Estimation of cardiovascular risk on routine chest CT: Ordinal coronary artery calcium scoring as an accurate predictor of Agatston score ranges

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• 作者：Lea Azour^a ; ^b ; ^{lea.azour@mountsinai.org} ; Michael A. Kadoch^c ; Thomas J. Ward^d ; Corey D. Eber^a ; Adam H. Jacobi^a ; ^b
• 关键词：Agatston ; Ordinal scoring ; Visual assessment ; Coronary artery calcium ; Cardiovascular risk ; Routine chest CT
• 刊名：Journal of Cardiovascular Computed Tomography
• 出版年：2017
• 出版时间：January-February 2017
• 年：2017
• 卷：11
• 期：1
• 页码：8-15
• 全文大小：1098 K
• 卷排序：11

文摘

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.MethodsTwo 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.ResultsCAC 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).ConclusionVisual 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.