Correlation between Measured and Visual Scoring of Coronary Artery Calcification

Abstract

Coronary artery calcification (CAC) is a well-known marker of subclinical coronary atherosclerosis, which is always detectable in non ECG-gated routine chest CT examinations, and its visual estimation is correlated to clinical outcomes. Agatston scoring is not routinely performed on these examinations. We sought to validate a visual scoring scheme we derived against ECG-gated CT's and compare our system with another previously published visual scoring scheme in a different cohort of lung cancer screening participants. 50 COPDGene participants received, regular dose full inspiration (non-gated high mA), and low dose expiration CT (non-gated low mA) and ECG-gated CT's at the same time. CAC was visually scored by 3 readers using our total visual scoring (TVS) method and compared to the Agatston score. The second portion of the study involved visual and Agatston scoring of a larger sample of 198 lung cancer screening patients, comparing visual scoring described by Shemesh et. al. and our TVS method. For the COPDGene participants, scores were highly correlated among readers (all ICC≥0.92), between the ECG-gated CT, non-gated high mA CT, and the non-gated low dose CT (all p<0.001), and with the Agatston score (all ICC≥0.90). For the cancer screening cohort there was very good agreement of our system and Shemesh scores. Correlations between reader scores, our system, Shemesh scores, and Agatston scores were also very good, ranging from 0.81-0.96. We derived cutoff values corresponding to Agatston risk quartiles for our system and Shemesh. There was excellent correlation of visual scoring with Agatston scoring on ECG-gated and non-gated CT. In lung cancer screening CT's both ours and Shemesh visual scoring correlated well with Agatston scores and with each other. Visual scoring may predict clinically significant CAC in major Agatston categories.

Utility of routine non-gated CT chest in detection of subclinical atherosclerotic calcifications of coronary arteries in hospitalised HIV patients

“…[14][15][16][17][18] The CAC scoring is conventionally performed using the Agatston method on an EKG-gated non-contrast cardiac CT. However, there was good correlation of visual calcium scoring with traditional Agatston score [19][20][21] and recently visual scoring of CAC on non-EKG-gated low-dose screening CT for lung cancer proved to be useful in predicting future CV mortality. 22 Our aim is to retrospectively evaluate subclinical CAC in hospitalised HIV patients undergoing routine non-EKG-gated chest CT for non-cardiac indications and to assess prevalence and risk factors.…”