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Reproducibility of quantitative coronary calcium scoring from PET/CT attenuation maps: comparison to ECG-gated CT scans

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Abstract

Purpose

We sought to evaluate inter-scan and inter-reader agreement of coronary calcium (CAC) scores obtained from dedicated, ECG-gated CAC scans (standard CAC scan) and ultra-low-dose, ungated computed tomography attenuation correction (CTAC) scans obtained routinely during cardiac PET/CT imaging.

Methods

From 2928 consecutive patients who underwent same-day 82Rb cardiac PET/CT and gated CAC scan in the same hybrid PET/CT scanning session, we have randomly selected 200 cases with no history of revascularization. Standard CAC scans and ungated CTAC scans were scored by two readers using quantitative clinical software. We assessed the agreement between readers and between two scan protocols in 5 CAC categories (0, 1–10, 11–100, 101–400, and > 400) using Cohen’s Kappa and concordance.

Results

Median age of patients was 70 (inter-quartile range: 63–77), and 46% were male. The inter-scan concordance index and Cohen’s Kappa for readers 1 and 2 were 0.69; 0.75 (0.69, 0.81) and 0.72; 0.8 (0.75, 0.85) respectively. The inter-reader concordance index and Cohen’s Kappa (95% confidence interval [CI]) was higher for standard CAC scans: 0.9 and 0.92 (0.89, 0.96), respectively, vs. for CTAC scans: 0.83 and 0.85 (0.79, 0.9) for CTAC scans (p = 0.02 for difference in Kappa). Most discordant readings between two protocols occurred for scans with low extent of calcification (CAC score < 100).

Conclusion

CAC can be quantitatively assessed on PET CTAC maps with good agreement with standard scans, however with limited sensitivity for small lesions. CAC scoring of CTAC can be performed routinely without modification of PET protocol and added radiation dose.

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Data availability

The imaging protocols and results generated and analyzed in the course of the study are available from the corresponding author on reasonable written request.

Abbreviations

CAC:

Coronary artery calcium

CABG:

Coronary artery bypass grafting

CT:

Computed tomography

CTAC:

Computed tomography attenuation correction

ECG:

Electrocardiogram

IQR:

Inter-quartile range

LAD:

Left anterior descending coronary artery

LCX:

Left circumflex coronary artery

LM:

Left main coronary artery

MPI:

Myocardial perfusion imaging

PET/CT:

Positron emission tomography/computed tomography

RCA:

Right coronary artery

SPECT:

Single-photon emission computed tomography

PCI:

Percutaneous coronary intervention

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Funding

This research was supported in part by grant R01HL089765 from the National Heart, Lung, and Blood Institute/National Institutes of Health (NHLBI/NIH) (PI: Piotr Slomka). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Pieszko was supported by the Polish Agency of International Academic Exchange (NAWA).

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Authors and Affiliations

  1. Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite Metro 203, Los Angeles, CA, 90048, USA

    Konrad Pieszko, Aakash D. Shanbhag, Mark Lemley, Mark Hyun, Serge Van Kriekinge, Yuka Otaki, Joanna X. Liang, Daniel S. Berman, Damini Dey & Piotr J. Slomka

  2. Department of Interventional Cardiology and Cardiac Surgery, Collegium Medicum, University of Zielona Gora, Zielona Gora, Poland

    Konrad Pieszko

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  1. Konrad Pieszko
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  2. Aakash D. Shanbhag
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Corresponding author

Correspondence to Piotr J. Slomka.

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Ethical approval

This study complies with the Declaration of Helsinki. The institutional review board at Cedars-Sinai as well as at the participating sites approved the collection of data for the registry. Informed consent has been obtained from the subjects (or their legally authorized representative).

Conflict of interest

Drs. Berman, Slomka, and Van Kriekinge participate in software royalties for nuclear cardiology software at Cedars-Sinai Medical Center. Dr. Slomka has received research grant support from Siemens Medical Systems. Dr. Berman has served as a consultant for GE Healthcare. The remaining authors have no relevant disclosures.

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Pieszko, K., Shanbhag, A.D., Lemley, M. et al. Reproducibility of quantitative coronary calcium scoring from PET/CT attenuation maps: comparison to ECG-gated CT scans. Eur J Nucl Med Mol Imaging 49, 4122–4132 (2022). https://doi.org/10.1007/s00259-022-05866-x

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