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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
A Modified Length-Based Grading Method for Assessing Coronary Artery Calcium Severity on Non-Electrocardiogram-Gated
Suh Young Kim1,2, Young Joo Suh3, Na Young Kim4
1Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
Insights
A new grading method, modified length-based grading, effectively assesses coronary artery calcium (CAC) on chest CT scans. This method shows better agreement with cardiac CT standards and improved interobserver reliability compared to visual assessment.
Area of Science:
- Radiology
- Cardiovascular Imaging
- Medical Diagnostics
Background:
- Coronary artery calcium (CAC) scoring is crucial for cardiovascular risk assessment.
- Non-electrocardiogram (ECG)-gated chest computed tomography (CT) is widely available but assessing CAC severity can be challenging.
- Standardized and reliable methods for CAC assessment on non-ECG-gated CT are needed.
Purpose of the Study:
- To validate a simplified ordinal scoring method, modified length-based grading, for assessing CAC severity.
- To compare the performance of modified length-based grading against visual assessment on non-ECG-gated chest CT.
- To evaluate the agreement of these methods with the Agatston score on ECG-gated cardiac CT.
Main Methods:
- Retrospective analysis of 120 patients who underwent both non-ECG-gated chest CT and ECG-gated cardiac CT.
- Six radiologists independently assessed CAC severity using visual assessment and modified length-based grading on chest CT.
- CAC categories were compared to the reference standard Agatston score on cardiac CT.
- Interobserver agreement (Fleiss kappa) and agreement with the reference standard (Cohen's kappa) were calculated.
- Time taken for grading was also compared between methods.
Main Results:
- Modified length-based grading showed good interobserver agreement (Fleiss kappa, 0.695), superior to visual assessment (Fleiss kappa, 0.553).
- Modified length-based grading demonstrated better agreement with the Agatston score (Cohen's kappa, 0.695) than visual assessment (Cohen's kappa, 0.565).
- Visual assessment was slightly faster (41.8 s) than modified length-based grading (43.5 s), but this difference was not clinically significant (P < 0.001).
Conclusions:
- Modified length-based grading is a reliable method for assessing CAC severity on non-ECG-gated chest CT.
- This simplified grading method offers improved interobserver agreement and better concordance with established cardiac CT scoring.
- It provides a valuable alternative for routine CAC assessment in clinical practice.
Objective:
To validate a simplified ordinal scoring method, referred to as modified length-based grading, for assessing coronary artery calcium (CAC) severity on non-electrocardiogram (ECG)-gated chest computed tomography (CT).
Materials And Methods:
This retrospective study enrolled 120 patients (mean age ± standard deviation [SD], 63.1 ± 14.5 years; male, 64) who underwent both non-ECG-gated chest CT and ECG-gated cardiac CT between January 2011 and December 2021. Six radiologists independently assessed CAC severity on chest CT using two scoring methods (visual assessment and modified length-based grading) and categorized the results as none, mild, moderate, or severe. The CAC category on cardiac CT assessed using the Agatston score was used as the reference standard. Agreement among the six observers for CAC category classification was assessed using Fleiss kappa statistics. Agreement between CAC categories on chest CT obtained using either method and the Agatston score categories on cardiac CT was assessed using Cohen's kappa. The time taken to evaluate CAC grading was compared between the observers and two grading methods.
Results:
For differentiation of the four CAC categories, interobserver agreement was moderate for visual assessment (Fleiss kappa, 0.553 [95% confidence interval {CI}: 0.496-0.610]) and good for modified length-based grading (Fleiss kappa, 0.695 [95% CI: 0.636-0.754]). The modified length-based grading demonstrated better agreement with the reference standard categorization with cardiac CT than visual assessment (Cohen's kappa, 0.565 [95% CI: 0.511-0.619 for visual assessment vs. 0.695 [95% CI: 0.638-0.752] for modified length-based grading). The overall time for evaluating CAC grading was slightly shorter in visual assessment (mean ± SD, 41.8 ± 38.9 s) than in modified length-based grading (43.5 ± 33.2 s) (P < 0.001).
Conclusion:
The modified length-based grading worked well for evaluating CAC on non-ECG-gated chest CT with better interobserver agreement and agreement with cardiac CT than visual assessment.
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