基于光子计数冠状动脉 CT 血管成像的虚拟与真实非对比图像的冠状动脉钙化积分。
Coronary Artery Calcium Scoring Using Virtual Versus True Noncontrast Images From Photon-Counting Coronary CT Angiography.
机构信息
From the Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Strasse 1, 32429 Minden, Germany (N.P.H., A.E.M., J.H.N., J.B., J.R.K.); Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L.); Siemens Healthcare, Erlangen, Germany (C.P., I.S.); and National Center for Tumor Diseases, Dresden, Germany (A.Z.).
出版信息
Radiology. 2024 Mar;310(3):e230545. doi: 10.1148/radiol.230545.
Background Coronary artery calcium scoring (CACS) for coronary artery disease requires true noncontrast (TNC) CT alongside contrast-enhanced coronary CT angiography (CCTA). Photon-counting CT provides an algorithm (PureCalcium) for reconstructing virtual noncontrast images from CCTA specifically for CACS. Purpose To assess CACS differences based on PureCalcium images derived from contrast-enhanced photon-counting CCTA compared with TNC images and evaluate the impact of these differences on the clinically relevant classification of patients into plaque burden groups. Materials and Methods Photon-counting CCTA images acquired between August 2022 and May 2023 were retrospectively identified. Agatston scores were derived from both TNC and PureCalcium images and tested for differences with use of the Wilcoxon signed-rank test. The agreement was assessed with use of equivalence tests, Bland-Altman analysis, and intraclass correlation coefficient. Plaque burden groups were established based on Agatston scores, and agreement was evaluated using weighted Cohen kappa. The dose-length product was analyzed. Results Among 170 patients (mean age, 63 years ± 13 [SD]; 92 male), 111 had Agatston scores higher than 0. Median Agatston scores did not differ between TNC and PureCalcium images (4.8 [IQR, 0-84.4; range, 0.0-2151.8] vs 2.7 [IQR, 0-90.7; range, 0.0-2377.1]; = .99), with strong correlation (intraclass correlation coefficient, 0.98 [95% CI: 0.97, 0.99]). The equivalence test was inconclusive, with a 95% CI of 0.90, 1.19. Bland-Altman analysis showed wide repeatability limits, indicating low agreement between the two scores. With use of the PureCalcium algorithm, 125 of 170 patients (74%) were correctly classified into plaque burden groups (excellent agreement, κ = 0.88). Patients without plaque burden were misclassified at higher than normal rates ( < .001). TNC image acquisition contributed a mean of 19.7% ± 8.8 of the radiation dose of the entire examination. Conclusion PureCalcium images show potential to replace TNC images for measuring Agatston scores, thereby reducing radiation dose in CCTA. There was strong correlation in calcium scores between TNC and PureCalcium, but limited agreement. © RSNA, 2024 See also the editorial by Sakuma in this issue.
背景 冠状动脉钙评分（CACS）用于诊断冠状动脉疾病需要真实非对比（TNC）CT 与对比增强冠状动脉 CT 血管造影（CCTA）联合使用。光子计数 CT 提供了一种算法（PureCalcium），可专门用于 CACS 从 CCTA 重建虚拟非对比图像。目的 评估基于对比增强光子计数 CCTA 得出的 PureCalcium 图像与 TNC 图像的 CACS 差异，并评估这些差异对患者斑块负担分组的临床相关分类的影响。材料与方法 回顾性识别 2022 年 8 月至 2023 年 5 月采集的光子计数 CCTA 图像。从 TNC 和 PureCalcium 图像中得出 Agatston 评分，并使用 Wilcoxon 符号秩检验检验差异。使用等效性检验、Bland-Altman 分析和组内相关系数评估一致性。根据 Agatston 评分确定斑块负担组，并使用加权 Cohen kappa 评估一致性。分析剂量长度乘积。结果 在 170 例患者（平均年龄，63 岁±13[标准差]；92 例男性）中，111 例患者的 Agatston 评分高于 0。TNC 图像和 PureCalcium 图像的中位数 Agatston 评分无差异（4.8[四分位距，0-84.4；范围，0.0-2151.8]与 2.7[四分位距，0-90.7；范围，0.0-2377.1]； =.99），具有很强的相关性（组内相关系数，0.98[95%置信区间：0.97，0.99]）。等效性检验不确定，95%置信区间为 0.90，1.19。Bland-Altman 分析显示重复性限制较宽，表明两种评分的一致性较低。使用 PureCalcium 算法，170 例患者中有 125 例（74%）被正确分类为斑块负担组（极好的一致性，κ=0.88）。无斑块负担的患者被错误分类的比例高于正常水平（ <.001）。TNC 图像采集使整个检查的辐射剂量平均增加了 19.7%±8.8%。结论 PureCalcium 图像具有替代 TNC 图像测量 Agatston 评分的潜力，从而降低 CCTA 的辐射剂量。TNC 和 PureCalcium 之间的钙评分具有很强的相关性，但一致性有限。 ©2024RSNA，见本期 Sakuma 社论。
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