title: Estimation of cardiovascular risk on routine chest CT: Ordinal coronary artery calcium scoring as an accurate predictor of Agatston score ranges.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Two 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.
  
  
  RESULTS
  CAC 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).
  
  
  CONCLUSIONS
  Visual 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.
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States. Electronic address: lea.azour@mountsinai.org.
authors.forename: Lea
authors.initials: L
authors.lastname: Azour
authors.affiliation: Department of Radiology, University of California Davis, Sacramento, CA 95817, United States.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kadoch
authors.affiliation: Radiology Specialists of Florida, Maitland, FL 32751, United States.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Ward
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Corey D
authors.initials: CD
authors.lastname: Eber
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Adam H
authors.initials: AH
authors.lastname: Jacobi
mesh_terms: D000328:Adult; D000368:Aged; D055424:Cardiac-Gated Imaging Techniques; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D042241:Early Diagnosis; D004562:Electrocardiography; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: Agatston; Cardiovascular risk; Coronary artery calcium; Ordinal scoring; Routine chest CT; Visual assessment