Coronary Arterial Calcification on Low-Dose Ungated MDCT for Lung Cancer Screening: Concordance Study with Dedicated Cardiac CT

Abstract

Low-dose ungated MDCT with an optimized protocol is reliable for prediction of the presence of CAC and categorization of the four major Agatston score ranks. This technique may be useful for coronary artery disease risk stratification of persons undergoing low-dose ungated MDCT for lung cancer screening.

Coronary calcium scoring of CT attenuation correction scans: Automatic, manual, or visual?

“…Einstein et al 4 suggested that lower CT numbers up to 80 HU represent CAC. However, the findings of Wu et al, 13 who observed that a standard Agatston method (threshold 130 HU) could be reliably used on low-dose CT scans performed for lung cancer screening, concur with those of the current author.…”

Validation and Prognosis of Coronary Artery Calcium Scoring in Nontriggered Thoracic Computed Tomography

“…The agreement of repeated calcium scoring in nontriggered CT within and between observers is high, although slightly lower than in electrocardiography-triggered CT. Nearly all studies in this systematic review investigated either intraobserver or interobserver variability of calcium scoring in nontriggered CT. For example, in 483 subjects, Wu et al 21 reported an interobserver variability of 3.6% for electrocardiographytriggered CT, and of 9.6% for nontriggered CT. However, all studies found a very strong concordance in score categorization within and between observers (κ=0.77-0.91; intraclass correlation coefficient, 0.93-0.99).…”

“…The most commonly used slice thicknesses were 2.5/3 mm and 5 mm. Four studies used a (medium-) smooth kernel, 10,20,21,25 the other studies did not indicate the applied kernel. Six studies used Agatston scoring, 10,[17][18][19]21,25 whereas 4 others used visual grading of the presence and extent of coronary calcification.…”

“…[17][18][19][20][21] Diagnostic performance of nontriggered CT was calculated in 4 studies with 1153 subjects (Table 3), [17][18][19]21 in which, 137 (11.9%) subjects had CS of 100 to 400 in nontriggered CT. Fifty-five subjects (8.8%) showed no coronary calcification in nontriggered CT examination among 625 subjects with CS>0 in electrocardiography-triggered CT. In those 55 subjects, 52 (8.3%) had CS 1 to 100 in electrocardiography-triggered CT, and 3 (0.5%) subjects had CS 100 to 400.…”

“…17,19,21 The study by Kirsch et al 20 could not be included because it evaluated the amount of coronary calcification using visual grading score. The pooled correlation coefficient for CS was 0.94 (95% confidence interval, 0.89-0.…”