title: Reliability analysis of visual ranking of coronary artery calcification on low-dose CT of the thorax for lung cancer screening: comparison with ECG-gated calcium scoring CT.
abstract: Coronary artery calcification (CAC) is frequently detected on low-dose CT (LDCT) of the thorax. Concurrent assessment of CAC and lung cancer screening using LDCT is beneficial in terms of cost and radiation dose reduction. The aim of our study was to evaluate the reliability of visual ranking of positive CAC on LDCT compared to Agatston score (AS) on electrocardiogram (ECG)-gated calcium scoring CT. We studied 576 patients who were consecutively registered for health screening and undergoing both LDCT and ECG-gated calcium scoring CT. We excluded subjects with an AS of zero. The final study cohort included 117 patients with CAC (97 men; mean age, 53.4 ± 8.5). AS was used as the gold standard (mean score 166.0; range 0.4-3,719.3). Two board-certified radiologists and two radiology residents participated in an observer performance study. Visual ranking of CAC was performed according to four categories (1-10, 11-100, 101-400, and 401 or higher) for coronary artery disease risk stratification. Weighted kappa statistics were used to measure the degree of reliability on visual ranking of CAC on LDCT. The degree of reliability on visual ranking of CAC on LDCT compared to ECG-gated calcium scoring CT was excellent for board-certified radiologists and good for radiology residents. A high degree of association was observed with 71.6% of visual rankings in the same category as the Agatston category and 98.9% varying by no more than one category. Visual ranking of positive CAC on LDCT is reliable for predicting AS rank categorization.
authors.affiliation: Department of Radiology, Gachon University Gil Medical Center, 21, Namdong-daero, 774 Beon-gil, Namdong-gu, Incheon, 405-760, Republic of Korea.
authors.forename: Yoon Kyung
authors.initials: YK
authors.lastname: Kim
authors.forename: Yon Mi
authors.initials: YM
authors.lastname: Sung
authors.forename: So Hyun
authors.initials: SH
authors.lastname: Cho
authors.forename: Young Nam
authors.initials: YN
authors.lastname: Park
authors.forename: Hye-Young
authors.initials: HY
authors.lastname: Choi
mesh_terms: D055424:Cardiac-Gated Imaging Techniques; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015588:Observer Variation; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D061205:Vascular Calcification / Q000000981:diagnostic imaging*; D014796:Visual Perception
references.citation: N Engl J Med. 2011 Aug 4;365(5):395-409
references.pmid: 21714641
references.citation: J Am Coll Cardiol. 2010 Oct 19;56(17):1407-14
references.pmid: 20946998
references.citation: Am Heart J. 2009 Oct;158(4):554-61
references.pmid: 19781414
references.citation: JAMA. 2012 Aug 22;308(8):788-95
references.pmid: 22910756
references.citation: J Natl Compr Canc Netw. 2012 Feb;10(2):240-65
references.pmid: 22308518
references.citation: J Am Coll Cardiol. 2007 Jan 23;49(3):378-402
references.pmid: 17239724
references.citation: AJR Am J Roentgenol. 2008 Apr;190(4):923-8
references.pmid: 18356438
references.citation: Arch Intern Med. 2009 Jul 13;169(13):1188-94
references.pmid: 19597067
references.citation: J Am Coll Cardiol. 2010 Nov 30;56(23):1914-21
references.pmid: 21109114
references.citation: AJR Am J Roentgenol. 2010 May;194(5):1244-9
references.pmid: 20410410
references.citation: Acad Radiol. 2012 Nov;19(11):1402-7
references.pmid: 22925933
references.citation: AJR Am J Roentgenol. 2000 Mar;174(3):803-9
references.pmid: 10701629
references.citation: Clin Imaging. 2006 May-Jun;30(3):181-5
references.pmid: 16632153
references.citation: J Am Coll Cardiol. 1990 Mar 15;15(4):827-32
references.pmid: 2407762
references.citation: Radiology. 2010 Nov;257(2):541-8
references.pmid: 20829542
references.citation: JACC Cardiovasc Imaging. 2009 Jun;2(6):692-700
references.pmid: 19520338
references.citation: Am J Cardiol. 2006 Jul 17;98(2A):2H-15H
references.pmid: 16843744
references.citation: Radiology. 2007 May;243(2):527-38
references.pmid: 17456875
references.citation: AJR Am J Roentgenol. 2008 Apr;190(4):917-22
references.pmid: 18356437
references.citation: Radiology. 2003 Sep;228(3):826-33
references.pmid: 12869688