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Plaques on CCTA were defined as missed if they showed no spatial overlap with NCCT-detected plaques after deep learning-aided co-registration. Comparisons of plaque volume, density, and local coronary luminal attenuation between plaques missed and those detected by CCTA were performed using the Mann\u2013Whitney U-test. In addition, the presence of these plaques on standard calcium scoring CT was assessed. Interobserver agreement was assessed using the intraclass correlation coefficient and Bland\u2012Altman analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This study included 45 patients (40% female, mean age 62\u2009\u00b1\u200911 years), in whom CCTA missed 37.6% of calcified plaques detected by NCCT (121\/322). Missing calcified plaques on CCTA misclassified 8.9% of patients (4\/45) as having no plaques. Compared with detected plaques, plaques missed by CCTA were both significantly smaller in volume (3.0\u2009mm\u00b3 [IQR, 1.5\u20134.9] vs. 9.2\u2009mm\u00b3 [IQR, 4.3\u201321.9],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and had lower density (212.7 HU [IQR, 174.5\u2013242.4] vs. 292.7 HU [IQR, 243.2\u2013361.3],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Only 44.0% of plaques (53\/121) missed by CCTA were detected by standard calcium scoring CT. Interobserver analysis demonstrated excellent agreement for calcified plaque volume on CCTA (ICC\u2009=\u20090.91) and NCCT (ICC\u2009=\u20090.98).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CCTA missed more than one-third of coronary calcified plaques that are identifiable on co-registered thin-slice NCCT, which suggests an underutilized role of thin-slice NCCT in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      Accurate detection of all coronary plaques is crucial for risk stratification. CCTA misses calcified plaques, which are detectable by thin-slice non-contrast CT (NCCT).\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      CCTA misses over one-third of calcified plaques, nearly half of which are also missed by calcium scoring CT. NCCT detected these calcified plaques.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      Deep learning-aided registration enables multimodal CCTA\u2013NCCT assessment, improving detection of calcified plaques overlooked by CCTA alone and providing more accurate plaque burden quantification that may support better clinical decision-making, which should be investigated in future studies.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12501-y","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T17:15:32Z","timestamp":1776705332000},"page":"6636-6646","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Detection of calcified plaques: comparison between coronary CT angiography and thin-slice non-contrast CT with deep learning-aided image registration"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7104-9049","authenticated-orcid":false,"given":"Kenrick","family":"Schulze","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Biavati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"F\u00f6llmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sotirios","family":"Tsogias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surenjav","family":"Chimed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Balogh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Nagy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferhat","family":"Yavuz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Marieke","family":"Stantien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renad-Heyam","family":"Abdelrahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Lukas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Bosserdt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Kachelrie\u00df","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Samek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Dewey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"12501_CR1","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/j.jacc.2005.02.088","volume":"46","author":"Y Arad","year":"2005","unstructured":"Arad Y, Goodman KJ, Roth M, Newstein D, Guerci AD (2005) Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis Heart Study. 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M.D. has received grant support from the FP7 Program of the European Commission for the randomized multicenter DISCHARGE trial (EC-GA 603266 in HEALTH.2013.2.4.2-2). He also received grant support from German Research Foundation (DFG) in the Heisenberg Program (DE 1361\/14-1, DFG project number: 213705389), graduate program on quantitative biomedical imaging (BIOQIC, GRK 2260\/1, DFG project number: 289347353), for fractal analysis of myocardial perfusion (DE 1361\/18-1\/2, DFG project number: 392304398), the DFG Priority Programme Radiomics (DFG project number: 402688427) for the investigation of coronary plaque and coronary flow (DE 1361\/19-1 [DFG project number: 428222922] and DE 1361\/20-1 [DFG project number: 428223139] in SPP 2177\/1), the GUIDE-IT project on data sharing of medical imaging trials (DE 1361\/24-1 [DFG project number: 495697118]), the Quantitative Cardiovascular Imaging (QCI) meetings (2nd: DE 1361\/22-1 and 3rd: DE 1361\/32-1), and the Future of Medical Imaging meeting (DE 1361\/28-1). He also received funding from the Berlin University Alliance (GC_SC_PC 27), from the Innovationsfond of the G-BA for the IMPRO project (01NVF23002), and from the Digital Health Accelerator of the Berlin Institute of Health for fractal analysis of CT and MRI. He was the European Society of Radiology (ESR) Publications Chair (2022\u20132025), and the opinions expressed in this article are the author\u2019s own and do not represent the view of ESR. Per the guiding principles of ESR, the work as Publications Chair is on a voluntary basis, and only remuneration of travel expenses occurs. He is also the editor of\n                      Cardiac CT\n                      , published by Springer Nature, and offers hands-on courses on CT imaging (\n                      \n                      ). No other conflicts of interest are reported by any of the authors.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"No complex statistical methods were necessary for this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all participants in this trial before randomization.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The DISCHARGE trial obtained ethical approval at the coordinating site (EA1\/294\/13) and from the German Federal Office for Radiation Protection (Z5-2246\/2-2014-001). All clinical sites obtained ethical approval according to national law.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All study subjects have been previously reported in the DISCHARGE trial (NCT02400229).","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}