Evaluation of Subsecond Gated Helical CT for Quantification of Coronary  Artery Calcium and Comparison with Electron Beam CT

Carr, J. Jeffrey; Crouse, John R.; Goff, David C.; D’Agostino, Ralph B.; Peterson, Neil P.; Burke, Gregory L.

doi:10.2214/ajr.174.4.1740915

Cited by 227 publications

(130 citation statements)

References 28 publications

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“…Two trained readers blinded to the clinical characteristics of the participants analysed the CT images. As previously reported, helical CT scans yield comparable vascular calcium measurements to electron beam CT [36]. The cardiac CT methods that we used in the DHS replicate those employed in the Multi-Ethnic Study of Atherosclerosis (MESA) and Coronary Artery Risk Development In Young Adults studies [37].…”

Section: Vascular Imagingmentioning

confidence: 62%

The impact of ethnicity and sex on subclinical cardiovascular disease: the Diabetes Heart Study

et al. 2005

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Aims/hypothesis: African Americans with type 2 diabetes and access to adequate healthcare are at lower risk of clinical coronary artery disease than are white diabetic patients. We evaluated whether ethnic differences in subclinical cardiovascular disease, coronary and carotid artery calcified plaque and carotid artery intima-medial thickness (IMT) were present in members of The Diabetes Heart Study families. Subjects and Methods: In a biracial cohort of 1,180 individuals from families enriched for members with type 2 diabetes, we calculated coronary and carotid artery calcified plaque using fast-gated helical computed tomography, and measured carotid artery IMT and clinical risk factor profiles. Generalised estimating equations were used to test for an association between measures of subclinical cardiovascular disease and ethnicity and sex. Results: After adjustment for age, ethnicity and kidney function, African Americans had significantly lower amounts of coronary artery calcified plaque (mean±SE) (866±158 vs 1,915±135, respectively; p=0.0466) and carotid artery calcified plaque (179±51 vs 355±27, respectively; p=0.0240) relative to whites, despite having increased carotid IMT (0.71±0.01 vs 0.67±0.004 cm, respectively; p=0.0007), and higher blood pressure, albuminuria and HbA 1 c. Sex-specific analyses revealed that African American men had significantly lower coronary and carotid artery calcified atheroma than white men. In women, ethnic differences in calcified carotid artery plaque, but not coronary artery plaque, were observed. Conclusions/interpretation: In families enriched for members with type 2 diabetes, African American men had markedly lower levels of coronary and carotid artery calcified plaque than white men, despite increased carotid artery IMT and conventional risk factors. These findings suggest that susceptibility to subclinical cardiovascular disease differs markedly according to ethnicity and sex.

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Section: Vascular Imagingmentioning

confidence: 62%

The impact of ethnicity and sex on subclinical cardiovascular disease: the Diabetes Heart Study

et al. 2005

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“…22 Multidetector CT (MDCT) scanners have evolved to the point that cardiac image acquisition is comparable to that of electron beam CT scanners. Studies have showed CAC detection equivalency between electron beam CT and multislice CT. 23,24 With MDCT, accurate CAC detection is now widely available to EDs across the United States. Detection of CAC by CT is noninvasive, easily tolerated, and rapid, and it requires no intravenous contrast medium.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomographic Coronary Artery Calcium Assessment for Evaluating Chest Pain in the Emergency Department: Long-term Outcome of a Prospective Blind Study

Laudon¹,

Behrenbeck²,

Wood

et al. 2010

Mayo Clinic Proceedings

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For editorial comment, see page 309 C hest pain is the presenting concern for more than 8 million emergency department (ED) visits annually. The ED evaluation of chest pain is resource-intense and has inherent limitations. Medical history and physical examination frequently yield little insight into the source of the chest pain. More than one-third of patients with docu- OBJECTIVE: To determine the long-term outcome of computed tomographic (CT) quantification of coronary artery calcium (CAC) used as a triage tool for patients presenting with chest pain to an emergency department (ED). PATIENTS AND METHODS:Patients (men aged 30-62 years and women aged 30-65 years) with chest pain and low-to-moderate probability of coronary artery disease underwent both conventional ED chest pain evaluation and CT CAC assessment prospectively. Patients' physicians were blinded to the CAC results. The results of the conventional evaluation were compared with CAC findings on CT, and the long-term outcome in patients undergoing CT CAC assessment was established. Primary end points (acute coronary syndrome, death, fatal or nonfatal non-ST-segment elevation myocardial infarction, fatal or nonfatal ST-segment elevation myocardial infarction) and secondary outcomes (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, coronary stenting, or a combination thereof) were obtained when the patient was dismissed from the ED or hospital and then at 30 days, 1 year, and 5 years. RESULTS:Of the 263 study patients, 133 (51%) had a CAC score of zero. This absence of CAC correlated strongly with the likelihood of noncardiac chest pain. Among 133 patients with a CAC score of zero, only 1 (<1%) had cardiac chest pain. Conversely, of the 31 patients shown to have cardiac chest pain, 30 (97%) had evidence of CAC on CT. When a CAC cutoff score of 36 was used, as suggested by receiver operating characteristic analysis, sensitivity was 90%; specificity, 85%; positive predictive value, 44%; and negative predictive value, 99%. During long-term follow-up, patients without CAC experienced no cardiac events at 30 days, 1 year, and 5 years.CONCLUSION: Findings suggest that CT CAC assessment is a powerful adjunct in chest pain evaluation for the population at low-tointermediate risk. Absent or minimal CAC in this population makes cardiac chest pain extremely unlikely. The absence of CAC suggests an excellent long-term (5-year) prognosis, with no primary or secondary cardiac outcomes ocurring in study patients at 5-year follow-up. Proc. 2010;85(4):314-322 ACS = acute coronary syndrome; CAC = coronary artery calcium; CAD = coronary artery disease; CI = confidence interval; CT = computed tomography; CTA = CT angiography; ECG = electrocardiography; ED = emergency department; IQR = interquartile range; MDCT = multidetector CT; MI = myocardial infarction; ROC = receiver operating characteristic mented acute myocardial infarctions (MIs) lack chest pain on presentation. Mayo Clin2 Resting 12-lead electrocardiography (ECG) has limited value in ...

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“…Therefore CAC scores are mostly assessed today using MDCT. Others have suggested that the thresholds derived from EBCT technology may not be readily transferred to newer CT scanners [9,23,24,26,32]. Our results show that systematic differences in CAC scores due to different scanner types cause only a few misclassifications of CACderived risk group categories, and adjustment according to the systematic bias did not lead to a significant improvement in risk group classification.…”

Section: Discussionmentioning

confidence: 49%

“…They found EBCT and MDCT to be highly correlated (correlation coefficient between 0.95-0.99). However, newer scanner generations implicate a systematic difference in scoring due to differences in temporal and spatial resolution, image noise and lack of calibration [7,26], resulting in a variation from 17% to 32% in CAC scores compared with EBCT [8,9,[23][24][25]. Our results also showed a high correlation of r50.971 and a standard variation of 14% in CAC scores.…”

Section: Discussionmentioning

confidence: 59%

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Comparison of dual-source and electron-beam CT for the assessment of coronary artery calcium scoring

Reinsch

Aa²,

Lehmann³

et al. 2012

BJR

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Objective: Cardiac CT allows the detection and quantification of coronary artery calcification (CAC). Electron-beam CT (EBCT) has been widely replaced by high-end CT generations in the assessment of CAC. The aim of this study was to compare the CAC scores derived from an EBCT with those from a dual-source CT (DSCT). Methods: We retrospectively selected 92 patients (61 males; mean age, 60.7¡12 years) from our database, who underwent both EBCT and DSCT. CAC was assessed using the Agatston score by two independent readers (replicates: 1, 2; 35mean of reading 1 and 2). Results: EBCT scores were on average slightly higher than DSCT scores (281¡569 vs 241¡502; p,0.05). In regression analysis R Cardiac CT allows the detection and quantification of coronary artery calcification (CAC) and may thus add important in vivo information on the path from risk factor exposure to formation of clinical events [1][2][3][4]. Because of its advantages of being a fast technique with limited radiation exposure to the patients, various published clinical outcome data from CAC are based on electronbeam CT (EBCT), and therefore cut-points have been established for EBCT scans. However, since the appearance of newer generations of CT scanners such as dualsource CT (DSCT), scanners of this type are also widely used for CAC scoring as an alternative to EBCT. The spatial resolution of DSCT scanners is much higher, enabling the detection of smaller lesions, and DSCT is more applicable to other radiological procedures such as CT angiography [5]. CAC scoring is performed on these newer scanner generations using the Agatston score algorithm as the standard measure of CAC quantification. There is direct comparison of CAC scores between newer scanners and EBCT [6][7][8][9]. However, comparison between EBCT and DSCT is rare [10]. This is of interest for firsttime CAC scoring in asymptomatic subjects, and especially for evaluation of disease progression in subjects with prior EBCT testing. Therefore, the aim of this study was to evaluate the diagnostic accuracy of DSCT in the detection of CAC scores to EBCT. In addition, we compared techniques with each other, verifying the ability of CAC score classification. Methods and materials ParticipantsBetween September 2006 and February 2008 we selected participants from our database who had undergone DSCT coronary angiography for clinical evaluation of suspected coronary heart disease and who had recent EBCT scans for cardiovascular risk stratification. As part of the DSCT protocol, a prospectively gated non-contrast scan was performed. All patients were selected retrospectively. We did not collect any data prospectively. According to the clinical presentation, patients indicating a low pre-test likelihood of having a significant coronary artery stenosis were referred for coronary CT angiography instead of invasive coronary angiogram, just as those with a high pre-test likelihood of having

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Evaluation of Subsecond Gated Helical CT for Quantification of Coronary Artery Calcium and Comparison with Electron Beam CT

Cited by 227 publications

References 28 publications

The impact of ethnicity and sex on subclinical cardiovascular disease: the Diabetes Heart Study

The impact of ethnicity and sex on subclinical cardiovascular disease: the Diabetes Heart Study

Computed Tomographic Coronary Artery Calcium Assessment for Evaluating Chest Pain in the Emergency Department: Long-term Outcome of a Prospective Blind Study

Comparison of dual-source and electron-beam CT for the assessment of coronary artery calcium scoring

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