Skip to main content
SpringerLink
Log in

Comparison of artery-based methods for ordinal grading of coronary artery calcium on low-dose chest computed tomography

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To identify the optimal artery-based method for ordinal grading of coronary artery calcium (CAC) on non-electrocardiogram (ECG)-gated low-dose chest computed tomography (LDCT) among three methods.

Methods

A total of 120 asymptomatic subjects who underwent both LDCT and ECG-gated calcium scoring CT on the same day were retrospectively enrolled. Three cardiothoracic radiologists independently assessed CAC severity on LDCT (1.25-mm and 2.5-mm slice thickness) and classified it into four categories (none, mild, moderate, or severe) using three artery-based ordinal scoring methods (extent-based scoring, Weston scoring, and length-based scoring). Inter- and intra-observer CAC severity agreements of each method were assessed by Fleiss kappa statistics. Agreements between each method and ECG-gated calcium scoring CT were assessed by weighted kappa statistics.

Results

The inter-observer agreement was highest with length-based method for both 1.25-mm (Fleiss kappa 0.735 for extent-based method, 0.801 for Weston score, and 0.813 for length-based method) and 2.5-mm slice thickness evaluation (Fleiss kappa 0.755 for extent-based method, 0.776 for Weston score, and 0.833 for extent-based method). Agreement across the three grading methods for the same observer was poor to moderate on 1.25-mm (Fleiss kappa 0.379–0.441) and moderate on 2.5-mm thickness evaluation (Fleiss kappa 0.427–0.461). Agreement of CAC severity between each method and ECG-gated calcium scoring CT was highest with the length-based method for all three observers on both 1.25-mm (weighted kappa 0.773–0.786) and 2.5-mm (weighted kappa 0.794–0.825) LDCT images.

Conclusion

Among the three artery-based ordinal grading methods, the length-based method appears to be the most reliable for evaluating CAC on non-ECG-gated LDCT.

Key Points

• The length-based method showed the highest inter-observer agreement and the highest agreement with the ECG-gated calcium scoring CT, compared with the extent-based method and the Weston score.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

CAC:

Coronary artery calcium

CI:

Confidence interval

CTDIvol :

CT dose index volume

ECG:

Electrocardiogram

LDCT:

Low-dose chest computed tomography

References

  1. Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS (1995) Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation 92:2157–2162

    Article  CAS  Google Scholar 

  2. Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE (2018) Coronary calcium score and cardiovascular risk. J Am Coll Cardiol 72:434–447

    Article  CAS  Google Scholar 

  3. LaMonte MJ, FitzGerald SJ, Church TS et al (2005) Coronary artery calcium score and coronary heart disease events in a large cohort of asymptomatic men and women. Am J Epidemiol 162:421–429

    Article  Google Scholar 

  4. Jacobs PC, Gondrie MJ, van der Graaf Y et al (2012) Coronary artery calcium can predict all-cause mortality and cardiovascular events on low-dose CT screening for lung cancer. AJR Am J Roentgenol 198:505–511

    Article  Google Scholar 

  5. Chiles C, Duan F, Gladish GW et al (2015) Association of coronary artery calcification and mortality in the National Lung Screening Trial: a comparison of three scoring methods. Radiology 276:82–90

    Article  Google Scholar 

  6. ACR NRDR – LCSR Exam Form. Available via https://nrdrsupport.acr.org/support/solutions/articles/11000041249?_ga=2.141997808.373020462.1559750799-1976387718.1559750799. Accessed Jan 3 2021

  7. Hecht HS, Cronin P, Blaha MJ et al (2017) 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. J Cardiovasc Comput Tomogr 11:74–84

    Article  Google Scholar 

  8. Mets OM, Vliegenthart R, Gondrie MJ et al (2013) Lung cancer screening CT-based prediction of cardiovascular events. JACC Cardiovasc Imaging 6:899–907

    Article  Google Scholar 

  9. Shemesh J, Henschke CI, Shaham D et al (2010) Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease. Radiology 257:541–548

    Article  Google Scholar 

  10. Suh YJ, Lee JW, Shin SY, Goo JM, Kim Y, Yong HS (2020) Coronary artery calcium severity grading on non-ECG-gated low-dose chest computed tomography: a multiple-observer study in a nationwide lung cancer screening registry. Eur Radiol 30:3684–3691

    Article  CAS  Google Scholar 

  11. Kirsch J, Buitrago I, Mohammed TL, Gao T, Asher CR, Novaro GM (2012) Detection of coronary calcium during standard chest computed tomography correlates with multi-detector computed tomography coronary artery calcium score. Int J Cardiovasc Imaging 28:1249–1256

    Article  Google Scholar 

  12. Huang YL, Wu FZ, Wang YC et al (2013) Reliable categorisation of visual scoring of coronary artery calcification on low-dose CT for lung cancer screening: validation with the standard Agatston score. Eur Radiol 23:1226–1233

    Article  Google Scholar 

  13. Kazerooni EA, Austin JH, Black WC et al (2014) ACR–STR practice parameter for the performance and reporting of lung cancer screening thoracic computed tomography (CT): 2014 (Resolution 4). J Thorac Imaging 29:310–316

    Article  Google Scholar 

  14. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832

    Article  CAS  Google Scholar 

  15. Germano G, Hoes A, Karadeniz S et al (2012) European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J 33:1635–1701

    Article  Google Scholar 

  16. Mets OM, Vliegenthart R, Gondrie MJ et al (2013) Lung cancer screening CT-based prediction of cardiovascular events. JACC Cardiovasc Imaging 6:899–907

    Article  Google Scholar 

  17. Xie X, Zhao Y, de Bock GH et al (2013) Validation and prognosis of coronary artery calcium scoring in nontriggered thoracic computed tomography: systematic review and meta-analysis. Circ Cardiovasc Imaging 6:514–521

    Article  Google Scholar 

  18. Wu M-T, Yang P, Huang Y-L et al (2008) Coronary arterial calcification on low-dose ungated MDCT for lung cancer screening: concordance study with dedicated cardiac CT. AJR Am J Roentgenol 190:923–928

    Article  Google Scholar 

  19. Kim SM, Chung MJ, Lee KS, Choe YH, Yi CA, Choe BK (2008) Coronary calcium screening using low-dose lung cancer screening: effectiveness of MDCT with retrospective reconstruction. AJR Am J Roentgenol 190:917–922

    Article  Google Scholar 

  20. Wan YL, Tsay PK, Wu PW et al (2017) Impact of filter convolution and displayed field of view on estimation of coronary Agatston scores in low-dose lung computed tomography. Int J Cardiol 236:451–457

    Article  Google Scholar 

  21. Fujioka C, Funama Y, Kiguchi M et al (2012) Coronary artery calcium scoring on different 64-detector scanners using a low-tube voltage (80 kVp). Acad Radiol 19:1402–1407

    Article  Google Scholar 

  22. Nakazato R, Dey D, Gutstein A et al (2009) Coronary artery calcium scoring using a reduced tube voltage and radiation dose protocol with dual-source computed tomography. J Cardiovasc Comput Tomogr 3:394–400

    Article  Google Scholar 

  23. van der Werf N, Willemink M, Willems TP, Greuter MJ, Leiner T (2018) Influence of iterative reconstruction on coronary calcium scores at multiple heart rates: a multivendor phantom study on state-of-the-art CT systems. Int J Cardiovasc Imaging 34:947–957

    Article  Google Scholar 

Download references

Funding

This study has received funding by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (2018R1C1B6007251).

Author information

Authors and Affiliations

  1. Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea

    Suji Lee, Young Joo Suh, Kyungsun Nam, Kyeho Lee, Hye-Jeong Lee & Byoung Wook Choi

Authors
  1. Suji Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Young Joo Suh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyungsun Nam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kyeho Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hye-Jeong Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Byoung Wook Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Young Joo Suh.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Young Joo Suh.

Conflict of interest

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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary materials

ESM 1

(DOCX 37 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, S., Suh, Y.J., Nam, K. et al. Comparison of artery-based methods for ordinal grading of coronary artery calcium on low-dose chest computed tomography. Eur Radiol 31, 8108–8115 (2021). https://doi.org/10.1007/s00330-021-07987-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-021-07987-7

Keywords

Search

Navigation