What is the clinical evidence from this study?

Study design: Observational. Population: Clinically indicated coronary CTA (n=42). Intervention: PureCalcium virtual non-contrast (VNCPC) reconstruction vs. True non-contrast (TNC) series. Primary outcome: Epicardial adipose tissue (EAT) volume (mL) (-5.7 mL difference, p=0.001).

December 3, 2022Open Access

Assessment of epicardial adipose tissue on virtual non-contrast images derived from photon-counting detector coronary CTA datasets

Key Result

PureCalcium virtual non-contrast reconstructions from photon-counting CCTA datasets assessed epicardial adipose tissue volume with only a 3% mean difference compared to true non-contrast series.

Study Design

Type

Observational (n=42)

Multicenter

Structured PICO

Can virtual non-contrast reconstructions derived from photon-counting detector coronary CTA datasets reliably assess epicardial adipose tissue volume and attenuation compared to true non-contrast series?

Population

42 consecutive patients (mean age 72 ± 10 years, 47.6% female) with a clinically indicated ECG-gated CT scan of the heart on a photon-counting detector CT system, who had pre-contrast true non-contrast (TNC) series for calcium scoring, contrast-enhanced CCTA series, and raw CT data available.

Intervention

Virtual non-contrast (VNC) reconstructions (conventional VNCConv and PureCalcium VNCPC) derived from photon-counting detector coronary CTA datasets.

Comparator

True non-contrast (TNC) series and standard CCTA series (CTA-30, CTA0).

Outcome

Epicardial adipose tissue (EAT) volume and attenuation.surrogate

A novel calcium-preserving virtual non-contrast algorithm derived from photon-counting detector coronary CTA datasets enables highly accurate assessment of epicardial adipose tissue volume and attenuation, potentially obviating the need for true non-contrast scans and reducing radiation dose.

Main Result

Effect estimate: -5.7 mL difference

Absolute Event Rate: 189.5% vs 195.6%

p-value: p=0.001

Limitations

Retrospective and single-centered study design
Only two currently available VNC algorithms were evaluated
Possibility to adjust the upper threshold for quantifying the EAT volume on VNC or CCTA series was not fully exploited

Abstract

OBJECTIVES: To assess epicardial adipose tissue (EAT) volume and attenuation of different virtual non-contrast (VNC) reconstructions derived from coronary CTA (CCTA) datasets of a photon-counting detector (PCD) CT-system to replace true non-contrast (TNC) series. METHODS: ). EAT volumes and their histograms were assessed for each series. Linear regression was used to correlate EAT volumes and the Euclidian distance for histograms. The paired t-test and the Wilcoxon signed-rank test were used to assess differences for parametric and non-parametric data. RESULTS: (mean attenuation difference +7% vs. +2%; Euclidean distance of histograms 0.029 vs. 0.016). CONCLUSIONS: -reconstructions of PCD-CCTA datasets can be used to reliably assess EAT volume with a high accuracy and only minor differences in CT values compared to TNC. Substitution of TNC would significantly decrease patient's radiation dose. KEY POINTS: ) enables reliable assessment of EAT volume and attenuation with superior accuracy compared to measurements on conventional VNC- and CCTA-series.

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