Becker Judith, Decker Josua A, Bette Stefanie, Braun Franziska, Canalini Luca, Wollny Claudia, Scheurig-Muenkler Christian, Kroencke Thomas, Schwarz Florian, Risch Franka
Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
Centre for Advanced Analytics and Predictive Sciences, University of Augsburg, Universitätsstr. 2, 86159, Augsburg, Germany.
Int J Cardiovasc Imaging. 2025 May 19. doi: 10.1007/s10554-025-03419-5.
The study evaluates the impact of body mass index (BMI), heart rate and rhythm on coronary artery calcium scoring (CACS) derived from calcium-sensitive virtual non-contrast (VNC) series of photon-counting detector (PCD) computed tomography angiography (CTA) compared to true non-contrast (TNC) series. Patients who underwent cardiac imaging with TNC and CTA on a PCD-CT were included. Agatston scores from TNC and VNC images were used to assign CACS risk category. Analyses considered BMI, heart rhythm and heart rate. Distributions were tested for differences between TNC and VNC derived scores and their correlation was assessed. The final cohort included 88 patients. CACS on VNC showed an underestimation of TNC derived values on median Agatston score TNC = 542 (IQR 200-1294), on median Agatston score VNC = 449 (IQR 130-1183), p < 0.001, percentage difference - 11%. However, linear correlation coefficient was high (r = 0.95), and the CAC severity was categorized equivalent in 80%. In approximately 11% of the study cohort, the misclassification of CAC severity could have potentially led to inappropriate treatment following established guidelines. An impact on the significance and extent of the difference in CACS for BMI > 28 kg/m and heart rate groups > 69 bpm was found. VNC reconstructions from PCD-CT reliably estimates TNC CACS for BMI ≤ 28 kg/m and heart rate ≤ 69 bpm in patients with severe coronary artery disease. Potential underestimation of risk category, especially with increased BMI and heart rate, must be considered for clinical decision making.
本研究评估了体重指数（BMI）、心率和心律对基于光子计数探测器（PCD）计算机断层扫描血管造影（CTA）的钙敏感虚拟非增强（VNC）序列与真实非增强（TNC）序列得出的冠状动脉钙化评分（CACS）的影响。纳入了在PCD-CT上接受TNC和CTA心脏成像的患者。使用TNC和VNC图像的阿加斯顿评分来划分CACS风险类别。分析考虑了BMI、心律和心率。检验了TNC和VNC得出的评分之间的分布差异，并评估了它们的相关性。最终队列包括88名患者。VNC上的CACS在阿加斯顿评分中位数方面显示低估了TNC得出的值，TNC = 542（四分位间距200 - 1294），VNC的阿加斯顿评分中位数 = 449（四分位间距130 - 1183），p < 0.001，百分比差异为 - 11%。然而，线性相关系数很高（r = 0.95），并且80%的患者CAC严重程度分类相当。在大约11%的研究队列中，CAC严重程度的错误分类可能会导致按照既定指南进行不适当的治疗。发现BMI > 28 kg/m和心率 > 69 bpm的组对CACS差异的显著性和程度有影响。对于患有严重冠状动脉疾病的患者，PCD-CT的VNC重建在BMI≤28 kg/m和心率≤69 bpm时能可靠地估计TNC CACS。在临床决策时，必须考虑风险类别可能被低估的情况，尤其是BMI和心率增加时。
