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Coronary Artery Calcium Scoring Using ECG-Gated Multidetector CT: Effect of Individually Optimized Image-Reconstruction Windows on Image Quality and Measurement Reproducibility

¹ All authors: Department of Radiology, Onze Lieve Vrouw Hospital, Moorselbaan 164, Aalst 9300 Belgium.

View larger version (96K): [in a new window]   Fig. 1A. —64-year-old man with atypical chest pain. Percentage of interscan variability was 54%, 109%, and 70% for images calculated at 60%, 50%, and 40% of R-R interval, respectively (results based on evaluation of all coronary arteries). Images shown in different figure parts are consecutively reconstructed axial slices with 3-mm slice width and 1.5-mm overlap. Unenhanced multidetector CT (MDCT) images reconstructed at 60% of R-R interval and obtained with scan 1 show heavily calcified left anterior descending artery. Calculated calcium mass value for entire left anterior descending artery was 14 mg.

View larger version (95K): [in a new window]   Fig. 1B. —64-year-old man with atypical chest pain. Percentage of interscan variability was 54%, 109%, and 70% for images calculated at 60%, 50%, and 40% of R-R interval, respectively (results based on evaluation of all coronary arteries). Images shown in different figure parts are consecutively reconstructed axial slices with 3-mm slice width and 1.5-mm overlap. Unenhanced MDCT images reconstructed at 60% of R-R interval and obtained with scan 2 show heavily calcified left anterior descending artery. Calculated calcium mass value for entire left anterior descending artery was 35 mg. Note that calcifications are visible on more slices when compared with A. Finding suggests different motion patterns of left anterior descending artery along craniocaudal axis during scanning (different speed or direction of coronary motion or both).

View larger version (94K): [in a new window]   Fig. 1C. —64-year-old man with atypical chest pain. Percentage of interscan variability was 54%, 109%, and 70% for images calculated at 60%, 50%, and 40% of R-R interval, respectively (results based on evaluation of all coronary arteries). Images shown in different figure parts are consecutively reconstructed axial slices with 3-mm slice width and 1.5-mm overlap. Unenhanced MDCT images reconstructed at 50% of R-R interval and obtained with scan 1 show that artery is well visualized, but no calcium is detected (density, < 130 H). Calculated calcium mass value for entire left anterior descending artery is 0 mg. Apparent absence of calcium reflects presence of data gaps that can be explained only by rapid coronary motion.

View larger version (97K): [in a new window]   Fig. 1D. —64-year-old man with atypical chest pain. Percentage of interscan variability was 54%, 109%, and 70% for images calculated at 60%, 50%, and 40% of R-R interval, respectively (results based on evaluation of all coronary arteries). Images shown in different figure parts are consecutively reconstructed axial slices with 3-mm slice width and 1.5-mm overlap. Unenhanced MDCT images reconstructed at 50% of R-R interval and obtained with scan 2 show heavily calcified left anterior descending artery. Calculated calcium mass value for entire left anterior descending artery was 42 mg.

View larger version (95K): [in a new window]   Fig. 1E. —64-year-old man with atypical chest pain. Percentage of interscan variability was 54%, 109%, and 70% for images calculated at 60%, 50%, and 40% of R-R interval, respectively (results based on evaluation of all coronary arteries). Images shown in different figure parts are consecutively reconstructed axial slices with 3-mm slice width and 1.5-mm overlap. Unenhanced CT images reconstructed at 40% of R-R interval and obtained with scan 1 show left anterior descending artery with several calcific plaques. Calculated calcium mass value for entire left anterior descending artery was 4 mg.

View larger version (89K): [in a new window]   Fig. 1F. —64-year-old man with atypical chest pain. Percentage of interscan variability was 54%, 109%, and 70% for images calculated at 60%, 50%, and 40% of R-R interval, respectively (results based on evaluation of all coronary arteries). Images shown in different figure parts are consecutively reconstructed axial slices with 3-mm slice width and 1.5-mm overlap. Unenhanced CT images reconstructed at 40% of the R-R wave interval are obtained with scan 2. When compared with that in E, left anterior descending artery shows more homogeneous and more extensive pattern of calcification. Calculated calcium mass value for entire left anterior descending artery was 23 mg.

View larger version (11K): [in a new window]   Fig. 2. —Scatterplot shows correlation between percentage of interscan variability using optimized image-reconstruction window and calcium mass in individual patients (r = –0.24). Interscan variability tends to be lower in patients with higher values for calcium mass; however, large scatter can be observed.

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