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Half-dose Coronary Artery Calcium Scoring

Impact of Iterative Reconstruction

Caruso, Damiano, MD*; De Santis, Domenico, MD*; Biondi, Tommaso, MD*; Panvini, Nicola, MD; Zerunian, Marta, MD; Rivosecchi, Flaminia, MD; Montesano, Marta, MD; Bellini, Davide, MD; Rengo, Marco, MD, PhD; Laghi, Andrea, MD*

doi: 10.1097/RTI.0000000000000340
Imaging in Cardiac Risk Prediction

Purpose: The purpose of this study was to assess the impact of adaptive statistical iterative reconstruction (ASiR) on half-dose coronary artery calcium scoring (CACS) acquisition protocol.

Materials and Methods: Between September 2016 and October 2017, 89 patients (54 male patients, mean age 64.6±10.7 y) with a clinically indicated coronary computed tomography angiography were prospectively enrolled. On a 64-row computed tomography scanner, patients underwent a standard CACS protocol (120 kVp, 170 mAs) reconstructed by filtered-back projection, and a half-dose CACS protocol (120 kVp, 85 mAs) reconstructed by ASiR at different percentages, from 10% to 100%, in 10% increments. CACS determinants (Agatston score, number of plaques, volume, and mass), signal-to-noise ratio, contrast-to-noise ratio, and radiation dose of both protocols were calculated. Patient risk categories based on CACS were determined for each protocol, and analysis of risk reclassification of half-dose protocol was performed. Depending on their body mass index (BMI), patients were divided into nonobese (BMI<30 kg/m2) and obese (BMI≥30 kg/m2) groups to investigate the influence of BMI on CACS determinants and risk reclassification.

Results: Half-dose protocol reconstructed with ASiR 70% showed no significant differences in any CACS determinant compared with the standard protocol for both nonobese and obese patients (all P≥0.070 and 0.066, respectively) and reclassified 1 (1.7%) and 6 (20.0%) patients, respectively, with excellent (κ=0.91) and good (κ=0.74) agreement with standard protocol, respectively. ASiR 70% also resulted in a higher signal-to-noise ratio (1.88±0.78) and contrast-to-noise ratio (7.10±2.73) compared with standard protocol (all P≤0.001). Half-dose protocol provided 52% less radiation dose than standard acquisition (0.31±0.06 vs. 0.64±0.10 mSv; P<0.001).

Conclusions: ASIR 70% coupled with reduction of tube current by 50% allowed for significant dose reduction and no detrimental effects on image quality, with minimal patient reclassification in nonobese patients. In obese patients, excessive noise may lead to a clinically significant reclassification rate.

*Radiology Unit, Sant’Andrea Hospital, “Sapienza”, University of Rome, Rome

Department of Radiological Sciences, Oncology and Pathology, I.C.O.T. Hospital, “Sapienza”, University of Rome, Latina, Italy

The authors declare no conflicts of interest.

Correspondence to: Damiano Caruso, MD, Radiology Unit, Sant’Andrea Hospital, “Sapienza”, University of Rome, Rome, Italy (e-mail:

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