{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T14:08:10Z","timestamp":1765980490018,"version":"3.48.0"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T00:00:00Z","timestamp":1753142400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T00:00:00Z","timestamp":1753142400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"Abstract<\/jats:title>\n \n Objectives:<\/jats:title>\n This study investigated differences between aortic valve calcium (AVC) scores derived from true non-contrast (TNC) and virtual-non-contrast reconstructions acquired with photon-counting detector CT (PCD-CT) and the impact of ECG-phase variability on AVC scores.<\/jats:p>\n <\/jats:sec>\n \n Materials and methods<\/jats:title>\n \n A hundred patients undergoing PCD-CT for transcatheter aortic valve implantation (TAVI) planning were retrospectively analyzed. Scores were computed using the Agatston methodology for TNC and virtual-non-iodine (VNI) reconstruction at scanner-selected optimal phase (best) and a fixed ECG-phase (300\u2009ms). For VNI reconstructions, additional phases from 150\u2009ms to 450\u2009ms with 50\u2009ms increments were reconstructed. AVC scores of TNC\n best<\/jats:sub>\n vs TNC\n 300<\/jats:sub>\n , VNI\n best<\/jats:sub>\n vs TNC\n best,<\/jats:sub>\n VNI\n 300<\/jats:sub>\n vs TNC\n 300<\/jats:sub>\n , and all VNI phases vs VNI\n best<\/jats:sub>\n were compared using Wilcoxon signed-rank tests. The agreement was assessed using scatter plots, Bland\u2013Altman plots, and intra-class coefficients. AVC scores were also categorized based on the likelihood of severe aortic stenosis. Differences between reconstructions were evaluated as percentages (reclassification) and analyzed using Cohen\u2019s kappa coefficients.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n TNC\n best<\/jats:sub>\n and TNC\n 300<\/jats:sub>\n differed significantly (mean bias: 226; LoA: [\u2212820, 1300];\n p<\/jats:italic>\n \u2009<\u20090.001, reclassification 17%). VNI\n best<\/jats:sub>\n vs TNC\n best<\/jats:sub>\n resulted in a mean bias of \u2212512 (LoA: [\u22121900, 860];\n p<\/jats:italic>\n \u2009<\u20090.001) and reclassification of 17%. TNC\n 300<\/jats:sub>\n vs VNI\n 300<\/jats:sub>\n demonstrated a bias of \u2212200 and reclassification of 14% (\u03ba\u2009=\u20090.72). VNI reconstructions showed less variability across phases than the difference between TNC\n best<\/jats:sub>\n and TNC\n 300<\/jats:sub>\n (range, mean bias: 22\u2013146).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n VNI is a feasible alternative for AVC scoring but tends to overestimate compared to TNC. While phase-dependent variability in TNC underscores the need for standardization, further optimization of VNI is necessary for routine clinical use.<\/jats:p>\n <\/jats:sec>\n \n Key Points<\/jats:title>\n \n \n Question<\/jats:italic>\n <\/jats:bold>\n What is the performance of AVC score calculation from virtual non-contrast images with PCD-CT and the impact of the reconstructed ECG-phase<\/jats:italic>\n ?\n <\/jats:p>\n \n \n Findings<\/jats:italic>\n <\/jats:bold>\n VNI reconstructions tend to overestimate the scores compared to non-enhanced acquisitions. ECG phase significantly impacts AVC scores for non-enhanced acquisitions and VNI reconstructions<\/jats:italic>\n .\n <\/jats:p>\n \n \n Clinical relevance<\/jats:italic>\n <\/jats:bold>\n Utilizing VNI reconstructions to calculate AVC scores might reduce radiation dose, and understanding the influence of ECG-phase on these scores might improve reliability<\/jats:italic>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Graphical Abstract<\/jats:title>\n <\/jats:sec>","DOI":"10.1007\/s00330-025-11814-8","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T16:10:35Z","timestamp":1753200635000},"page":"194-202","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multiphase aortic valve calcium scoring on true-non-contrast and calcium-preserving spectral reconstructions using dual-source photon-counting detector CT"],"prefix":"10.1007","volume":"36","author":[{"given":"Judith","family":"van der Bie","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark M. 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Budde.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript declare relationships with the following companies: Institutional support to Erasmus MC by Siemens Healthineers. R.P.J. Budde: Speaker's bureau, Siemens and Bayer, and advisory board, Bayer, payment to Erasmus MC.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"D. Bos kindly provided statistical advice for this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all subjects (patients) in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}