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Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
Coronary CT Calcium Score in Patients With Prior Nongated CT, Is it Necessary?
Joan M Chi1, John N Makaryus2, Navid Rahmani1
1Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Departments of Radiology, Manhasset, NY.
Insights
Prior chest CTs accurately detect coronary artery calcium (CAC) and correlate with gated calcium score CTs, but CAC is often underreported. This highlights potential for improved cardiovascular risk assessment using existing imaging data.
Area of Science:
- Radiology
- Cardiovascular Imaging
- Preventive Cardiology
Background:
- Cardiovascular disease is a leading global cause of mortality.
- Quantifying coronary artery calcification (CAC) via gated calcium score CT is crucial for predicting adverse coronary artery disease events.
- Nongated chest CTs, while not specifically designed for CAC, can provide valuable information through visual estimation and ordinal scoring.
Purpose of the Study:
- To determine the proportion of patients undergoing gated coronary artery calcium score CTs who had a prior nongated chest CT.
- To assess the diagnostic accuracy of prior nongated chest CTs in identifying coronary calcium.
- To evaluate the correlation between CAC findings on nongated chest CTs and quantitative scores on gated CTs.
Main Methods:
- Retrospective analysis of consecutive gated calcium score CTs (10/2014-10/2016) at a single institution.
- Comparison of the presence/absence of coronary calcium and ordinal scoring on prior nongated chest CTs with the Agatston score on gated calcium score CTs.
- Institutional Review Board (IRB) approval and waiver of informed consent were obtained.
Main Results:
- 9.5% of patients with gated calcium score CTs had a prior nongated chest CT (mean interval 810 days).
- Prior nongated chest CTs demonstrated 100% accuracy in detecting the presence or absence of coronary artery calcium (CAC).
- An 86% correlation was observed between the Agatston score on gated CTs and the ordinal score on prior nongated CTs, with ordinal severity predicting Agatston score severity (P<0.001).
Conclusions:
- A significant percentage of gated calcium score CTs are performed despite available prior chest CT data.
- Ordinal scoring of CAC on nongated chest CTs shows good correlation with quantitative Agatston scores from gated CTs.
- Coronary artery calcium is frequently underreported in the final reports of nongated chest CTs, indicating missed opportunities for risk stratification.
Purpose:
To evaluate the percentage of patients undergoing gated coronary artery calcium score CTs that had a prior nongated chest CT. To assess the accuracy of prior nongated chest CTs in the detection of coronary calcium.
Background:
Cardiovascular disease is the most common cause of death worldwide. Quantifying coronary artery calcification on gated calcium score CT has proven to be strongly predictive of adverse coronary artery disease events. However, visual estimation and ordinal scoring on nongated chest CTs is predictive of coronary calcium burden.
Methods:
Consecutive gated calcium score CTs at a single institution from 10/2014 to 10/2016 were retrospectively evaluated with IRB approval/waiver of informed consent. The presence or absence of coronary calcium and ordinal score on nongated chest CT was compared to Agatston score on gated calcium score CT.
Results:
Forty-two of 441 patients (9.5%) with a gated calcium score had a prior nongated chest CT, with a mean time difference of 810 days. Of the 42 prior chest CTs, 69% had coronary artery calcium (CAC) and 31% did not, with 100% predictive accuracy for the presence or absence of CAC on subsequent gated calcium score CTs. There was 86% correlation of Agatston score on gated calcium score CT with ordinal score on the prior chest CT. Ordinal score divided into independent groups of severity was related to increased severity of Agatston score on the gated calcium score CT (P< 0.001). A majority of prior chest CT studies with coronary calcium failed to include this information in the final report.
Conclusions:
A large percentage of gated calcium score CTs were performed despite a prior chest CT. The ordinal score on chest CTs correlated with Agatston score on gated calcium score CTs. The presence of CAC on chest CTs was underreported in a majority of cases.
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