title: Reliable categorisation of visual scoring of coronary artery calcification on low-dose CT for lung cancer screening: validation with the standard Agatston score.
abstract: OBJECTIVE
  To validate the reliability of the visual coronary artery calcification score (VCACS) on low-dose CT (LDCT) for concurrent screening of CAC and lung cancer.
  
  
  METHODS
  We enrolled 401 subjects receiving LDCT for lung cancer screening and ECG-gated CT for the Agatston score (AS). LDCT was reconstructed with 3- and 5-mm slice thickness (LDCT-3mm and LDCT-5mm respectively) for VCACS to obtain VCACS-3mm and VCACS-5mm respectively. After a training session comprising 32 cases, two observers performed four-scale VCACS (absent, mild, moderate, severe) of 369 data sets independently, the results were compared with four-scale AS (0, 1-100, 101-400, >400).
  
  
  RESULTS
  CACs were present in 39.6 % (146/369) of subjects. The sensitivity of VCACS-3mm was higher than for VCACS-5mm (83.6 % versus 74.0 %). The median of AS of the 24 false-negative cases in VCACS-3mm was 2.3 (range 1.1-21.1). The false-negative rate for detecting AS ≥ 10 on LDCT-3mm was 1.9 %. VCACS-3mm had higher concordance with AS than VCACS-5mm (k = 0.813 versus k = 0.685). An extended test of VCACS-3mm for four junior observers showed high inter-observer reliability (intra-class correlation = 0.90) and good concordance with AS (k = 0.662-0.747).
  
  
  CONCLUSIONS
  This study validated the reliability of VCACS on LDCT for lung cancer screening and showed that LDCT-3mm was more feasible than LDCT-5mm for CAD risk stratification.
  
  
  CONCLUSIONS
  • Low-dose computed tomography (LDCT) rarely misses significant coronary artery calcification (CAC). • Visual scoring of CAC on LDCT is highly concordant with Agatston scoring. • LDCT-3mm is more feasible than LDCT-5mm for CAD risk stratification. • CAC assessment enriched the screening information for LDCT lung cancer screening.
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung 813, Taiwan, Republic of China.
authors.forename: Yi-Luan
authors.initials: YL
authors.lastname: Huang
authors.forename: Fu-Zong
authors.initials: FZ
authors.lastname: Wu
authors.forename: Yen-Chi
authors.initials: YC
authors.lastname: Wang
authors.forename: Yu-Jeng
authors.initials: YJ
authors.lastname: Ju
authors.forename: Guang-Yuan
authors.initials: GY
authors.lastname: Mar
authors.forename: Chiung-Chen
authors.initials: CC
authors.lastname: Chuo
authors.forename: Huey-Shyan
authors.initials: HS
authors.lastname: Lin
authors.forename: Ming-Ting
authors.initials: MT
authors.lastname: Wu
mesh_terms: D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013624:Taiwan / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*