Feasibility of coronary artery calcium scoring on virtual unenhanced images derived from single-source fast kVp-switching dual-energy coronary CT angiography

• Virtual unenhanced (VUE) images in this study use multimaterial decomposition.
• Coronary artery calcium scores can be calculated from VUE images.
• Coronary artery calcium scores on VUE images and true noncontrast images were excellently correlated.
• Fast kVp-switch dual-energy coronary CT angiography (CCTA) showed better image quality than single-energy CCTA.
• Dual-energy CCTA imparts lower radiation dose than noncontrast + single-energy CCTA.

BackgroundDual-energy CT technology enables acquisition of virtual unenhanced (VUE) images from contrast-enhanced scans.ObjectiveTo assess the feasibility of coronary artery calcium (CAC) scoring on VUE images derived from fast kVp-switching dual-energy coronary CT angiography.MethodsTwenty-seven patients underwent true noncontrast CAC-scoring CT followed by routine single-energy (120-kVp) and fast kVp-switching dual-energy coronary CT angiography, in a random acquisition order on the same day. We calculated the CAC scores on true noncontrast and VUE images. The image noises and the signal-to-noise and contrast-to-noise ratios of the aorta and coronary arteries were measured on both the single-energy coronary CT angiography images and dual-energy coronary CT angiography images (70 keV virtual monochromatic spectral images). The Pearson correlation coefficient test and paired t test were used for statistical analysis.ResultsExcellent correlation was observed between the CAC scores on the true noncontrast and those on the VUE images (r = 0.88; P < .001). Compared with single-energy coronary CT angiography, dual-energy coronary CT angiography showed significantly reduced image noise and increased signal-to-noise and contrast-to-noise ratios in all regions (all P < .001). The effective dose of dual-energy coronary CT angiography (4.3 ± 0.3 mSv) was significantly lower than that of true noncontrast CAC-scoring CT plus single-energy coronary CT angiography (5.4 ± 0.7 mSv; P < .0001).ConclusionsExcellent correlation was observed between the CAC scores on the VUE images and true noncontrast images. Thus, fast kVp-switching dual-energy coronary CT angiography could allow prediction of the true CAC scores, potentially reducing the total radiation exposure and image acquisition time by obviating the need for true noncontrast CAC-scoring CT.