Objectives The aim of this study was to evaluate a prototype dual-energy computed tomography calcium subtraction algorithm and its impact on luminal visualization in patients with heavily calcified coronary arteries. Materials and Methods Twenty-nine patients (62% male; mean age, 64 ± 7 years) who had undergone dual-energy coronary computed tomography angiography were retrospectively included in this institutional review board–approved, Health Insurance Portability and Accountability Act–compliant study. Linearly blended (M_0.6) and calcium-subtracted images were reconstructed. Two independent observers assessed luminal visualization of the coronary arteries in a segment-based analysis, subjective image quality, and diagnostic confidence using 5-point Likert scales. Contrast-to-noise ratios for both data sets were calculated. Wilcoxon testing and Cohen's κ were used for statistical comparisons. Results Calcium-subtracted image series showed improved lumen visualization of the coronary arteries (P = 0.008), with excellent interreader agreement (mean score, 3.3; κ = 0.82), compared with M_0.6 series (mean score, 2.9; κ = 0.77). The calcium subtraction algorithm improved diagnostic confidence compared with the M_0.6 reconstructions (mean scores, 4.0 and 3.1, respectively; all P ≤ 0.002). The image quality analysis showed no significant differences between calcium-subtracted and M_0.6 data sets (subjectively: mean scores, 4.1 and 4.2, respectively, P = 0.442; objectively: mean contrast-to-noise ratio, 37.0 and 38.2, respectively, P = 0.733). Conclusions A prototype algorithm for calcium subtraction improves coronary lumen visualization and diagnostic confidence in patients with heavy coronary calcifications without differences in conventional subjective and objective measures of image quality.from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2A5T2jf
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