ArticleEuropean radiology2021
Subtraction improves the accuracy of coronary CT angiography for detecting obstructive disease in severely calcified segments.
Article in European radiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 9 citations in OpenAlex.
- Integration of Magnetocardiography and Coronary Computed Tomography Angiography With Machine Learning for Detection of Functionally Significant Myocardial Ischemia.Reviews in cardiovascular medicine · 2026Article
- Diagnostic value of subtraction CT in evaluating the efficacy of transcatheter arterial chemoembolization-treated hepatocellular carcinoma patients compared to conventional CT and MRI.Quantitative imaging in medicine and surgery · 2026Article
- Diagnostic Performance of Photon-Counting CT Angiography in Vascular Stenosis Assessment: A Systematic Review and Meta-Analysis.Diagnostics (Basel, Switzerland) · 2026Review
- Subtraction fractional flow reserve with computed tomography and pericoronary fat attenuation index enhances the identification of revascularization needs in patients.BMC medical imaging · 2025Article
- Comparison of magnetocardiography and coronary computed tomographic angiography for detection of coronary artery stenosis and the influence of calcium.European radiology · 2025Article
- Diagnostic Accuracy of Subtraction Coronary CT Angiography in Severely Calcified Segments: Comparison Between Readers With Different Levels of Experience.Frontiers in cardiovascular medicine · 2022Article
- Diagnostic Improvements of Deep Learning-Based Image Reconstruction for Assessing Calcification-Related Obstructive Coronary Artery Disease.Frontiers in cardiovascular medicine · 2021Article
Corrections and comments
- Erratum issued
Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo investigate the accuracy, diagnostic confidence, and interobserver agreement of subtraction coronary CT angiography (CCTA) versus invasive coronary angiography on 320-row CT in coronary segments with severe or non-severe calcification. MATERIALS/
methodsSixty-four patients (33 men, 66.6 ± 8.2 years) with suspected coronary artery disease (CAD) were prospectively enrolled from October 2019 to June 2020. The cross-sectional circumferential extent of calcification was used to classify calcified segments as non-severely ( < 180°) or severely calcified ( ≥ 180°). Three independent, blinded radiologists evaluated the severity of coronary stenosis. Interobserver agreement was evaluated using Fleiss' kappa (κ). A multiple-reader multiple-case receiver operating characteristic (ROC) method was conducted, and diagnostic accuracy was measured using the mean areas under the ROC curves (AUCs), with ≥ 50% stenosis as a cut-off. Diagnostic confidence, diagnostic accuracy, and interobserver agreement were compared between CCTA with or without subtraction information in severely and non-severely calcified segments.
resultsIn cases with severe calcification (51 patients, 146 segments), CCTA with subtraction information achieved better diagnostic accuracy (per-patient AUC: 0.73 vs 0.57, p = 0.03; per-segment AUC: 0.85 vs 0.62, p = 0.01), diagnostic confidence (3.7 vs 2.6, p < 0.001), and interobserver agreement (κ: 0.59 vs 0.30). Diagnostic accuracy (per-patient AUC: 0.81 vs 0.93, p = 0.30; per-patient AUC: 0.79 vs 0.82, p = 0.54) was not increased in cases with non-severe calcification (13 patients, 190 segments).
conclusionsCCTA with subtraction information achieved better diagnostic accuracy in cases of severe calcification (circumferential extent ≥ 180°). However, for non-severe calcification (circumferential extent < 180°), the effect of calcium subtraction was unclear, as it did not improve diagnostic accuracy. KEY POINTS: • Subtraction coronary CT angiography achieves better diagnostic accuracy, higher diagnostic confidence, and increased interobserver agreement for severe calcification (circumferential extent ≥ 180°). • Calcium subtraction does not improve the diagnostic accuracy of coronary CT angiography for calcification with a circumferential extent of < 180°.
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