Evidence map›Paper›PMID 41714425›Full record

ArticleEuropean radiology2026

Coronary artery calcium scoring: expanding the new standard by photon-counting detector CT Part II: Impact of virtual monoenergetic image reconstructions with adjusted calcium scoring thresholds.

Nicola Fink, Lennart R Koetzier, Emese Zsarnoczay, Milan Vecsey-Nagy, Dmitrij Kravchenko, Muhammad Taha Hagar, Jim O'Doherty, Moritz C Halfmann, Pal Suranyi, Gijs D van Praagh and 6 more

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Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Nicola FinkDepartment of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
Lennart R KoetzierDepartment of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
Emese ZsarnoczayDepartment of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
Milan Vecsey-NagyDepartment of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
Dmitrij KravchenkoDepartment of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
Muhammad Taha HagarDepartment of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
Jim O'DohertyDepartment of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
Moritz C HalfmannDepartment of Diagnostic and Interventional Radiology, University Medical Center of Johannes Gutenberg-University, Mainz, Germany.
Pal SuranyiDepartment of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
Gijs D van PraaghDepartment of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
Jens RickeDepartment of Radiology, University Hospital, LMU Munich, Munich, Germany.
Pal Maurovich-HorvatDepartment of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary.
Tobias BäuerleDepartment of Diagnostic and Interventional Radiology, University Medical Center of Johannes Gutenberg-University, Mainz, Germany.
Martin J WilleminkDepartment of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
Akos Varga-SzemesDepartment of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. musccvi@musc.edu.ORCID http://orcid.org/0000-0002-2781-7462
Tilman EmrichDepartment of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesPart I of this study introduced a new photon-counting detector (PCD-)CT protocol for coronary artery calcium (CAC) scoring using 120 kVp, 75% dose, thin slices, quantum iterative reconstructions (IR) 2, leading to a significant reduction of score variability. The second part evaluated the potential of virtual monoenergetic image (VMI) reconstruction in further reducing score variability with PCD-CT. MATERIALS AND

methodsCAC scoring was performed on PCD-CT with a chest phantom containing nine calcifications using the optimized PCD-CT protocol from Part I. Images were reconstructed at different VMI levels (50-80 keV, 5 keV-steps), with adjusted CAC thresholds to maintain density equivalence to 70 keV. CAC scores, image noise, and calcification detectability were investigated. Results were compared to standard PCD-CT, EID-CT and previously proposed EID-CT protocols.

resultsUsing 65 keV reconstructions, score variability decreased by 9% compared to the optimized PCD-CT protocol from Part I, by 43% vs. the standard PCD-CT, by 78% vs. the standard EID-CT, and by 69% vs. the proposed EID-CT protocol. Image noise remained within targets, eliminating the risk of false-positives. Calcification detectability was comparable to the optimized PCD-CT protocol (7.1 ± 0.6 vs. 7.1 ± 0.8). Calcium volume and mass scores from the keV-optimized PCD protocol were closer to the physical reference compared to scores from the standard PCD protocol.

conclusionsScore variability and calcification detectability in PCD-CT-based CAC scoring can be further improved when augmenting an optimized PCD-CT protocol at 65 keV. In addition to reducing the radiation dose, this protocol may enable more consistent CAC quantification and seems to perform even better than the proposed, multivendor EID-CT protocol. KEY POINTS: Question Coronary calcium scoring lacks reproducibility. Adding virtual monoenergetic imaging with adapted thresholds to a pre-optimized photon-counting CT protocol may further improve score variability. Findings A 120 kVp, 75%-dose, thin-slice photon-counting CT protocol at 65 keV achieved the lowest coronary calcium score variability compared to previous protocols. Clinical relevance Minimizing variability in coronary calcium scoring improves the technical reliability of serial measurements. The additional use of virtual monoenergetic imaging further reduces variability in photon-counting CT, supporting a precise and consistent cardiovascular risk assessment.

Indexed as

CalcinosisCoronary AngiographyCoronary Artery DiseaseRadiographic Image Interpretation, Computer-AssistedTomography, X-Ray ComputedAlgorithmsCalciumHumansPhantoms, ImagingPhotonsRadiation DosageReproducibility of ResultsSensitivity and SpecificityCalciumAgatston scoreCoronary artery calciumPhantom studyPhoton-counting detector CTVirtual monoenergetic images

Identifiers

PMID41714425
PMCPMC13282229

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.