Objectives Reducing motion artifacts in coronary computed tomography angiography (CCTA) is essential for accurate coronary artery disease assessment. We evaluated the clinical performance of a motion-compensated reconstruction (MCR) using subjective image quality (SIQ) and interpretability of CCTA at varying heart rates (HR). Materials and methods We retrospectively identified 150 patients, grouped by HR (≤ 60, 60–69, ≥ 70 bpm, n = 50 each), referred for prospective ECG-gated CCTA on a spectral dual-layer CT. Two blinded observers independently assessed SIQ on a per-segment (≥ 1.5 mm) and per-patient level using a 4-point Likert scale in 18 coronary segments (78% RR-interval). Sufficient diagnostic interpretability was defined as SIQ ≥ 2. Per-vessel scores were calculated excluding side branch segments. Per-segment SIQ interobserver agreement was assessed using Cohen’s Weighted Kappa. Between MCR and standard reconstruction (SR) at 78% RR-interval, SIQ was compared with Wilcoxon signed-rank tests and diagnostic interpretability and HR-categories using McNemar tests. Results Mean age was 57 (50–64) years, with 50% men, and 1970 included segments. Interobserver agreement was 0.80 for SR and 0.77 for MCR. Positive trends of improved SIQ were seen across all HR-categories and levels, with significant improvements in all but ≥ 70 bpm on a patient level (p = 0.22). Likewise, positive trends were seen for diagnostic interpretability across all levels and HR-categories with significant improvements at the per-segment level for HR > 60 bpm and per-patient level for 61–69 bpm. Conclusion Compared to the standard reconstruction at 78% RR-interval, MCR significantly improves SIQ and diagnostic interpretability in patients referred for CCTA in most HRs and major vessels (≥ 1.5 mm). Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Motion artifacts hinder the assessment of coronary arteries on coronary CT angiography (CCTA), leading to more non-diagnostic segments or scans. <Emphasis Type="BoldItalic">Findings</Emphasis> Compared to the standard reconstruction 78% RR-interval, motion compensated reconstruction (MCR) significantly improves subjective image quality (SIQ) and diagnostic interpretability across heart rate categories. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> By integrating multi-phase data into an optimized single-phase reconstruction with improved SIQ and diagnostic interpretability, MCR may reduce the need for multi-phase assessments when the target phase is non-diagnostic. Graphical Abstract

Motion compensated reconstruction improves image quality and interpretability of dual-layer coronary CT angiography

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2025年9月3日

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Philip M. Tetteroo,
Niels R. van der Werf,
Isabelle Bax,
Mani Vembar,
Tim Leiner,
Pim A. de Jong,
Birgitta K. Velthuis,
Dominika Suchá

摘要

Objectives

Reducing motion artifacts in coronary computed tomography angiography (CCTA) is essential for accurate coronary artery disease assessment. We evaluated the clinical performance of a motion-compensated reconstruction (MCR) using subjective image quality (SIQ) and interpretability of CCTA at varying heart rates (HR).

Materials and methods

We retrospectively identified 150 patients, grouped by HR (≤ 60, 60–69, ≥ 70 bpm, n = 50 each), referred for prospective ECG-gated CCTA on a spectral dual-layer CT. Two blinded observers independently assessed SIQ on a per-segment (≥ 1.5 mm) and per-patient level using a 4-point Likert scale in 18 coronary segments (78% RR-interval). Sufficient diagnostic interpretability was defined as SIQ ≥ 2. Per-vessel scores were calculated excluding side branch segments. Per-segment SIQ interobserver agreement was assessed using Cohen’s Weighted Kappa. Between MCR and standard reconstruction (SR) at 78% RR-interval, SIQ was compared with Wilcoxon signed-rank tests and diagnostic interpretability and HR-categories using McNemar tests.

Results

Mean age was 57 (50–64) years, with 50% men, and 1970 included segments. Interobserver agreement was 0.80 for SR and 0.77 for MCR. Positive trends of improved SIQ were seen across all HR-categories and levels, with significant improvements in all but ≥ 70 bpm on a patient level (p = 0.22). Likewise, positive trends were seen for diagnostic interpretability across all levels and HR-categories with significant improvements at the per-segment level for HR > 60 bpm and per-patient level for 61–69 bpm.

Conclusion

Compared to the standard reconstruction at 78% RR-interval, MCR significantly improves SIQ and diagnostic interpretability in patients referred for CCTA in most HRs and major vessels (≥ 1.5 mm).

Key Points

Question Motion artifacts hinder the assessment of coronary arteries on coronary CT angiography (CCTA), leading to more non-diagnostic segments or scans.

Findings Compared to the standard reconstruction 78% RR-interval, motion compensated reconstruction (MCR) significantly improves subjective image quality (SIQ) and diagnostic interpretability across heart rate categories.

Clinical relevance By integrating multi-phase data into an optimized single-phase reconstruction with improved SIQ and diagnostic interpretability, MCR may reduce the need for multi-phase assessments when the target phase is non-diagnostic.

Graphical Abstract