Abstract
Computed tomographic (CT) coronary artery angiography with calcium scoring is crucial in suspecting coronary artery disease (CAD). The routine protocol for CAD radiological investigation involves a precontrast series for calcium scoring and a postcontrast series for investigating structural changes in coronary arteries. This review intends to investigate the feasibility of virtual noncontrast images to replace the true noncontrast (TNC) images in coronary artery calcium scoring to decrease the radiation dose. The current review included articles found in the PubMed database. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the further evaluation of the articles for inclusion criteria, 25 articles were finally shortlisted for the final review. It is found that the calcium score of coronary arteries estimated by virtual unenhanced images generated by dual-energy CT (DECT) is comparable with that of TNC images. The virtual unehncanced images has the potential to eliminate the need for the TNC series acquisition, thereby reducing the radiation dose. Especially, photon-counting detector-based DECT has excellent potential in the estimation of calcium scores and the reduction in radiation dose. In addition, contrast dose also can be significantly reduced, which is crucial in patients with renal insufficiency. In conclusion, using DECT for CAD investigations significantly reduces both radiation and contrast doses compared to conventional CT scans. This reduction is particularly crucial for patients who require repeated follow-up scans, as it enhances their safety and minimizes potential risks.