TY - JOUR
T1 - Estimation of cardiovascular risk on routine chest CT
T2 - Ordinal coronary artery calcium scoring as an accurate predictor of Agatston score ranges
AU - Azour, Lea
AU - Kadoch, Michael A
AU - Ward, Thomas J.
AU - Eber, Corey D.
AU - Jacobi, Adam H.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Background Coronary artery calcium (CAC) is often identified on routine chest computed tomography (CT). The purpose of our study was to evaluate whether ordinal scoring of CAC on non-gated, routine chest CT is an accurate predictor of Agatston score ranges in a community-based population, and in particular to determine the accuracy of an ordinal score of zero on routine chest CT. Methods Two thoracic radiologists reviewed consecutive same-day ECG-gated and routine non-gated chest CT scans of 222 individuals. CAC was quantified using the Agatston scoring on the ECG-gated scans, and using an ordinal method on routine scans, with a score from 0 to 12. The pattern and distribution of CAC was assessed. The correlation between routine exam ordinal scores and Agatston scores in ECG-gated exams, as well as the accuracy of assigning a zero calcium score on routine chest CT was determined. Results CAC was most prevalent in the left anterior descending coronary artery in both single and multi-vessel coronary artery disease. There was a strong correlation between the non-gated ordinal and ECG-gated Agatston scores (r = 0.811, p < 0.01). Excellent inter-reader agreement (k = 0.95) was shown for the presence (total ordinal score ≥1) or absence (total ordinal score = 0) of CAC on routine chest CT. The negative predictive value for a total ordinal score of zero on routine CT was 91.6% (95% CI, 85.1–95.9). Total ordinal scores of 0, 1–3, 4–5, and ≥6 corresponded to average Agatston scores of 0.52 (0.3–0.8), 98.7 (78.2–117.1), 350.6 (264.9–436.3) and 1925.4 (1526.9–2323.9). Conclusion Visual assessment of CAC on non-gated routine chest CT accurately predicts Agatston score ranges, including the zero score, in ECG-gated CT. Inclusion of this information in radiology reports may be useful to convey important information on cardiovascular risk, particularly premature atherosclerosis in younger patients.
AB - Background Coronary artery calcium (CAC) is often identified on routine chest computed tomography (CT). The purpose of our study was to evaluate whether ordinal scoring of CAC on non-gated, routine chest CT is an accurate predictor of Agatston score ranges in a community-based population, and in particular to determine the accuracy of an ordinal score of zero on routine chest CT. Methods Two thoracic radiologists reviewed consecutive same-day ECG-gated and routine non-gated chest CT scans of 222 individuals. CAC was quantified using the Agatston scoring on the ECG-gated scans, and using an ordinal method on routine scans, with a score from 0 to 12. The pattern and distribution of CAC was assessed. The correlation between routine exam ordinal scores and Agatston scores in ECG-gated exams, as well as the accuracy of assigning a zero calcium score on routine chest CT was determined. Results CAC was most prevalent in the left anterior descending coronary artery in both single and multi-vessel coronary artery disease. There was a strong correlation between the non-gated ordinal and ECG-gated Agatston scores (r = 0.811, p < 0.01). Excellent inter-reader agreement (k = 0.95) was shown for the presence (total ordinal score ≥1) or absence (total ordinal score = 0) of CAC on routine chest CT. The negative predictive value for a total ordinal score of zero on routine CT was 91.6% (95% CI, 85.1–95.9). Total ordinal scores of 0, 1–3, 4–5, and ≥6 corresponded to average Agatston scores of 0.52 (0.3–0.8), 98.7 (78.2–117.1), 350.6 (264.9–436.3) and 1925.4 (1526.9–2323.9). Conclusion Visual assessment of CAC on non-gated routine chest CT accurately predicts Agatston score ranges, including the zero score, in ECG-gated CT. Inclusion of this information in radiology reports may be useful to convey important information on cardiovascular risk, particularly premature atherosclerosis in younger patients.
KW - Agatston
KW - Cardiovascular risk
KW - Coronary artery calcium
KW - Ordinal scoring
KW - Routine chest CT
KW - Visual assessment
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U2 - 10.1016/j.jcct.2016.10.001
DO - 10.1016/j.jcct.2016.10.001
M3 - Article
C2 - 27743881
AN - SCOPUS:85002489644
VL - 11
SP - 8
EP - 15
JO - Journal of Cardiovascular Computed Tomography
JF - Journal of Cardiovascular Computed Tomography
SN - 1934-5925
IS - 1
ER -