Coronary artery calcification on low-dose computed tomography: comparison of Agatston and Ordinal Scores

2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology

“…The 3 ordinal score categories have an excellent agreement (k ¼ 0.83, 95% CI:0.76e0.85) with the 3 nongated Agatston score categories of 0, 1e400 and >400. 70 A different summed segmented vessel-specific ordinal scale was also utilized in the NLST referred to above, in which 1447 patients were followed for coronary heart disease deaths over~7 years. 68 The coronary tree was divided into 10 segments, which were scored 0, 1, 2 and 3 for no, mild, moderate and heavy calcium respectively, for a total score range of 0e30.…”

The importance of the regimen of screening in maximizing the benefit and minimizing the harms

“…New rapid scanning techniques minimize cardiac motion and allow for improved Agatston scoring on non-gated examinations. However, the equivalence of these Ordinal scores, based on analyses of screening data showed there is excellent agreement in the ordinal CAC score for the categories of the Agatston scores (54).…”

“…Minimal calcification was defined if less than 1/3 of the length of the entire artery, moderate as 1/3-2/3, and severe as more than 2/3 shows calcification. With 4 arteries thus scored, each subject received an Ordinal CAC Score in the range from 0 to 12 and the corresponding recommendations are given in the section on the workup of ancillary findings (52)(53)(54)(55)(56). Currently, it is also possible to obtain the Agatston, volume or mass calcium scores on low-dose CT scans and then the standard Agatston recommendations can be used.…”

Status of lung cancer screening

“…Dissemination of the quantitative imaging acquisition and quality approaches can potentially be accomplished by leveraging cloud-based computing environment as it can allow easy access to defined automated image quality analyses using integrated reference tools to evaluate conformance with best quantitative imaging practice (13). As suggested by the review, these quantitative approaches for lung cancer screening may also allow for evaluation of other tobacco-related thoracic findings seen on low dose CT scans such as coronary artery calcium deposition and parenchymal lung injury findings consistent with chronic obstructive pulmonary disease as reported by I-ELCAP investigations (3,14,15). The simultaneous analysis of the three tobacco-related diseases in a defined high-risk population that also happen include individuals at-risk for three of the most lethal diseases in most societies, is an extraordinary public health opportunity.…”

“…Early research on outcomes of low dose CT lung cancer screened individuals suggests that while only 1% of screening subjects may have lung cancer on baseline screening. However, more than 20% of CT screening candidates may have evidence of clinically significant coronary calcium and upwards of 25% may have objective evidence of chronic obstructive pulmonary disease (COPD) (14,15). These thoracic cavity confined comorbidities have been extensively characterized in the low-dose CT literature and integrating screening of heavily tobacco-exposed cohorts with best practice tobacco cessation approaches has been shown to enhance the cost utility of low-dose CT screening (16).…”