2025/11/20 by Demmert, Tristan T, Klambauer, Konstantin, Moser, Lukas +7
Engineering · Medicine · #610 Medicine & #Advanced X-ray and CT Imaging #Agatston score #CCTA #Calcification #Cardiac Imaging and Diagnostics #Coronary #ICA #Medical Imaging Techniques and Applications #health
paper · doi:10.5167/uzh-280827
openalex publication_date 2025/11/20 · openalex created_date 2025/12/11 · openalex updated_date 2026/07/28
Objectives: Severe coronary artery calcification leads to blooming artifacts in conventional coronary CT angiography (CCTA), which may reduce diagnostic accuracy. Ultra-high resolution (UHR) photon-counting detector CT (PCD-CT) reduces calcium blooming. This study aimed to evaluate the diagnostic performance of UHR CCTA with PCD-CT for detecting coronary stenoses in patients with a high coronary calcium burden compared to invasive coronary angiography (ICA). Materials and methods: In this IRB-approved single-center study, patients with Agatston scores > 600 were included, who underwent ICA and coronary UHR PCD-CT angiography within 2 months. 94% of patients underwent CT prior to transcatheter aortic valve replacement. Coronary arteries were graded for diameter stenosis severity (> 50, > 70%) by two blinded, independent readers. Accuracy, sensitivity, and specificity of CCTA were calculated using ICA as the reference standard. Subgroup analyses were performed across Agatston score groups (600-999, 1000-1999, 2000-2999, and > 3000). Results: 62 patients (mean age, 76 ± 9 years, 16 women) were included. The median Agatston score was 2423 (IQR: 1085-3340). Across all Agatston categories, CCTA demonstrated high diagnostic accuracy and strong agreement with ICA (Cohen's kappa 0.71-1.00). In patients with Agatston scores > 3000 (n = 18), the diagnostic performance of coronary UHR PCD-CT angiography for detecting > 50% (sensitivity 92-100%, specificity 83-100%) and > 70% diameter stenosis (sensitivity 88-100%, specificity 89-100%) remained high for both readers. There was no correlation between the Agatston score and diagnostic error (p > 0.05). Conclusion: UHR CCTA with PCD-CT provides high diagnostic performance even in patients with extensive coronary calcifications.