Abstract
Objectives: The objective of this study was to explore the diagnostic value of deep learning-based image reconstruction (DLR) and hybrid iterative reconstruction (HIR) for calcification-related obstructive coronary artery disease (CAD) evaluation by using coronary CT angiography (CCTA) images and subtraction CCTA images.Methods: Forty-two consecutive patients with known or suspected coronary artery disease who underwent coronary CTA on a 320-row CT scanner and subsequent invasive coronary angiography (ICA), which was used as the reference standard, were enrolled. The DLR and HIR images were reconstructed as CTADLR and CTAHIR, and, based on which, the corresponding subtraction CCTA images were established as CTAsDLR and CTAsHIR, respectively. Qualitative images quality comparison was performed by using a Likert 4 stage score, and quantitative images quality parameters, including image noise, signal-to-noise ratio, and contrast-to-noise ratio were calculated. Diagnostic performance on the lesion level was assessed and compared among the four CCTA approaches (CTADLR, CTAHIR, CTAsDLR, and CTAsHIR).Results: There were 166 lesions of 86 vessels in 42 patients (32 men and 10 women; 62.9 ± 9.3 years) finally enrolled for analysis. The qualitative and quantitative image qualities of CTAsDLR and CTADLR were superior to those of CTAsHIR and CTAHIR, respectively. The diagnostic accuracies of CTAsDLR, CTADLR, CTAsHIR, and CTAHIR to identify calcification-related obstructive diameter stenosis were 83.73%, 69.28%, 75.30%, and 65.66%, respectively. The false-positive rates of CTAsDLR, CTADLR, CTAsHIR, and CTAHIR for luminal diameter stenosis ≥50% were 15%, 31%, 24%, and 34%, respectively. The sensitivity and the specificity to identify ≥50% luminal diameter stenosis was 90.91% and 83.23% for CTAsDLR.Conclusion: Our study showed that deep learning–based image reconstruction could improve the image quality of CCTA images and diagnostic performance for calcification-related obstructive CAD, especially when combined with subtraction technique.
Highlights
With excellent sensitivity and negative predictive value, coronary CT angiography (CCTA) has developed into one of the first choices of non-invasive diagnostic strategies for the evaluation of coronary artery disease (CAD) during clinical practice [1,2,3,4]
On account of the blooming and beam hardening artifacts, the accuracy of stenosis evaluation related to calcified plaques was still unsatisfactory, since the calcification might lead to overestimation of the stenosis and excessive downstream testing [5,6,7]
Subtraction CCTA approaches have been investigated previously and put forward in decreasing the impacts of the calcification artifacts, improving the image quality [10] and diagnostic accuracy [6, 11,12,13,14,15]. Both Guo et al [10] and Xu et al [15] reported that, in comparison with conventional CCTA, subtraction CCTA based on standard kernel iterative reconstruction would allow stenosis regarding and improve the diagnostic accuracy in coronary segments with severe calcification
Summary
With excellent sensitivity and negative predictive value, coronary CT angiography (CCTA) has developed into one of the first choices of non-invasive diagnostic strategies for the evaluation of coronary artery disease (CAD) during clinical practice [1,2,3,4]. Subtraction CCTA approaches have been investigated previously and put forward in decreasing the impacts of the calcification artifacts, improving the image quality [10] and diagnostic accuracy [6, 11,12,13,14,15]. Both Guo et al [10] and Xu et al [15] reported that, in comparison with conventional CCTA, subtraction CCTA based on standard kernel iterative reconstruction would allow stenosis regarding and improve the diagnostic accuracy in coronary segments with severe calcification. Takamura et al [11] showed the diagnostic ability of subtraction CCTA using the low-radiation dose protocol for patients with calcification was superior to that of conventional CCTA alone
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