The effect of heart rate, vessel angulation and acquisition protocol on the estimation accuracy of calcified artery stenosis in dual energy cardiac CT: A phantom study

Published:February 11, 2020DOI:


      • Measurement of %Stenosis in single energy cardiac CT is considerably overestimated.
      • Dual energy cardiac CT provides images that are less affected by cardiac motion.
      • The detail reconstruction kernel provides a more accurate assessment of %Stenosis.
      • Effective dose in dual energy cardiac CT is lower than in routine gated acquisition.



      To investigate the effects of heart beat rate (bpm), vessel angulation and acquisition protocol on the estimation accuracy of calcified stenosis using a dual-energy CT scanner.


      A thorax semi-anthropomorphic phantom coupled with a motion simulator and a vessel phantom representing a 50% coronary artery calcified stenosis, were used. Electrocardiograph (ECG)-synchronized acquisitions were performed at different bpms. Acquisitions were performed using A, B, and C single-energy and D dual-energy protocols. Protocol A was prospective ECG-triggered axial and protocols B and C were retrospective single- and two-segment reconstruction ECG-gated helical acquisitions. Protocol D was prospective ECG-triggered axial acquisition. The vessel phantom was placed at two angulations relative to z-axis. Images were reconstructed using all available kernels with iterative reconstruction. Stenosis-percentage was estimated using the CT vendor’s vessel analysis tool. Effective dose (ED) was estimated using the dose-length product method.


      In protocols A, B, and C, measured Stenosis-percentage increased with bpm. Stenosis-percentage estimate ranged from 56.8% at 40 bpm to 62.6% at 100 bpm. In protocol D, Stenosis-percentage ranged from 59.3% at 40 bpm to 54.8% at 80 bpm. Stenosis-percentage was overestimated on respect to the nominal value in most kernels. The detail kernel exhibited the highest accuracy. Stenosis-percentage was not affected by the vessel angulation. ED for protocols A, B, C, and D was 2.4 mSv, 5.1 mSv, 5.5 mSv, and 2.8 mSv, respectively.


      Use of the dual-energy cardiac CT examination protocol along with the detail kernel is recommended for a more accurate assessment of Stenosis-percentage.


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