Related Experiment Video
Updated: Jan 7, 2026
Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
Distribution of coronary artery calcium volume and density by age, sex, and race using AI-based quantification
Gabrielle Gershon1, Kari Zhou1, Yan Yang1
1Department of Radiology and Imaging Sciences, Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University School of Medicine, Atlanta, GA, USA.
Background:
The Agatston score is commonly used for coronary artery calcium (CAC) quantification which integrates calcium volume and density into a single measure. Recent studies suggest CAC volume and mean density offer independent prognostic value. However, normative distributions of these parameters across demographic subgroups are not well characterized.
Methods:
A total of 23,844 patients were analyzed who underwent non-contrast ECG-gated cardiac CT at 120 kVp from 2010 to 2023 at our institution. Patients included were older than 35, asymptomatic, and without prior atherosclerotic cardiovascular disease. CAC volume and mean density were directly quantified using a validated deep learning-based software. Participants were stratified by sex, self-reported race (White, Black), and age (in 10-year strata). Percentile distributions were constructed for CAC total volume and average mean density using a LOESS-based approach to account for the zero-inflated nature of the data. Between-group comparisons were conducted with Mann-Whitney U.
Results:
The cohort (mean age 58 ± 9 years) included 41 % women and 74 % White and 10 % Black participants. Men had significantly higher CAC volume than women across all race/age strata (59 mm3 (IQR 14-223) vs 28 mm3 (IQR 8-100), p < 0.001). Black men and women generally had lower CAC volumes than their White counterparts, with the exception of Black women, who demonstrated higher CAC volumes than White women in several age strata. Average mean CAC density increased with age and was consistently higher in White patients compared to Black patients (194 HU (IQR 163-226) vs 171 HU (IQR 152-205), p < 0.001), independent of sex. Sex-based differences in CAC volume persisted after stratification by race. Age-related increases in both volume and density were observed in all groups.
Conclusion:
This analysis provides percentile distributions of directly measured CAC volume and average mean density across age, sex, and race. The data may better contextualize CAC interpretation and risk stratification.
More Related Videos
04:40Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
08:02Author Spotlight: Enhanced Quantification of Cardiovascular Calcification Progression for Longitudinal Micro PET/CT Studies in Small Research Animals
Published on: November 15, 2024
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Coronary Artery Disease I: Introduction
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...