OBJECTIVE Determination of coronary artery calcium scoring (CACS) in non-contrast computed tomography (CT) images has been shown to be an important prognostic factor in coronary artery disease (CAD). The objective of this study was to evaluate the accuracy of CACS from virtual non-contrast (VNC) imaging generated from spectral data in comparison to standard (true) non-contrast (TNC) imaging in a representative patient cohort with clinically approved software. METHODS One hundred three patients referred to coronary CTA with suspicion of CAD were investigated on a dual-layer spectral detector CT (SDCT) scanner. CACS was calculated from both TNC and VNC images by software certified for medical use. Patients with a CACS of 0 were excluded from analysis. RESULTS The mean age of the study population was 61 ± 11 years with 48 male patients (67%). Inter-quartile range of clinical CACS was 22-282. Correlation of measured CACS from true- and VNC images was high (0.95); p < 0.001. The slope was 3.83, indicating an underestimation of VNC CACS compared to TNC CACS by that factor. Visual analysis of the Bland-Altman plot of CACS showed good accordance with both methods after correction of VNC CACS by the abovementioned factor. CONCLUSIONS In clinical diagnostics of CAD, the determination of CACS is feasible using VNC images generated from spectral data obtained on a dual-layer spectral detector CT. When multiplied by a correction factor, results were in good agreement with the standard technique. This could enable radiation dose reductions by obviating the need for native scans typically used for CACS. KEY POINTS • Calcium scoring is feasible from contrast-enhanced CT images using a dual-layer spectral detector CT scanner. • When multiplied by a correction factor, calcium scoring from virtual non-contrast images shows good agreement with the standard technique. • Omitting native scans for calcium scoring could enable radiation dose reduction.

中文翻译：

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使用来自双层光谱探测器 CT 的虚拟非对比图像进行钙评分：与真实非对比数据的比较和对大型患者群体的比例因子的评估。

目的 非对比计算机断层扫描 (CT) 图像中冠状动脉钙化评分 (CACS) 的确定已被证明是冠状动脉疾病 (CAD) 的重要预后因素。本研究的目的是评估来自光谱数据生成的虚拟非对比 (VNC) 成像与标准（真实）非对比 (TNC) 成像相比，在具有临床批准软件的代表性患者队列中 CACS 的准确性。方法 在双层光谱检测器 CT (SDCT) 扫描仪上对 103 名疑似 CAD 转诊至冠状动脉 CTA 的患者进行了调查。CACS 是通过医疗用认证软件根据 TNC 和 VNC 图像计算得出的。CACS 为 0 的患者被排除在分析之外。结果 研究人群的平均年龄为 61 ± 11 岁，其中 48 名男性患者 (67%)。临床 CACS 的四分位间距为 22-282。来自真实和 VNC 图像的测量 CACS 的相关性很高 (0.95)；p < 0.001。斜率为 3.83，表明与 TNC CACS 相比，VNC CACS 被该因素低估了。CACS 的 Bland-Altman 图的可视化分析表明，在通过上述因素校正 VNC CACS 后，两种方法都具有良好的一致性。结论 在 CAD 的临床诊断中，使用从双层光谱探测器 CT 上获得的光谱数据生成的 VNC 图像确定 CACS 是可行的。当乘以校正因子时，结果与标准技术非常吻合。这可以通过避免对通常用于 CACS 的本地扫描的需要来减少辐射剂量。要点 • 从使用双层光谱探测器 CT 扫描仪的对比增强 CT 图像进行钙评分是可行的。• 当乘以一个校正因子时，来自虚拟非对比图像的钙离子评分显示出与标准技术的良好一致性。• 省略钙评分的本地扫描可以减少辐射剂量。