title: Assessment of coronary artery calcium using dual-energy subtraction digital radiography.
abstract: Cardiovascular disease is the leading cause of global mortality, yet its early detection remains a vexing problem of modern medicine. Although the computed tomography (CT) calcium score predicts cardiovascular risk, relatively high cost ($250-400) and radiation dose (1-3 mSv) limit its universal utility as a screening tool. Dual-energy digital subtraction radiography (DE; <$60, 0.07 mSv) enables detection of calcified structures with high sensitivity. In this pilot study, we examined DE radiography's ability to quantify coronary artery calcification (CAC). We identified 25 patients who underwent non-contrast CT and DE chest imaging performed within 12 months using documented CAC as the major inclusion criteria. A DE calcium score was developed based on pixel intensity multiplied by the area of the calcified plaque. DE scores were plotted against CT scores. Subsequently, a validation cohort of 14 additional patients was independently evaluated to confirm the accuracy and precision of CAC quantification, yielding a total of 39 subjects. Among all subjects (n = 39), the DE score demonstrated a correlation coefficient of 0.87 (p < 0.0001) when compared with the CT score. For the 13 patients with CT scores of <400, the correlation coefficient was -0.26. For the 26 patients with CT scores of ≥400, the correlation coefficient yielded 0.86. This pilot study demonstrates the feasibility of DE radiography to identify patients at the highest cardiovascular risk. DE radiography's accuracy at lower scores remains unclear. Further evaluation of DE radiography as an inexpensive and low-radiation imaging tool to diagnose cardiovascular disease appears warranted.
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
authors.forename: John N
authors.initials: JN
authors.lastname: Mafi
authors.forename: Baowei
authors.initials: B
authors.lastname: Fei
authors.forename: Sharon
authors.initials: S
authors.lastname: Roble
authors.forename: Anthony
authors.initials: A
authors.lastname: Dota
authors.forename: Prashanth
authors.initials: P
authors.lastname: Katrapati
authors.forename: Hiram G
authors.initials: HG
authors.lastname: Bezerra
authors.forename: Hesheng
authors.initials: H
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Leslie
authors.initials: L
authors.lastname: Ciancibello
authors.forename: Marco
authors.initials: M
authors.lastname: Costa
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Simon
authors.forename: Carl E
authors.initials: CE
authors.lastname: Orringer
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gilkeson
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods*; D002114:Calcinosis / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric