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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans

Published on: August 28, 2018

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

Suji Lee1, Young Joo Suh2, Kyungsun Nam1

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

European Radiology
|April 22, 2021
PubMed

Insights

The length-based method is the most reliable for grading coronary artery calcium (CAC) on low-dose chest CT scans without ECG gating. This method demonstrated superior inter-observer agreement and better correlation with ECG-gated calcium scoring CT.

Area of Science:

  • Radiology
  • Cardiovascular Imaging
  • Medical Diagnostics

Background:

  • Coronary artery calcium (CAC) scoring is crucial for cardiovascular risk assessment.
  • Non-electrocardiogram (ECG)-gated low-dose chest computed tomography (LDCT) is increasingly used for lung cancer screening and may provide incidental CAC information.
  • Standardizing CAC grading on non-ECG-gated LDCT is essential for consistent risk stratification.

Purpose of the Study:

  • To compare the reliability of three artery-based ordinal grading methods for CAC on non-ECG-gated LDCT.
  • To identify the optimal method for assessing CAC severity using non-ECG-gated LDCT.
  • To evaluate inter-observer and intra-observer agreement, as well as agreement with ECG-gated calcium scoring CT.

Main Methods:

  • Retrospective enrollment of 120 asymptomatic subjects who underwent both LDCT and ECG-gated calcium scoring CT.
  • Three cardiothoracic radiologists independently graded CAC severity on LDCT (1.25-mm and 2.5-mm slice thickness) using extent-based, Weston, and length-based scoring methods.
  • Inter-observer and intra-observer agreements were assessed using Fleiss kappa statistics; agreement with ECG-gated CT was assessed using weighted kappa statistics.

Main Results:

  • The length-based method exhibited the highest inter-observer agreement for both 1.25-mm (kappa=0.813) and 2.5-mm (kappa=0.833) slice thicknesses.
  • Agreement between the three grading methods for the same observer was poor to moderate.
  • The length-based method showed the highest agreement with ECG-gated calcium scoring CT across all observers and slice thicknesses (weighted kappa 0.773-0.825).

Conclusions:

  • The length-based method is the most reliable artery-based ordinal grading technique for evaluating CAC on non-ECG-gated LDCT.
  • This method offers superior consistency among observers and better concordance with the gold standard ECG-gated calcium scoring CT.
  • The findings support the utility of the length-based method for incidental CAC detection and risk assessment on LDCT scans.
Abstract

Keywords:
CalciumCoronary vesselsObserver variationThoraxTomography, X-ray computed

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