Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 3/2013

01-03-2013 | Cardiac

Fully automated derivation of coronary artery calcium scores and cardiovascular risk assessment from contrast medium-enhanced coronary CT angiography studies

Authors: Ullrich Ebersberger, Dov Eilot, Roman Goldenberg, Alon Lev, J. Reid Spears, Garrett W. Rowe, Nicholas Y. Gallagher, William T. Halligan, Philipp Blanke, Marcus R. Makowski, Aleksander W. Krazinski, Justin R. Silverman, Fabian Bamberg, Alexander W. Leber, Ellen Hoffmann, U. Joseph Schoepf

Published in: European Radiology | Issue 3/2013

Login to get access

Abstract

Objectives

Performance evaluation of a fully automated system for calculating computed tomography (CT) coronary artery calcium scores from contrast medium-enhanced coronary CT angiography (cCTA) studies.

Methods

One hundred and twenty-seven patients (58 ± 11 years, 71 men) who had undergone cCTA as well as an unenhanced CT calcium scoring study where included. Calcium scores were computed from cCTA by an automated image processing algorithm and compared with calcium scores obtained by standard manual assessment of unenhanced CT calcium scoring studies. Results were compared vis-a-vis (1) absolute calcium score values, (2) age-, gender- and race-dependent percentiles, and (3) commonly used calcium score risk classification categories.

Results

One hundred and nineteen out of 127 (93.7%) studies were successfully processed. Mean Agatston calcium score values obtained by traditional non-contrast CT calcium scoring studies and derived from contrast medium-enhanced cCTA did not significantly differ (235.6 ± 430.5 vs 262.0 ± 499.5; P > 0.05). Calcium score risk categories and Multi-Ethnic Study of Atherosclerosis (MESA) percentiles showed very high correlation (Spearman rank correlation coefficient = 0.97, P < 0.0001/0.95, P < 0.0001) between the two approaches.

Conclusions

Calcium score values automatically computed from cCTA are highly correlated with standard unenhanced CT calcium scoring studies. These results suggest a radiation dose- and time-saving potential when deriving calcium scores from cCTA studies without a preceding unenhanced CT calcium scoring study.

Key Points

• CT coronary calcium scoring is now widely used for cardiac risk stratification
• Derivation of calcium scores from coronary CT angiography saves time and radiation
• Automatically derived scores are comparable to conventional coronary artery calcium scores
• Patient risk stratification is similar, whether using automatically derived or conventional scores
Literature
1.
Genders TSS, Pugliese F, Mollet NR et al (2010) Incremental value of the CT coronary calcium score for the prediction of coronary artery disease. Eur Radiol 20:2331–2340PubMedCrossRef
2.
Sarwar A, Shaw LJ, Shapiro MD et al (2009) Diagnostic and prognostic value of absence of coronary artery calcification. JACC Cardiovasc Imaging 2:675–688PubMedCrossRef
3.
Erbel R, Möhlenkamp S, Moebus S et al (2010) Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis. J Am Coll Cardiol 56:1397–1406PubMedCrossRef
4.
Polonsky TS, McClelland RL, Jorgensen NW et al (2010) Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA 303:1610–1616PubMedCrossRef
5.
Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC (2004) Coronary artery calcium score combined with framingham score for risk prediction in asymptomatic individuals. JAMA 291:210–215PubMedCrossRef
6.
Palumbo AA, Maffei E, Martini C et al (2009) Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis. Eur Radiol 19:2127–2135PubMedCrossRef
7.
Taylor AJ, Cerqueira M, Hodgson JMB et al (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. J Am Coll Cardiol 56:1864–1894PubMedCrossRef
8.
Leschka S, Scheffel H, Desbiolles L et al (2008) Combining dual-source computed tomography coronary angiography and calcium scoring: added value for the assessment of coronary artery disease. Heart 94:1154–1161PubMedCrossRef
9.
Mühlenbruch G, Wildberger JE, Koos R et al (2005) Coronary calcium scoring using 16-row multislice computed tomography: nonenhanced versus contrast-enhanced studies in vitro and in vivo. Invest Radiol 40:148–154PubMedCrossRef
10.
Bischoff B, Kantert C, Meyer T et al (2011) Cardiovascular risk assessment based on the quantification of coronary calcium in contrast-enhanced coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 13:468–475PubMedCrossRef
11.
Hong C, Becker CR, Schoepf UJ, Ohnesorge B, Bruening R, Reiser MF (2002) Coronary artery calcium: absolute quantification in nonenhanced and contrast-enhanced multi-detector row CT studies. Radiology 223:474–480PubMedCrossRef
12.
van der Bijl N, Joemai RMS, Geleijns J et al (2010) Assessment of agatston coronary artery calcium score using contrast-enhanced CT coronary angiography. AJR Am J Roentgenol 195:1299–1305PubMedCrossRef
13.
Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832PubMedCrossRef
14.
Rumberger JA, Brundage BH, Rader DJ, Kondos G (1999) Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc 74:243–252PubMedCrossRef
15.
McClelland RL (2005) Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 113:30–37PubMedCrossRef
16.
Goldenberg R, Eilot D, Begelman G, Walach E, Ben-Ishai E, Peled N (2012) Computer-aided simple triage (CAST) for coronary CT angiography (CCTA). Int J Comput Assist Radiol Surg. doi:10.​1007/​s11548-012-0684-7
17.
Glodny B, Helmel B, Trieb T et al (2009) A method for calcium quantification by means of CT coronary angiography using 64-multidetector CT: very high correlation with Agatston and volume scores. Eur Radiol 19:1661–1668PubMedCrossRef
18.
Otton J, Lønborg J, Boshell D et al (2012) A method for coronary artery calcium scoring using contrast-enhanced computed tomography. J Cardiovasc Comput Tomogr 6:37–44PubMedCrossRef
19.
Moselewski F, Ferencik M, Achenbach S et al (2006) Threshold-dependent variability of coronary artery calcification measurements—implications for contrast-enhanced multi-detector row-computed tomography. Eur J Radiol 57:390–395PubMedCrossRef
20.
Leber AW, Johnson T, Becker A et al (2007) Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease. Eur Heart J 28:2354–2360PubMedCrossRef
21.
Meijboom WB, Meijs MFL, Schuijf JD et al (2008) Diagnostic accuracy of 64-slice computed tomography coronary angiography. J Am Coll Cardiol 52:2135–2144PubMedCrossRef
22.
Schlattmann P, Schuetz GM, Dewey M (2011) Influence of coronary artery disease prevalence on predictive values of coronary CT angiography: a meta-regression analysis. Eur Radiol 21:1904–1913PubMedCrossRef
23.
Becker CR, Majeed A, Crispin A et al (2004) CT measurement of coronary calcium mass: impact on global cardiac risk assessment. Eur Radiol 15:96–101PubMedCrossRef
24.
Hadamitzky M, Distler R, Meyer T et al (2011) Prognostic value of coronary computed tomographic angiography in comparison with calcium scoring and clinical risk scores. Circ Cardiovasc Imaging 4:16–23PubMedCrossRef
25.
Raman V, McWilliams ETM, Holmberg SRM, Miles K (2011) Economic analysis of the use of coronary calcium scoring as an alternative to stress ECG in the non-invasive diagnosis of coronary artery disease. Eur Radiol 22:579–587PubMedCrossRef
26.
Achenbach S, Marwan M, Ropers D et al (2010) Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Eur Heart J 31:340–346PubMedCrossRef
27.
Yoon HC, Goldin JG, Greaser LE, Sayre J, Fonarow GC (2000) Interscan variation in coronary artery calcium quantification in a large asymptomatic patient population. AJR Am J Roentgenol 174:803–809PubMed
28.
Rutten A, Isgum I, Prokop M (2007) Coronary calcification: effect of small variation of scan starting position on Agatston, volume, and mass scores. Radiology 246:90–98PubMedCrossRef
29.
Mahnken AH, Wildberger JE, Sinha AM et al (2002) Variation of the coronary calcium score depending on image reconstruction interval and scoring algorithm. Invest Radiol 37:496–502PubMedCrossRef
30.
Detrano RC, Anderson M, Nelson J et al (2005) Coronary calcium measurements: effect of CT scanner type and calcium measure on rescan reproducibility—MESA study. Radiology 236:477–484PubMedCrossRef
Metadata
Title
Fully automated derivation of coronary artery calcium scores and cardiovascular risk assessment from contrast medium-enhanced coronary CT angiography studies
Authors
Ullrich Ebersberger
Dov Eilot
Roman Goldenberg
Alon Lev
J. Reid Spears
Garrett W. Rowe
Nicholas Y. Gallagher
William T. Halligan
Philipp Blanke
Marcus R. Makowski
Aleksander W. Krazinski
Justin R. Silverman
Fabian Bamberg
Alexander W. Leber
Ellen Hoffmann
U. Joseph Schoepf
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
European Radiology / Issue 3/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-012-2652-6

Other articles of this Issue 3/2013

European Radiology 3/2013 Go to the issue

Gastrointestinal

The second ESGAR consensus statement on CT colonography

Interventional

Characteristics of vascular supply to uterine leiomyoma: an analysis of digital subtraction angiography imaging in 518 cases

Computed Tomography

Image quality of ultra-low radiation exposure coronary CT angiography with an effective dose <0.1 mSv using high-pitch spiral acquisition and raw data-based iterative reconstruction

Interventional

Placement of retrievable self-expandable metallic stents with barbs into patients with obstructive prostate cancer

Computed Tomography

IAEA survey of paediatric computed tomography practice in 40 countries in Asia, Europe, Latin America and Africa: procedures and protocols

Computed Tomography

Choi response criteria for prediction of survival in patients with metastatic renal cell carcinoma treated with anti-angiogenic therapies