounders: age, gender, symptoms, and CAD risk factors. Mean age was 61 ± 13 and 61% were men. DELC was found in 71%, any CAD in 71%, and significant CAD in 17% of patients. After adjusting for confounders, DELC remained a significant predictor of all 4 measurements of CAD (odds ratio 1.8 to 3.3, p = 0.002 to 0.017). Sensitivity, specificity, and positive and negative predictive values for DELC in detecting any CAD were 78%, 43%, 77%, and 45%. Test accuracy was calculated at 67%. Area under the receiver operator characteristic curve was 61% (p = 0.001). In conclusion, in this study of patients imaged with CT angiography, finding DELC was independently and significantly associated with increased prevalence, extent, and severity of CAD.

Coronary artery calcium scoring using a reduced tube voltage and radiation dose protocol with dual-source computed tomography.

BACKGROUND: Technical advances to minimize radiation exposure because of imaging are in accord with the "as low as reasonably achievable" principle. OBJECTIVE: We aimed to determine whether coronary calcium scoring (CCS) by multidetector CT at a tube voltage of 100 kVp yields comparable results to the standard 120-kVp protocol while reducing radiation dose. METHODS: Sixty consecutive outpatients were scanned with a dual-source CT scanner with both the120- and 100-kVp protocols. The calcium threshold was 130 Hounsfield units (HUs) for 120 kVp and 147 HU for 100 kVp, as determined from phantom data. All 100-kVp scans were scored by an experienced reader blinded to 120-kVp data. RESULTS: Image quality was comparable for 100- and 120- kVp scans. Mean Agatston scores for 100 and 120 kVp were 189 +/- 484 and 189 +/- 498 (P = 0.92), with perfect correlation (r = 1.0; P < 0.0001; 95% limits of agreement, -36 to 37; bias, 0.6). Mean coronary calcium volume scores for 100 and 120 kVp were 143 +/- 370 mm(3) and 149 +/- 392 mm(3) (P = 0.26), with perfect correlation (r = 1.0; P < 0.0001; 95% limits of agreement, -35 to 32 mm(3); bias, -1.4 mm(3)). The mean absolute difference for Agatston scores between the protocols was 16.9, with excellent agreement (kappa = 0.95; P < 0.0001). Mean effective radiation dose for the 100-kVp protocol was significantly lower (1.17 mSv versus 1.70 mSv; P < 0.0001). CONCLUSION: A reduced tube current protocol using 100 kVp gives equivalent CCS results at reduced radiation exposure compared with a standard protocol at 120 kVp.

Predicting success of prospective and retrospective gating with dual-source coronary computed tomography angiography: development of selection criteria and initial experience.

BACKGROUND: Prospectively gated coronary computed tomographic angiography (CCTA) with dual-source CT allows substantial reduction of radiation exposure but requires prospective single-phase selection and assessment of likelihood of adequate image quality. OBJECTIVE: We developed and tested the model for predicting success of prospectively gated CCTA. METHODS: Retrospectively gated CCTA was acquired with dual-source CT in 162 patients. Two cardiologists assessed by consensus whether diagnostic quality images could have been obtained in a single predefined phase, 70% of R-R interval (70P), thereby identifying patients in whom a prospectively gated scan at 70P would have been successful. Logistic regression models were built with and without a coronary calcium scan. The obtained criteria were applied on 42 additional patients. RESULTS: By logistic regression, heart rate before CCTA of >or=70 beats/min, maximal heart rate variation before CCTA of >or=10 beats/min, coronary calcium score >or= 400 U, and body mass index (in kg/m(2)) >or= 30 were independent predictors of unsuccessful prospectively gated CCTA using 70P. Excluding coronary calcium score from the model, these same variables in addition to age > 65 years were found to be predictors of unsuccessful prospectively gated CCTA. Applying this model to 42 additional patients, using prospective gating, only 5 segments in 4 patients were nondiagnostic. Mean radiation dose for prospectively gated CCTA was 2.2 +/- 0.8 mSv. CONCLUSION: Prospectively gated CCTA with dual-source CT can be successfully implemented with consideration of prescan heart rate, heart rate variability, body mass index, and coronary calcium score.

Algorithm for radiation dose reduction with helical dual source coronary computed tomography angiography in clinical practice.

BACKGROUND: Strategies to reduce the radiation dose of coronary computed tomography angiography (CCTA), while maintaining diagnostic image quality, are imperative for cardiac CT. OBJECTIVE: We aimed to reduce radiation dose during helical dual-source CCTA by combining lower tube voltage, shortest possible full tube current (FTC) window, and minimal tube current outside the FTC window, and to develop a patient-based algorithm for applying these dose-reduction components. METHODS: We compared FTC at 70% of the cardiac cycle (FTC70) to a 45% to 75% window (FTC45-75) using both 100 and 120 kVp (N=118). FTC70 was used in patients with heart rates <70 beats/min, no arrhythmia, age <65 years; 100 kVp was used in patients with body mass index (BMI) <30, a low coronary calcium score (CCS), and no stents. Objective and subjective image quality were assessed. RESULTS: Compared with FTC45-75 at 120 kVp, radiation dose was reduced by 66% for FTC70 at 100 kVp (mean radiation dose: 4.4 +/- 0.9 mSv) and by 43% for FTC70 at 120 kVp. 99% of 780 segments in the FTC70 group were of diagnostic quality. Noise, signal-to-noise ratio, and contrast-to-noise ratio were comparable between FTC70 and FTC45-75 for both 100 and 120 kVp. BMI, CCS and maximal heart rate variation were predictors of image quality. Tube voltage, FTC window width, scan length, and average heart rate were predictors of radiation dose. CONCLUSIONS: A successful patient-based algorithm for radiation dose reduction during helical CCTA using DSCT has been developed and validated in clinical practice.