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Cardiac valve calcifications on low-dose unenhanced ungated chest computed tomography: inter-observer and inter-examination reliability, agreement and variability

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Abstract

Objectives

To determine inter-observer and inter-examination variability for aortic valve calcification (AVC) and mitral valve and annulus calcification (MC) in low-dose unenhanced ungated lung cancer screening chest computed tomography (CT).

Methods

We included 578 lung cancer screening trial participants who were examined by CT twice within 3 months to follow indeterminate pulmonary nodules. On these CTs, AVC and MC were measured in cubic millimetres. One hundred CTs were examined by five observers to determine the inter-observer variability. Reliability was assessed by kappa statistics (κ) and intra-class correlation coefficients (ICCs). Variability was expressed as the mean difference ± standard deviation (SD).

Results

Inter-examination reliability was excellent for AVC (κ = 0.94, ICC = 0.96) and MC (κ = 0.95, ICC = 0.90). Inter-examination variability was 12.7 ± 118.2 mm3 for AVC and 31.5 ± 219.2 mm3 for MC. Inter-observer reliability ranged from κ = 0.68 to κ = 0.92 for AVC and from κ = 0.20 to κ = 0.66 for MC. Inter-observer ICC was 0.94 for AVC and ranged from 0.56 to 0.97 for MC. Inter-observer variability ranged from -30.5 ± 252.0 mm3 to 84.0 ± 240.5 mm3 for AVC and from -95.2 ± 210.0 mm3 to 303.7 ± 501.6 mm3 for MC.

Conclusions

AVC can be quantified with excellent reliability on ungated unenhanced low-dose chest CT, but manual detection of MC can be subject to substantial inter-observer variability. Lung cancer screening CT may be used for detection and quantification of cardiac valve calcifications.

Key points

• Low-dose unenhanced ungated chest computed tomography can detect cardiac valve calcifications.

• However, calcified cardiac valves are not reported by most radiologists.

• Inter-observer and inter-examination variability of aortic valve calcifications is sufficient for longitudinal studies.

• Volumetric measurement variability of mitral valve and annulus calcifications is substantial.

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Abbreviations

AVC:

Aortic valve calcifications

CT:

Computed tomography

ICC:

Intra-class correlation coefficient

MC:

Mitral valve and annulus calcifications

NELSON:

Dutch Belgium lung cancer screening trial

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Acknowledgements

The scientific guarantor of this publication is Pim A. de Jong, MD PhD. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported in NELSON screening trial articles. However, the cardiac valve calcifications were not quantified previously. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, E01.132, 3508 GA, Utrecht, The Netherlands

    Robbert W. van Hamersvelt, Martin J. Willemink, Richard A. P. Takx, Anouk L. M. Eikendal, Ricardo P. J. Budde, Tim Leiner & Pim A. de Jong

  2. Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands

    Christian P. Mol & Ivana Isgum

Authors
  1. Robbert W. van Hamersvelt
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  2. Martin J. Willemink
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  3. Richard A. P. Takx
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  4. Anouk L. M. Eikendal
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  5. Ricardo P. J. Budde
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  6. Tim Leiner
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  7. Christian P. Mol
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  8. Ivana Isgum
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  9. Pim A. de Jong
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Corresponding author

Correspondence to Martin J. Willemink.

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van Hamersvelt, R.W., Willemink, M.J., Takx, R.A.P. et al. Cardiac valve calcifications on low-dose unenhanced ungated chest computed tomography: inter-observer and inter-examination reliability, agreement and variability. Eur Radiol 24, 1557–1564 (2014). https://doi.org/10.1007/s00330-014-3191-0

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  • DOI: https://doi.org/10.1007/s00330-014-3191-0

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