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Devia-Rodriguez R, Derksen M, de Groot K, Vedder IR, Zeebregts CJ, Bokkers RPH, Pol RA, de Vries JPPM, Schuurmann RCL. Validation of a Length-Adjusted Abdominal Arterial Calcium Score Method for Contrast-Enhanced CT Scans. Diagnostics (Basel) 2023; 13:diagnostics13111934. [PMID: 37296786 DOI: 10.3390/diagnostics13111934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The Agatston score on noncontrast computed tomography (CT) scans is the gold standard for calcium load determination. However, contrast-enhanced CT is commonly used for patients with atherosclerotic cardiovascular diseases (ASCVDs), such as peripheral arterial occlusive disease (PAOD) and abdominal aortic aneurysm (AAA). Currently, there is no validated method to determine calcium load in the aorta and peripheral arteries with a contrast-enhanced CT. This study validated a length-adjusted calcium score (LACS) method for contrast-enhanced CT scans. METHOD The LACS (calcium volume in mm3/arterial length in cm) in the abdominal aorta was calculated using four-phase liver CT scans of 30 patients treated between 2017 and 2021 at the University Medical Center Groningen (UMCG) with no aortic disease. Noncontrast CT scans were segmented with a 130 Hounsfield units (HU) threshold, and a patient-specific threshold was used for contrast-enhanced CTs. The LACS was calculated and compared from both segmentations. Secondly, the interobserver variability and the influence of slice thickness (0.75 mm vs. 2.0 mm) was determined. RESULTS There was a high correlation between the LACS from contrast-enhanced CT scans and the LACS of noncontrast CTs (R2 = 0.98). A correction factor of 1.9 was established to convert the LACS derived from contrast-enhanced CT to noncontrast CT scans. LACS interobserver agreement on contrast-enhanced CT was excellent (1.0, 95% confidence interval = 1.0-1.0). The 0.75 mm CT threshold was 541 (459-625) HU compared with 500 (419-568) HU on 2 mm CTs (p = 0.15). LACS calculated with both thresholds was not significantly different (p = 0.63). CONCLUSION The LACS seems to be a robust method for scoring calcium load on contrast-enhanced CT scans in arterial segments with various lengths.
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Affiliation(s)
- Raul Devia-Rodriguez
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Maikel Derksen
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Kristian de Groot
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Issi R Vedder
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Clark J Zeebregts
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Robert A Pol
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
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Kim SY, Suh YJ, Lee HJ, Kim YJ. Progostic value of coronary artery calcium scores from 1.5 mm slice reconstructions of electrocardiogram-gated computed tomography scans in asymptomatic individuals. Sci Rep 2022; 12:7198. [PMID: 35504936 PMCID: PMC9064982 DOI: 10.1038/s41598-022-11332-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/22/2022] [Indexed: 11/18/2022] Open
Abstract
It is unknown whether the thinner slice reconstruction has added value relative to 3 mm reconstructions in predicting major adverse cardiac events (MACEs). This retrospective study included 550 asymptomatic individuals who underwent cardiac CT. Coronary artery calcium (CAC) scores and severity categories were assessed from 1.5 and 3 mm scans. CAC scores obtained from 1.5 and 3 mm scans were compared using Wilcoxon signed-rank tests. Cox proportional hazard models were developed to predict MACEs based on the degree of coronary artery stenosis on coronary CT angiography and the presence of CAC on both scans. Model performances were compared using the time-dependent ROC curve and integrated area under the curve (iAUC) methods. The CAC scores obtained from 1.5 mm scans were significantly higher than those from 3 mm scans (median, interquartile range 4.5[0–71] vs. 0[0–48.4]; p < 0.001). Models showed no difference in predictive accuracy of the presence of CAC between 1.5 and 3 mm scans (iAUC, 0.625 vs. 0.672). In conclusion, CAC scores obtained from 1.5 mm scans are significantly higher than those from 3 mm scans, but do not provide added prognostic value relative to 3 mm scans.
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Affiliation(s)
- Suh Young Kim
- Department of Medicine, College of Medicine, Yonsei University Graduate School, Seoul, Korea.,Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Young Joo Suh
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - Hye-Jeong Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
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Coronary calcification and bone microarchitecture by high-resolution peripheral quantitative computed tomography from the São Paulo Ageing and Health (SPAH) Study. Sci Rep 2022; 12:5282. [PMID: 35347151 PMCID: PMC8960801 DOI: 10.1038/s41598-022-08839-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 03/09/2022] [Indexed: 12/25/2022] Open
Abstract
Epidemiological studies reveal a link between osteoporosis and the risk of ischemic cardiovascular disease. We illustrate an association between coronary calcification and bone microarchitecture in older adults based on the SPAH study. This cross-sectional research comprised 256 individuals subjected to cardiac coronary computed tomography angiography (CCTA) for coronary artery calcification (CAC), high-resolution peripheral quantitative computed tomography (HR-pQCT) at the tibia and radius with standardized z score parameters, and dual-energy X-ray absorptiometry (DXA) to evaluate bone status. We used Student’s t test and the Mann–Whitney and Chi-squared tests for comparison of basal measurements. Association analysis was performed using the Poisson regression model with adjustment for CAC and sex. Multivariate analysis revealed different bone variables for predicting CAC in DXA and HR-pQCT scenarios. Although most of the bone parameters are related to vascular calcification, only cortical porosity (Ct.Po) remained uniform by HR-pQCT. Results for were as follows: the tibia—women (exp β = 1.12 (95% CI 1.10–1.13, p < 0.001) and men (exp β = 1.44, 95% CI 1.42–1.46, p < 0.001); the radius—women (exp β = 1.07 (95% CI 1.07–1.08, p < 0.001) and men (exp β = 1.33 (95% CI 1.30–1.37, p < 0.001). These findings suggest an inverse relationship between CAC and cortical bone content, as assessed by HR-pQCT, with higher coronary calcification in individuals older than 65 years.
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de Jong DJ, van der Star S, Bleys RLAW, Schilham AMR, Kuijf HJ, de Jong PA, Kok M. Computed tomography-based calcium scoring in cadaver leg arteries: Influence of dose, reader, and reconstruction algorithm. Eur J Radiol 2021; 146:110080. [PMID: 34875474 DOI: 10.1016/j.ejrad.2021.110080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Computed tomography (CT) might be a good diagnostic test to accurately quantify calcium in vascular beds but there are multiple factors influencing the quantification. The aim of this study was to investigate the influence of different computed tomography protocol settings in the quantification of calcium in the lower extremities using modified Agatston and volume scores. METHODS Fresh-frozen human legs were scanned at different tube current protocols and reconstructed at different slice thickness. Two different iterative reconstruction protocols for conventional CT images were compared. Calcium was manually scored using modified Agatston and volume scores. Outcomes were statistically analyzed using Wilcoxon signed-rank tests and mean absolute and relative differences were plotted in Bland-Altman plots. RESULTS Of the 20 legs, 16 had CT detectable calcifications. Differences between thick and thin slice reconstruction protocols were 129 Agatston units and 125% for Agatston and 78.4 mm3 and 57.8% for volume (all p ≤ 0.001). No significant differences were found between low and high tube current protocols. Differences between iDose4 and IMR reconstruction protocols for modified Agatston were 34.2 Agatston units and 17.7% and the volume score 33.5 mm3 and 21.2% (all p ≤ 0.001). CONCLUSIONS Slice thickness reconstruction and reconstruction method protocols influenced the modified Agatston and volume scores in leg arteries, but tube current and different observers did not have an effect. This data emphasizes the need for standardized quantification of leg artery calcifications. Possible implications are in the development of a more universal quantification method, independent of the type of scan and vasculature.
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Affiliation(s)
- Daan J de Jong
- Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Simone van der Star
- Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Arnold M R Schilham
- Image Sciences Institute, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Madeleine Kok
- Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands.
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Sandstedt M, Marsh J, Rajendran K, Gong H, Tao S, Persson A, Leng S, McCollough C. Improved coronary calcification quantification using photon-counting-detector CT: an ex vivo study in cadaveric specimens. Eur Radiol 2021; 31:6621-6630. [PMID: 33713174 DOI: 10.1007/s00330-021-07780-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/19/2021] [Accepted: 02/12/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To compare the accuracy of coronary calcium quantification of cadaveric specimens imaged from a photon-counting detector (PCD)-CT and an energy-integrating detector (EID)-CT. METHODS Excised coronary specimens were scanned on a PCD-CT scanner, using both the PCD and EID subsystems. The scanning and reconstruction parameters for EID-CT and PCD-CT were matched: 120 kV, 9.3-9.4 mGy CTDIvol, and a quantitative kernel (D50). PCD-CT images were also reconstructed using a sharper kernel (D60). Scanning the same specimens using micro-CT served as a reference standard for calcified volumes. Calcifications were segmented with a half-maximum thresholding technique. Segmented calcified volume differences were analyzed using the Friedman test and post hoc pairwise Wilcoxon signed rank test with the Bonferroni correction. Image noise measurements were compared between EID-CT and PCD-CT with a repeated-measures ANOVA test and post hoc pairwise comparison with the Bonferroni correction. A p < 0.05 was considered statistically significant. RESULTS The volume measurements in 12/13 calcifications followed a similar trend: EID-D50 > PCD-D50 > PCD-D60 > micro-CT. The median calcified volumes in EID-D50, PCD-D50, PCD-D60, and micro-CT were 22.1 (IQR 10.2-64.8), 21.0 (IQR 9.0-56.5), 18.2 (IQR 8.3-49.3), and 14.6 (IQR 5.1-42.4) mm3, respectively (p < 0.05 for all pairwise comparisons). The average image noise in EID-D50, PCD-D50, and PCD-D60 was 60.4 (± 3.5), 56.0 (± 4.2), and 113.6 (± 8.5) HU, respectively (p < 0.01 for all pairwise comparisons). CONCLUSION The PCT-CT system quantified coronary calcifications more accurately than EID-CT, and a sharp PCD-CT kernel further improved the accuracy. The PCD-CT images exhibited lower noise than the EID-CT images. KEY POINTS • High spatial resolution offered by PCD-CT reduces partial volume averaging and consequently leads to better morphological depiction of coronary calcifications. • Improved quantitative accuracy for coronary calcification volumes could be achieved using high-resolution PCD-CT compared to conventional EID-CT. • PCD-CT images exhibit lower image noise than conventional EID-CT at matched radiation dose and reconstruction kernel.
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Affiliation(s)
- Mårten Sandstedt
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jeffrey Marsh
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Hao Gong
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Shengzhen Tao
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Anders Persson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Tomizawa N. Could coronary calcification identified at non-gated chest CT be a predictor for cardiovascular events in breast cancer patients? Int J Cardiol 2019; 282:108-109. [PMID: 30745257 DOI: 10.1016/j.ijcard.2019.01.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 01/29/2019] [Indexed: 11/26/2022]
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Assessment of Coronary Artery Calcium on Low-Dose Coronary Computed Tomography Angiography With Iterative Reconstruction. J Comput Assist Tomogr 2016; 40:266-71. [PMID: 26720203 DOI: 10.1097/rct.0000000000000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to evaluate whether coronary calcium scoring (CCS) is also feasible using low-radiation-dose coronary computed tomography angiography (CCTA) in combination with iterative reconstruction. METHODS Forty-three individuals without known coronary artery disease underwent both noncontrast CCS (±1 mSv) for reference Agatston scores and low-dose CCTA (±3 mSv). Raw CCTA data were reconstructed with filtered back projection (FBP), hybrid iterative reconstruction (HIR), and model-based iterative reconstruction (MIR). Calcification volumes were derived with thresholds of >351 and >600 Hounsfield units (HU) and converted to proxy Agatston scores with linear regression analysis. RESULTS Intraclass correlation coefficients for Agatston scores versus CCTA volumes with FBP and iterative reconstruction were excellent (ranges 0.94-0.99 and 0.96-0.99 for >351 HU and >600 HU thresholds, respectively). The >351 HU threshold resulted in higher CCTA volume scores ranging from 65.9 (15.1-347.0) for HIR to 94.8 (42.0-423.0) for MIR (P = 0.001 and <0.001, respectively). The >600 HU threshold scores ranged from 14.1 (0.0-159.3) for HIR to 28.6 (0.0-215.6) for MIR (P = 0.003 and 0.027, respectively). At >351 HU, reclassification occurred in 21 individuals (49%) for FBP and HIR and 25 individuals (58%) for MIR. Reclassifications decreased with >600 HU to 10 (HIR, 23%), 8 (FBP, 19%), and 4 (MIR, 9%). CONCLUSIONS The CCS is feasible using iteratively reconstructed low-dose CCTA with a calcium threshold of >600 HU. Using MIR, only 9% of individuals were reclassified.
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Qian Z, Dhungel A, Vazquez G, Weeks M, Voros S, Rinehart S. Coronary artery calcium: 0.5 mm slice-thickness reconstruction with adjusted attenuation threshold outperforms 3.0 mm by validating against spatially registered intravascular ultrasound with radiofrequency backscatter. Acad Radiol 2015; 22:1128-37. [PMID: 26036721 DOI: 10.1016/j.acra.2015.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 03/09/2015] [Accepted: 03/18/2015] [Indexed: 01/07/2023]
Abstract
RATIONALE AND OBJECTIVES Coronary artery calcium (CAC) images can be reconstructed with thinner slice thickness on some modern multidetector-row computed tomography scanners without additional radiation. We hypothesized that the isotropic 0.5-mm CAC reconstruction outperforms the conventional 3.0-mm reconstruction in detecting and quantifying coronary calcium, and we proposed to compare them by validating against spatially registered intravascular ultrasound with radiofrequency backscatter-virtual histology (IVUS-VH). MATERIALS AND METHODS Twenty-seven patients were enrolled, and 5976 mm of coronary arteries were analyzed. A semiautomatic software was developed to coregister CAC and IVUS-VH on a detailed slice-by-slice basis. Calcium detection and calcium volume quantification were evaluated and compared using varying calcium attenuation thresholds. Algorithms for deriving individualized optimal threshold and comparable Agatston score on the 0.5-mm reconstruction were developed. RESULTS The isotropic 0.5-mm reconstruction achieved significantly higher area under receiver-operating curve than the conventional 3.0-mm reconstruction (0.9 vs. 0.74, P < .001). Using the optimal threshold, the 0.5-mm reconstruction had higher sensitivity (0.79 vs. 0.65), specificity (0.85 vs. 0.77), positive predictive value (0.42 vs. 0.29), and negative predictive value (0.97 vs. 0.94) than the 3.0 mm. Individualized optimal threshold was significantly correlated with the image noise (r = 0.66, P < .001) in the 0.5-mm reconstruction. CONCLUSIONS By optimizing the calcium threshold, the 0.5-mm reconstruction is superior to the conventional 3.0-mm in detecting and quantifying calcium, which may improve the clinical value of CAC without additional radiation.
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Brodov Y, Gransar H, Dey D, Shalev A, Germano G, Friedman JD, Hayes SW, Thomson LE, Rogatko A, Berman DS, Slomka PJ. Combined Quantitative Assessment of Myocardial Perfusion and Coronary Artery Calcium Score by Hybrid 82Rb PET/CT Improves Detection of Coronary Artery Disease. J Nucl Med 2015; 56:1345-50. [DOI: 10.2967/jnumed.114.153429] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/02/2015] [Indexed: 01/12/2023] Open
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Qanadli SD, Jouannic AM, Dehmeshki J, Lu TL. CT attenuation values of blood and myocardium: rationale for accurate coronary artery calcifications detection with multi-detector CT. PLoS One 2015; 10:e0124175. [PMID: 25875629 PMCID: PMC4397043 DOI: 10.1371/journal.pone.0124175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 03/13/2015] [Indexed: 11/24/2022] Open
Abstract
Objectives To determine inter-session and intra/inter-individual variations of the attenuations of aortic blood/myocardium with MDCT in the context of calcium scoring. To evaluate whether these variations are dependent on patients’ characteristics. Methods Fifty-four volunteers were evaluated with calcium scoring non-enhanced CT. We measured attenuations (inter-individual variation) and standard deviations (SD, intra-individual variation) of the blood in the ascending aorta and of the myocardium of left ventricle. Every volunteer was examined twice to study the inter-session variation. The fat pad thickness at the sternum and noise (SD of air) were measured too. These values were correlated with the measured aortic/ventricular attenuations and their SDs (Pearson). Historically fixed thresholds (90 and 130 HU) were tested against different models based on attenuations of blood/ventricle. Results The mean attenuation was 46HU (range, 17-84HU) with mean SD 23HU for the blood, and 39HU (10-82HU) with mean SD 18 HU for the myocardium. The attenuation/SD of the blood were significantly higher than those of the myocardium (p<0.01). The inter-session variation was not significant. There was a poor correlation between SD of aortic blood/ventricle with fat thickness/noise. Based on existing models, 90 HU threshold offers a confidence interval of approximately 95% and 130 HU more than 99%. Conclusions Historical thresholds offer high confidence intervals for exclusion of aortic blood/myocardium and by the way for detecting calcifications. Nevertheless, considering the large variations of blood/myocardium CT values and the influence of patient’s characteristics, a better approach might be an adaptive threshold.
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Affiliation(s)
- Salah D. Qanadli
- Department of Radiology, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Quantitative Medical Imaging International Institute, Digital Imaging Research center, Faculty of Computing, Information Systems and Mathematics, University of Kingston, London, United Kingdom
- * E-mail:
| | - Anne-Marie Jouannic
- Department of Radiology, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Jamshid Dehmeshki
- Quantitative Medical Imaging International Institute, Digital Imaging Research center, Faculty of Computing, Information Systems and Mathematics, University of Kingston, London, United Kingdom
| | - Tri-Linh Lu
- Department of Radiology, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Alluri K, Joshi PH, Henry TS, Blumenthal RS, Nasir K, Blaha MJ. Scoring of coronary artery calcium scans: history, assumptions, current limitations, and future directions. Atherosclerosis 2015; 239:109-17. [PMID: 25585030 DOI: 10.1016/j.atherosclerosis.2014.12.040] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 01/07/2023]
Abstract
Coronary artery calcium (CAC) scanning is a reliable, noninvasive technique for estimating overall coronary plaque burden and for identifying risk for future cardiac events. Arthur Agatston and Warren Janowitz published the first technique for scoring CAC scans in 1990. Given the lack of available data correlating CAC with burden of coronary atherosclerosis at that time, their scoring algorithm was remarkable, but somewhat arbitrary. Since then, a few other scoring techniques have been proposed for the measurement of CAC including the Volume score and Mass score. Yet despite new data, little in this field has changed in the last 15 years. The main focus of our paper is to review the implications of the current approach to scoring CAC scans in terms of correlation with the central disease - coronary atherosclerosis. We first discuss the methodology of each available scoring system, describing how each of these scores make important indirect assumptions in the way they account (or do not account) for calcium density, location of calcium, spatial distribution of calcium, and microcalcification/emerging calcium that might limit their predictive power. These assumptions require further study in well-designed, large event-driven studies. In general, all of these scores are adequate and are highly correlated with each other. Despite its age, the Agatston score remains the most extensively studied and widely accepted technique in both the clinical and research settings. After discussing CAC scoring in the era of contrast enhanced coronary CT angiography, we discuss suggested potential modifications to current CAC scanning protocols with respect to tube voltage, tube current, and slice thickness which may further improve the value of CAC scoring. We close with a focused discussion of the most important future directions in the field of CAC scoring.
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Affiliation(s)
- Krishna Alluri
- Department of Internal Medicine, UPMC Mckeesport Hospital, Mckeesport, PA, USA; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Parag H Joshi
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Travis S Henry
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Roger S Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Khurram Nasir
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
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MDCT evaluation of atherosclerotic coronary artery disease: What should radiologists know? Int J Cardiovasc Imaging 2014; 30 Suppl 1:1-11. [DOI: 10.1007/s10554-014-0411-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 03/24/2014] [Indexed: 01/07/2023]
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Aslam A, Khokhar US, Chaudhry A, Abramowicz A, Rajper N, Cortegiano M, Poon M, Voros S. Assessment of isotropic calcium using 0.5-mm reconstructions from 320-row CT data sets identifies more patients with non-zero Agatston score and more subclinical atherosclerosis than standard 3.0-mm coronary artery calcium scan and CT angiography. J Cardiovasc Comput Tomogr 2014; 8:58-66. [DOI: 10.1016/j.jcct.2013.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 12/03/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
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Yoshinobu T, Abe K, Sasaki Y, Tabei M, Tanaka S, Takahashi M, Furuhashi S, Tanaka I, Shizukuishi T, Aizawa T, Maebayashi T, Sakaguchi M, Okuhata Y, Kikuta J, Ishibashi N. Data management solution for large-volume computed tomography in an existing picture archiving and communication system (PACS). J Digit Imaging 2011; 24:107-13. [PMID: 19908094 DOI: 10.1007/s10278-009-9251-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Multidetector row computed tomography (MDCT) creates massive amounts of data, which can overload a picture archiving and communication system (PACS). To solve this problem, we designed a new data storage and image interpretation system in an existing PACS. Two MDCT image datasets, a thick- and a thin-section dataset, and a single-detector CT thick-section dataset were reconstructed. The thin-section dataset was archived in existing PACS disk space reserved for temporary storage, and the system overwrote the source data to preserve available disk space. The thick-section datasets were archived permanently. Multiplanar reformation (MPR) images were reconstructed from the stored thin-section datasets on the PACS workstation. In regular interpretations by eight radiologists during the same week, the volume of images and the times taken for interpretation of thick-section images with (246 CT examinations) or without (170 CT examinations) thin-section images were recorded, and the diagnostic usefulness of the thin-section images was evaluated. Thin-section datasets and MPR images were used in 79% and 18% of cases, respectively. The radiologists' assessments of this system were useful, though the volume of images and times taken to archive, retrieve, and interpret thick-section images together with thin-section images were significantly greater than the times taken without thin-section images. The limitations were compensated for by the usefulness of thin-section images. This data storage and image interpretation system improves the storage and availability of the thin-section datasets of MDCT and can prevent overloading problems in an existing PACS for the moment.
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Affiliation(s)
- Takashi Yoshinobu
- Department of Radiology, Nihon University School of Medicine, 30-1 Oyaguchi kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
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van der Bijl N, Geleijns J, Joemai RMS, Bax JJ, Schuijf JD, de Roos A, Kroft LJM. Recent developments in cardiac CT. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/iim.11.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Assessment of Agatston coronary artery calcium score using contrast-enhanced CT coronary angiography. AJR Am J Roentgenol 2011; 195:1299-305. [PMID: 21098187 DOI: 10.2214/ajr.09.3734] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The purpose of this article is to evaluate to what extent Agatston scores may be derived from CT coronary angiography (CTA) examinations, compared with traditional unenhanced CT calcium scores. MATERIALS AND METHODS Fifty patients with a CT calcium score-Agatston score of zero and 50 patients with a CT calcium score-Agatston score of 1 or greater whose CT calcium scores had been calculated and who had undergone CTA using volumetric 320-MDCT were included. Agatston scores were obtained at 3.0-mm slices for CT calcium score and CTA. Method agreement, interobserver agreement, and diagnostic performance of CTA for detecting coronary calcium were evaluated. RESULTS Of 50 patients with a positive CT calcium score-Agatston score, coronary artery calcium was detected with CTA in 43 patients by observer 1 (mean CTA score, 102 ± 202; mean CT calcium score, 254 ± 501) and in 46 patients by observer 2 (mean CTA score, 94 ± 147; mean CT calcium score, 272 ± 531). Of the 50 patients with a CT calcium score-Agatston score of zero, 49 (98%, observer 1) and 50 (100%, observer 2) had a zero score with CTA as well. An intraclass correlation of 0.78 and 0.62 was found between CT calcium score and CTA (p < 0.01), whereas higher Agatston scores were underestimated with CTA. For observer 1, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for detection of coronary calcium with CTA were 86%, 98%, 98%, 88%, and 92%, respectively, and the corresponding values for observer 2 were 92%, 100%, 100%, 93%, and 96%, respectively. Interobserver agreement was 0.996 for CT calcium score and 0.93 for CTA. CONCLUSION Coronary artery calcium can be detected on CTA images with high accuracy. The Agatston calcium score derived from CTA images shows good correlation with unenhanced CT calcium score and is highly reproducible. However, higher Agatston scores are systematically underestimated when derived from CTA images.
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Honda O, Yanagawa M, Inoue A, Kikuyama A, Yoshida S, Sumikawa H, Tobino K, Koyama M, Tomiyama N. Image quality of multiplanar reconstruction of pulmonary CT scans using adaptive statistical iterative reconstruction. Br J Radiol 2010; 84:335-41. [PMID: 21081572 DOI: 10.1259/bjr/57998586] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We investigated the image quality of multiplanar reconstruction (MPR) using adaptive statistical iterative reconstruction (ASIR). METHODS Inflated and fixed lungs were scanned with a garnet detector CT in high-resolution mode (HR mode) or non-high-resolution (HR) mode, and MPR images were then reconstructed. Observers compared 15 MPR images of ASIR (40%) and ASIR (80%) with those of ASIR (0%), and assessed image quality using a visual five-point scale (1, definitely inferior; 5, definitely superior), with particular emphasis on normal pulmonary structures, artefacts, noise and overall image quality. RESULTS The mean overall image quality scores in HR mode were 3.67 with ASIR (40%) and 4.97 with ASIR (80%). Those in non-HR mode were 3.27 with ASIR (40%) and 3.90 with ASIR (80%). The mean artefact scores in HR mode were 3.13 with ASIR (40%) and 3.63 with ASIR (80%), but those in non-HR mode were 2.87 with ASIR (40%) and 2.53 with ASIR (80%). The mean scores of the other parameters were greater than 3, whereas those in HR mode were higher than those in non-HR mode. There were significant differences between ASIR (40%) and ASIR (80%) in overall image quality (p<0.01). Contrast medium in the injection syringe was scanned to analyse image quality; ASIR did not suppress the severe artefacts of contrast medium. CONCLUSION In general, MPR image quality with ASIR (80%) was superior to that with ASIR (40%). However, there was an increased incidence of artefacts by ASIR when CT images were obtained in non-HR mode.
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Affiliation(s)
- O Honda
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan.
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18
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Arnold BA, Budoff MJ, Child J, Xiang P, Mao SS. Coronary calcium test phantom containing true CaHA microspheres for evaluation of advanced CT calcium scoring methods. J Cardiovasc Comput Tomogr 2010; 4:322-9. [DOI: 10.1016/j.jcct.2010.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 07/19/2010] [Accepted: 08/09/2010] [Indexed: 10/19/2022]
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Arnold BA, Xiang P, Mao SS, Budoff MJ. Peak SNR in automated coronary calcium scoring: Selecting CT scan parameters and statistically defined scoring thresholdsa). Med Phys 2010; 37:3621-32. [DOI: 10.1118/1.3442276] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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20
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van der Bijl N, de Bruin PW, Geleijns J, Bax JJ, Schuijf JD, de Roos A, Kroft LJM. Assessment of coronary artery calcium by using volumetric 320-row multi-detector computed tomography: comparison of 0.5 mm with 3.0 mm slice reconstructions. Int J Cardiovasc Imaging 2010; 26:473-82. [PMID: 20072817 PMCID: PMC2852589 DOI: 10.1007/s10554-010-9581-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 12/28/2009] [Indexed: 01/07/2023]
Abstract
The purpose of this study was to assess the performance of 0.5 versus 3.0 mm slice reconstructions in depicting coronary calcium with special attention to patients having zero calcium scores at 3.0 mm reconstructions by using computed tomography (CT). Imaging was performed by volumetric 320-detector row CT. Scans of 100 patients with a negative and 100 patients with a positive Agatston score at 3.0 mm reconstructions were consecutively selected. Non-overlapping volume sets with 3.0 and 0.5 mm slice thickness were reconstructed from the same raw data and Agatston and volume scores were obtained. The Wilcoxon signed ranks test was used to determine statistical differences between 3.0 and 0.5 mm calcium scores. Agatston and volume scores obtained at 0.5 mm were significantly higher than at 3.0 mm reconstructions (mean Agatston score: 266 +/- 495 vs. 231 +/- 461. Mean volume score: 223 +/- 399 vs. 206 +/- 385, both P < 0.01). In 21% of patients with zero 3.0 mm Agatston scores, a positive Agatston and/or volume score was found at 0.5 mm reconstructions. With volumetric 320-detector row CT, prospective ECG-triggered calcium scoring at 0.5 mm compared to 3.0 mm reconstructions leads to an increase in Agatston and volume scores and small amounts of coronary calcium are earlier depicted. This may be of special interest in patients with zero calcium scores with traditional 3.0 mm measures, where 0.5 mm reconstructions may help in superior depicting or ruling out coronary artery disease.
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Affiliation(s)
- Noortje van der Bijl
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Paul W. de Bruin
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jacob Geleijns
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Joanne D. Schuijf
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Albert de Roos
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Lucia J. M. Kroft
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Greuter MJW, Groen JM, Nicolai LJ, Dijkstra H, Oudkerk M. A model for quantitative correction of coronary calcium scores on multidetector, dual source, and electron beam computed tomography for influences of linear motion, calcification density, and temporal resolution: a cardiac phantom study. Med Phys 2010; 36:5079-88. [PMID: 19994518 DOI: 10.1118/1.3213536] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The objective of this study is to quantify the influence of linear motion, calcification density, and temporal resolution on coronary calcium determination using multidetector computed tomography (MDCT), dual source CT (DSCT), and electron beam tomography (EBT) and to find a quantitative method which corrects for the influences of these parameters using a linear moving cardiac phantom. METHODS On a robotic arm with artificial arteries with four calcifications of increasing density, a linear movement was applied between 0 and 120 mm/s (step of 10 mm/s). The phantom was scanned five times on 64-slice MDCT, DSCT, and EBT using a standard acquisition protocol. The average Agatston, volume, and mass scores were determined for each velocity, calcification, and scanner. Susceptibility to motion was quantified using a cardiac motion susceptibility (CMS) index. Resemblance to EBT and physical volume and mass was quantified using a Delta index. RESULTS Increasing motion artifacts were observed at increasing velocities on all scanners, with increasing severity from EBT to DSCT to 64-slice MDCT. The calcium score showed a linear dependency on motion from which a correction factor could be derived. This correction factor showed a linear dependency on the mean calcification density with a good fit for all three scoring methods and all three scanners (0.73 < or = R2 < or = 0.95). The slope and offset of this correction factor showed a linear dependency on temporal resolution with a good fit for all three scoring methods and all three scanners (0.83 < or = R2 < or = 0.98). CMS was minimal for EBT and increasing values were observed for DSCT and highest values for 64-slice MDCT. CMS was minimal for mass score and increasing values were observed for volume score and highest values for Agatston score. For all densities and scoring methods DSCT showed on average the closest resemblance to EBT calcium scores. When using the correction factor, CMS index decreased on average by 15% and Delta index decreased by 35%. CONCLUSIONS Calcium scores determined on DSCT and 64-slice MDCT are highly susceptible to motion as compared to EBT. The mass score is less susceptible to motion compared to volume and Agatston score. Calcium scores determined on DSCT bear a closer resemblance to EBT obtained calcium scores than 64-slice MDCT. In addition, the calcium score is highly dependent on the average density of individual calcifications and the dependency of the calcium score on motion showed a linear behavior on calcification density. From these relations, a quantitative method could be derived which corrects the measured calcium score for the influence of linear motion, mean calcification density, and temporal resolution.
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Affiliation(s)
- M J W Greuter
- University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
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Groen JM, Dijkstra H, Greuter MJW, Oudkerk M. Threshold adjusted calcium scoring using CT is less susceptible to cardiac motion and more accurate. Med Phys 2009; 36:438-46. [DOI: 10.1118/1.3049590] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Saur SC, Alkadhi H, Desbiolles L, Székely G, Cattin PC. ACCURATUM: improved calcium volume scoring using a mesh-based algorithm—a phantom study. Eur Radiol 2008; 19:591-8. [DOI: 10.1007/s00330-008-1181-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 07/24/2008] [Indexed: 12/22/2022]
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Geluk CA, Dikkers R, Perik PJ, Tio RA, Götte MJW, Hillege HL, Vliegenthart R, Houwers JB, Willems TP, Oudkerk M, Zijlstra F. Measurement of coronary calcium scores by electron beam computed tomography or exercise testing as initial diagnostic tool in low-risk patients with suspected coronary artery disease. Eur Radiol 2007; 18:244-52. [PMID: 17901959 PMCID: PMC2668594 DOI: 10.1007/s00330-007-0755-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 07/26/2007] [Accepted: 08/23/2007] [Indexed: 11/27/2022]
Abstract
We determined the efficiency of a screening protocol based on coronary calcium scores (CCS) compared with exercise testing in patients with suspected coronary artery disease (CAD), a normal ECG and troponin levels. Three-hundred-and-four patients were enrolled in a screening protocol including CCS by electron beam computed tomography (Agatston score), and exercise testing. Decision-making was based on CCS. When CCS>or=400, coronary angiography (CAG) was recommended. When CCS<10, patients were discharged. Exercise tests were graded as positive, negative or nondiagnostic. The combined endpoint was defined as coronary event or obstructive CAD at CAG. During 12+/-4 months, CCS>or=400, 10-399 and <10 were found in 42, 103 and 159 patients and the combined endpoint occurred in 24 (57%), 14 (14%) and 0 patients (0%), respectively. In 22 patients (7%), myocardial perfusion scintigraphy was performed instead of exercise testing due to the inability to perform an exercise test. A positive, nondiagnostic and negative exercise test result was found in 37, 76 and 191 patients, and the combined endpoint occurred in 11 (30%), 15 (20%) and 12 patients (6%), respectively. Receiver-operator characteristics analysis showed that the area under the curve of 0.89 (95% CI: 0.85-0.93) for CCS was superior to 0.69 (95% CI: 0.61-0.78) for exercise testing (P<0.0001). In conclusion, measurement of CCS is an appropriate initial screening test in a well-defined low-risk population with suspected CAD.
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Affiliation(s)
- Christiane A Geluk
- Thoraxcenter, Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, PB 30001, 9700 RB, Groningen, The Netherlands.
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Horiguchi J, Matsuura N, Yamamoto H, Hirai N, Kiguchi M, Fujioka C, Kitagawa T, Kohno N, Ito K. Variability of repeated coronary artery calcium measurements by 1.25-mm- and 2.5-mm-thickness images on prospective electrocardiograph-triggered 64-slice CT. Eur Radiol 2007; 18:209-16. [PMID: 17674003 DOI: 10.1007/s00330-007-0734-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2007] [Revised: 05/27/2007] [Accepted: 07/12/2007] [Indexed: 11/24/2022]
Abstract
High reproducibility on coronary artery calcium scoring is a key requirement in monitoring the progression of coronary atherosclerosis. The purpose of this prospective study is to assess the reproducibility of 1.25-mm- and 2.5-mm-thickness images on prospective electrocardiograph-triggered 64-slice CT with respect to 2.5-mm-thickness images on spiral overlapping reconstruction. One hundred patients suspected of coronary artery disease were scanned twice repeatedly, both on prospective electrocardiograph-triggered step-and-shoot and retrospective electrocardiograph-gated spiral scans. Using 1.25-mm-thickness collimation, 1.25-mm- and 2.5-mm-thickness image sets on prospective scans and 2.5-mm-thickness image sets with 1.25-mm increment (overlapping) on retrospective scans were obtained. Coronary artery calcium scores, interscan variability and interobserver variability were evaluated. The mean interscan variability in coronary artery calcium measurement on 1.25-mm prospective/2.5-mm prospective/2.5-mm overlapping retrospective scans were Agatston: 10%/18%/12%, volume: 10%/12%/10% and mass: 8%/13%/11% for observer 1 and Agatston: 8%/14%/10%, volume: 7%/9%/10% and mass: 7%/10%/9% for observer 2, respectively. The mean interobserver variability was 5% to 14%. In conclusion, prospective electrocardiograph-triggered 64-slice CT using the 1.25-mm prospective scan shows the lowest variability. The 2.5-mm prospective scan on volume or mass scoring shows variability of around 10%, comparable to 2.5-mm-thickness spiral overlapping reconstruction images.
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Affiliation(s)
- Jun Horiguchi
- Department of Clinical Radiology, Hiroshima University Hospital, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan.
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