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Technical feasibility and validation of a coronary artery calcium scoring system using CT coronary angiography images

  • Cardiac
  • Published:
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Abstract

Objectives

We validate a novel CT coronary angiography (CCTA) coronary calcium scoring system.

Methods

Calcium was quantified on CCTA images using a new patient-specific attenuation threshold: mean + 2SD of intra-coronary contrast density (HU). Using 335 patient data sets a conversion factor (CF) for predicting CACS from CCTA scores (CCTAS) was derived and validated in a separate cohort (n = 168). Bland–Altman analysis and weighted kappa for MESA centiles and Agatston risk groupings were calculated.

Results

Multivariable linear regression yielded a CF: CACS = (1.185 × CCTAS) + (0.002 × CCTAS × attenuation threshold). When applied to CCTA data sets there was excellent correlation (r = 0.95; p < 0.0001) and agreement (mean difference −10.4 [95 % limits of agreement −258.9 to 238.1]) with traditional calcium scores. Agreement was better for calcium scores below 500; however, MESA percentile agreement was better for high risk patients. Risk stratification was excellent (Agatston groups k = 0.88 and MESA centiles k = 0.91). Eliminating the dedicated CACS scan decreased patient radiation exposure by approximately one-third.

Conclusion

CCTA calcium scores can accurately predict CACS using a simple, individualized, semiautomated approach reducing acquisition time and radiation exposure when evaluating patients for CAD. This method is not affected by the ROI location, imaging protocol, or tube voltage strengthening its clinical applicability.

Key Points

• Coronary calcium scores can be reliably determined on contrast-enhanced cardiac CT

• This score can accurately risk stratify patients

• Elimination of a dedicated calcium scan reduces patient radiation by a third

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Abbreviations

CACS:

Coronary artery calcium score

CAD:

Coronary artery disease

CCTA:

Coronary CT angiography

CONFIRM study:

Coronary CT angiography evaluation for clinical outcomes international multi centre study

CT:

Computed tomography

DLP:

Dose–length product

DSCT:

Dual source multi-detector CT

LCX:

Left circumflex artery

LMA:

Left main coronary artery

LAD:

Left anterior descending artery

LRT:

Likelihood ratio test

MESA:

Multi-ethnic study atherosclerosis

MSCT:

Multi-slice CT

RCA:

Right coronary artery

ROI:

Region of interest

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Acknowledgments

The scientific guarantor of this publication is Dr. Edward D. Nicol. 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. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Some study subjects or cohorts have been previously reported in Pavitt CW, Harron K, Lindsay AC et al. (2014) Deriving coronary artery calcium scores from CT coronary angiography: a proposed algorithm for evaluating stable chest pain. Int J Cardiovasc Imaging 30(6):1135–1143.

Methodology: retrospective and prospective component, diagnostic study/observational, performed at one institution.

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Authors and Affiliations

  1. Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK

    Christopher W. Pavitt, Alistair C. Lindsay, Robin Ray & Edward D. Nicol

  2. Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, UCL, London, WC1N 1EH, UK

    Katie Harron

  3. Department of Radiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK

    Christopher W. Pavitt, Sayeh Zielke, Michael B. Rubens, Simon P. Padley & Edward D. Nicol

  4. Department of Physics, Royal Marsden Hospital, Fulham Rd, London, SW3 6JJ, UK

    Daniel Gordon

  5. Faculty of Medicine, Imperial College, London, SW7 2AZ, UK

    Simon P. Padley & Edward D. Nicol

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  1. Christopher W. Pavitt
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Correspondence to Edward D. Nicol.

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Pavitt, C.W., Harron, K., Lindsay, A.C. et al. Technical feasibility and validation of a coronary artery calcium scoring system using CT coronary angiography images. Eur Radiol 26, 1493–1502 (2016). https://doi.org/10.1007/s00330-015-3940-8

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  • DOI: https://doi.org/10.1007/s00330-015-3940-8

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