Measuring coronary artery calcification using positron emission tomography-computed tomography attenuation correction images

Cardiac computed tomography (CT) measured coronary artery calcium (CAC-CT) is a well-validated and accurate tool for estimating atherosclerotic burden and prognosis. Computed tomography attenuation correction (ACCT) obtained during cardiac positron emission tomography (PET) has been used to visually estimate CAC; however, quantification using a non-gated ACCT images has not been described. We sought to understand the relationship between CAC measured using cardiac computed tomography (CT) and CAC using ACCT images obtained during cardiac PET perfusion imaging.

Patients with both CAC-CT and cardiac PET within 6 months of each other were identified. CAC-CT images were scored using the Agatston scoring method, while ACCT images were scored using different attenuation thresholds for calcium. CAC-CT and ACCT scores were compared. Between August 2007 and October 2010, 91 patients were included in the analysis. Interobserver reliability was excellent at all thresholds of detection tested. Pearson correlation was strongest between CAC-CT and ACCT at 50 HU threshold of detection (ACCT(50)). Implementing CAC categories (0, 1-100, 101-400, >400), there was a high degree of agreement between observers as well as between CAC-CT and ACCT(50). Correlation was best for lower CAC scores; however, as CAC-CT increased, ACCT(50) underestimated CAC.

Quantifying CAC using ACCT images appears to be feasible and accurate. In a single cardiac PET examination, information regarding perfusion, LV function, flow quantification, and CAC can be obtained without additional radiation.