Quantitative coronary artery and aortic valve calcification by virtual non-contrast Images from dual-energy delayed CT scans in patients with severe aortic stenosis

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Publication Details

Journal
The International Journal of Cardiovascular Imaging
Published
2026-09-11
DOI
https://doi.org/10.1007/s10554-026-03822-6
Primary Topic
Advanced X-ray and CT Imaging
Type
article
Field-Weighted Citation Impact
0.00

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article

Quantitative coronary artery and aortic valve calcification by virtual non-contrast Images from dual-energy delayed CT scans in patients with severe aortic stenosis

Bashaer Gheyath, Alan C. Kwan, Damini Dey, Hidesato Fujito et al.
The International Journal of Cardiovascular Imaging
Advanced X-ray and CT Imaging
article

Quantitative coronary artery and aortic valve calcification by virtual non-contrast Images from dual-energy delayed CT scans in patients with severe aortic stenosis

Bashaer Gheyath, Alan C. Kwan, Damini Dey, Hidesato Fujito, Kaveh Rezaei Bookani, Sunam Lee, Daniel S. Berman, Balaji Tamarappoo, John Friedman, Piotr Slomka, Sung woo Cho, Donghee Han, Raj Makkar
article en

Abstract

With the growing use of delayed dual-energy computed tomography (DECT) imaging for extracellular volume assessment, this study aimed to assess the accuracy of coronary artery calcium (CAC) and aortic valve calcification (AVC) quantification in virtual non-contrast (VNC) images derived from delayed DECT images. Eighty-eight patients undergoing pre-transcatheter aortic valve replacement (TAVR) cardiac CTA with DECT were retrospectively enrolled. We compared CAC score (CACS), CAC volume, AVC score (AVCS), and AVC volume between true non-contrast (TNC) and VNC images. VNC images were created by subtracting iodine from delayed CT angiography using commercial post-processing software. Concordance for the likelihood of severe aortic stenosis (AS) between TNC and VNC was assessed using guideline-based AVCS thresholds: men > 3,000 AU, women > 1,600 AU (highly likely); men > 2,000 AU, women > 1,200 AU (likely). CACS was lower in VNC than TNC (363.0 [13.7-1,154.0] AU vs. 470.1 [46.8-1,569.9] AU, p < 0.001), but the correlation was excellent (r = 0.966). No significant difference between VNC and TNC was observed in AVCS (959.5 [321.2-2,475.0] AU vs. 1,079.6 [492.2-2,329.4] AU, p = 0.521), with strong correlation (r = 0.966). Application of a correction factor (1.1-fold) improved agreement between VNC- and TNC-derived CACS (weighted κ = 0.839 to 0.869). Diagnostic concordance for severe AS between VNC and TNC was 92.1% (weighted kappa = 0.785) at the "highly likely" threshold and 97.7% (weighted kappa = 0.952) at the "likely" threshold. Delayed VNC images from DECT demonstrate strong agreement with TNC images for CACS and AVCS, suggesting that delayed VNC could potentially reduce the need for TNC acquisition in pre-TAVR assessment.

The International Journal of Cardiovascular Imaging
Nihon University (JP), Cedars-Sinai Medical Center (US), University of Arizona (US), The Catholic University of Korea St. Vincent's Hospital (KR), Inje University Ilsan Paik Hospital (KR), Cedars-Sinai Smidt Heart Institute (US)
Cedars-Sinai Medical Center
Openalex Percentile: Top 20%
Advanced X-ray and CT Imaging
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