Coronary Artery Calcium Scoring with Photon-Counting Detector CT: Ultra-Low-Dose Scan Versus Coronary CT Angiography-Derived Images.

Authors

Suguru Araki, Satoshi Nakamura, Mana Deguchi, Akio Yamazaki, Shintaro Yamaguchi, Naoki Hashimoto, Takanori Kokawa, Masafumi Takafuji, Yasutaka Ichikawa, Hajime Sakuma, Kakuya Kitagawa

Published in

Journal of cardiovascular computed tomography. Aug 14, 2026. Epub Aug 14, 2026.

Abstract

To compare coronary artery calcium (CAC) scores from ultra-low-dose true non-contrast (TNC), virtual non-contrast (VNC), and virtual non-iodine (VNI) images with standard TNC on a dual-source photon-counting detector CT (PCD-CT).
In this prospective single-center study (January 2025-March 2026), patients underwent standard TNC (sequential, 120 kVp), ultra-low-dose TNC (high-pitch helical, tin-filtered 100 kVp), and coronary CT angiography (CCTA); VNC and VNI images were generated from CCTA. CAC scores and burden categories were evaluated. Correlation and agreement with standard TNC were assessed using Pearson coefficients with Williams' test, Bland-Altman plots, and weighted Cohen's kappa.
Seventy-one patients (median age, 75 years; 52 men) were evaluated. Median dose-length product was 7.98, 71.8, and 428 mGy cm for ultra-low-dose TNC, standard TNC, and CCTA, respectively. Ultra-low-dose TNC showed the strongest correlation with standard TNC (r = 0.996), superior to VNI (r = 0.976, P < 0.001) and VNC (r = 0.900, P < 0.001). Agreement in CAC burden categorization was excellent for ultra-low-dose TNC (κ = 0.932) and good for VNI (κ = 0.827), whereas VNC showed moderate agreement (κ = 0.424). VNI had minimal bias (mean difference, -3.9) but wider limits of agreement than ultra-low-dose TNC (-356.5 to 348.6 vs. -163.2 to 105.9). VNC underestimated CAC scores (mean bias, -442.0).
Ultra-low-dose TNC with dual-source PCD-CT showed excellent agreement with standard TNC while reducing radiation by nearly 90%. VNI was acceptable but less robust, whereas VNC substantially underestimated CAC scores. Ultra-low-dose TNC is a reliable, dose-efficient alternative to standard TNC for CAC scoring.

PMID:
42601305
Bibliographic data and abstract were imported from PubMed on 15 Aug 2026.

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