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Impact of Advanced Modeled Iterative Reconstruction on Coronary Artery Calcium Quantification

Posted Nov 30, 2016 Updated Apr 10, 2023
By Michael Messerli MD , Fabian Rengier MD , Lotus Desbiolles MD , Niklas F. Ehl MD , Ralf W. Bauer MD , Sebastian Leschka MD , Hatem Alkadhi MD MPH EBCR , Simon Wildermuth MD , Claas P. Nähle MD
9 min read

Highlights

  • Advanced modeled iterative reconstruction causes substantial reductions of coronary artery calcium scores.

  • Coronary artery calcium may no longer be detectable using advanced modeled iterative reconstruction, especially in patients with low calcium burden.

  • Advanced modeled iterative reconstruction should be used with caution in coronary artery calcium scanning.

Rationale and Objectives

To evaluate the influence of advanced modeled iterative reconstruction (ADMIRE) on the coronary artery calcium (CAC) scores by computed tomography (CT).

Materials and Methods

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Results

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Conclusions

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Introduction

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Materials and Methods

Study Population

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Table 1

Patient Characteristics and CT Acquisition Parameters

Male/female 38 (63%)/22 (37%) Age (years) 63.1 ± 11.7 BMI (kg/m 2 ) 27.7 ± 5.9 Weight (kg) 81.3 ± 20.0 Height (m) 1.71 ± 0.1 Heart rate during scan (beats/min) 76 ± 18 CTDI VOL (mGy) 1.96 ± 0.93 DLP (mGy × cm) 31.9 ± 15.2 Scan length (cm) 11.9 ± 2.5 Effective dose (mSv) 0.45 ± 0.21

BMI, body mass index; CT, computed tomography; CTDI vol , the volume CT dose index; DLP, dose length product; presented as N (%) and mean ± SD.

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CAC Image Acquisition

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Image Reconstruction and Evaluation

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Statistical Analysis

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Results

Image Quality Parameters

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CAC Scoring

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Figure 1, Box plots of coronary artery calcium (CAC) Agatston scores (a), volume scores (b), and mass scores (c) for filtered back projection (FBP) and incremental strength levels of advanced modeled iterative reconstruction (ADMIRE) in study group. Box and whisker plots show interquartile range (IQR) from the 25% to 75% percentile and the upper fence of the 1.5 IQR above the 75% percentile or lower fence of the 1.5 IQR below the 25% percentile. * P < 0.001; ADMIRE compared to FBP.

Table 2

Median Values and Difference Ratios of Coronary Agatston, Volumes, and Mass Scores for FBP and Incremental Strength Levels of ADMIRE

FBP ADMIRE 1 \* ADMIRE 2 \* ADMIRE 3 \* ADMIRE 4 \* ADMIRE 5 \* CAC Agatston Absolute 115 96 91 87 80 70 [23–450] [20–387] [19–367] [16–350] [14–310] [12–285] (0.1–3047) (0.1–2813) (0–2764) (0–2700) (0–2590) (0–2440) Difference ratio 0% −12% −18% −24% −32% −39% [−16–−10%] [−23–−14%] [−30–−18%] [−43–−26%] [−53–−33%] (−32–0%) (−100–−9%) (−100–−11%) (−100–−15%) (−100–−20%) CAC volume Absolute 91 79 74 70 63 55 [20–332] [17–293] [16–278] [14–281] [12–245] [10–224] (0–2468) (0–2273) (0–2226) (0–2172) (0–2070) (0–1956) Difference ratio 0% −14% −20% −25% −32% −41% [−16–−11%] [−25–−15%] [−34–−18%] [−44–−24%] [−54–−30%] (−50–0%) (−100–−8%) (−100–−10%) (−100–−14%) (−100–−18%) CAC mass Absolute 20 18 16 15 14 12 [4–77] [4–68] [3–66] [3–64] [3–59] [2–55] (0.03–618) (0.03–576) (0–567) (0–553) (0–531) (0–504) Difference ratio 0% −13% −19% −24% −31% −40% [−15–−11%] [−22–−15%] [−29–−18%] −39–−24%] [−49–−31%] (−31.4–0%) (−100–−7.2%) (−100–−9%) (−100–−12%) (−100–−16%)

ADMIRE, advanced modeled iterative reconstruction; CAC, coronary artery calcium; FBP, filtered back projection.

Data are presented as median [25th to 75th percentile] and (range). Difference ratio of different ADMIRE strength levels is calculated in comparison to FBP as reference.

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Figure 2, Box plots of difference ratios of coronary artery calcium (CAC) Agatston scores (a), volume scores (b), and mass scores (c) by incremental strength levels of advanced modeled iterative reconstruction (ADMIRE) in study group using filtered back projection (FBP) as reference. Box and whisker plots show interquartile range (IQR) from 25% to the 75% percentile and upper fence of the 1.5 IQR above the 75% percentile or lower fence of the 1.5 IQR below the 25% percentile. * P < 0.001; ADMIRE compared to FBP.

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Figure 3, Figure shows axial CT images of a 49-year-old male patient with suspected coronary artery disease undergoing coronary artery calcium scanning. Images are reconstructed with filtered back projection (FBP) and incremental strength levels of advanced modeled iterative reconstruction (ADMIRE). (a) FBP, (b) ADMIRE 1, (c) ADMIRE 2, (d) ADMIRE 3, (e) ADMIRE 4, (f) ADMIRE 5. Several calcified plaques located in the proximal left anterior descending artery are color coded. Incremental strength levels of ADMIRE are resulting in a decrease of total Agatston scores of 118, 94, 87, 86, 78, and 68 for FBP and ADMIRE 1–5, respectively. Note that one coronary lesion is no longer color coded as coronary calcification in ADMIRE 5 (arrow).

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Figure 4, Differences in Agatston score associated risk category between filtered back projection (FBP) and incremental strength levels of advanced modeled iterative reconstruction (ADMIRE). Bar shows the number of patients classified to each risk group based on the Agatston score. With incremental strength levels of ADMIRE, the number of the patients being reassigned to a lower risk category increased. * P < 0.05, ** P < 0.001; ADMIRE compared to FBP.

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Figure 5, Differences in calculated coronary artery calcium percentile for patients in the 45–85 year range (n = 53) based on the observed Agatston score, age, gender, and race using the database of the Multi-Ethnic Study of Atherosclerosis (17) for filtered back projection (FBP) and incremental strength levels of advanced modeled iterative reconstruction (ADMIRE). Bar shows the number of patients classified to each percentile group. With incremental strength levels of ADMIRE, the number of the patients being reassigned to a lower risk category increased. * P < 0.05, ** P < 0.001; ADMIRE compared to FBP.

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Discussion

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Academic Radiology, Volume 23, Issue 12
Journals General Radiology
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