Integrated intensity-based technique for coronary artery calcium mass measurement: A phantom study

Area of Science:

• Medical Imaging
• Cardiovascular Diagnostics
• Radiology

Background:

• Traditional Agatston scoring for coronary artery calcium has limitations in quantifying low-density calcifications.
• The inaccuracy is partly due to Agatston scoring's requirement for arbitrary thresholding.

Purpose of the Study:

• To develop and evaluate a new calcium quantification technique that eliminates arbitrary thresholding.
• The goal is to achieve greater accuracy, sensitivity, reproducibility, and robustness in calcium scoring.

Main Methods:

• Adapted the integrated Hounsfield technique for calcium scoring, termed integrated calcium mass.
• Utilized phantom images with known calcium hydroxyapatite densities across multiple CT vendors.
• Analyzed accuracy, reproducibility, sensitivity, and robustness, including the effect of motion.

Main Results:

• Integrated calcium mass demonstrated higher accuracy than Agatston scoring for both stationary and motion-affected scans.
• Integrated calcium mass showed lower false-negative (15.00%) and false-positive (0.00%) rates compared to Agatston scoring (28.33%, 6.67%).
• The new technique proved more robust to changes in scan parameters and more reproducible across different CT vendors.

Conclusions:

• Integrated calcium mass is a more accurate, reproducible, and sensitive method for coronary artery calcium scoring.
• The significant reduction in false-negative scores is expected to enhance patient risk stratification and clinical outcomes.