Photon-Counting CCTA PureCalcium Images Show Potential to Replace TNC Images for Measuring Agatston Scores

Background: Coronary artery calcium scoring (CACS) has been utilized for the detection and management of coronary artery disease and is acquired before coronary CT angiography (CCTA) as part of the noninvasive workup. This adds to the total radiation dose of the examination. Photon-counting CT is a newer technology that can provide a customized algorithm for virtual noncontrast image reconstruction from the spectral data derived from CCTA specifically for the purpose of CACS (PureCalcium, Siemens Healthineers). A prior study (using a prior software version) found significant differences in the Agatston score between PureCalcium images and true noncontrast (TNC) CT images. The newest software version (VA50) incorporates an improved PureCalcium algorithm. Objective: To evaluate CACS differences based on PureCalcium images derived from contrast-enhanced photon-counting CCTA compared to TNC images and also to evaluate the impact of these differences on the clinically relevant patient cla more...