Measurement of coronary artery calcium with dual-slice helical CT compared with coronary angiography: Evaluation of CT scoring methods, interobserver variations, and reproducibility

Lynn S. Broderick, Joseph Shemesh, Robert L. Wilensky, George J. Eckert, Xiao Hua Zhou, William E. Torres, Michael A. Balk, Wendy J. Rogers, Dewey Conces, Kenyon K. Kopecky

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

OBJECTIVE. This study was performed to evaluate new scoring methods for quantitating coronary artery calcifications with helical CT and to compare the results with those of quantitative coronary angiography in patients with suspected coronary artery disease. SUBJECTS AND METHODS. Unenhanced dual- slice helical CT and coronary angiography were performed within 24 hr of each other in 101 patients with symptoms of coronary artery disease. Coronary artery calcifications with a density above 90 H were identified on each slice and, with the same regions of interest, quantitative scoring was performed at thresholds of 90 H (new) and 130 H (old). Two mathematical algorithms (one new and one old) were evaluated for both thresholds (yielding four scoring systems). By CT imaging, we defined disease as a score of greater than zero. By angiography, we defined disease as a 50% or greater reduction in the luminal diameter of any major vessel. Interobserver variations in calcification scoring were evaluated. Seventeen of our patients also underwent a second, consecutive CT scan to determine reproducibility. RESULTS. With the new threshold and the new algorithm, the sensitivity, specificity, and accuracy of helical CT in predicting disease were 88%, 52%, and 76%, respectively. We found a moderate positive association between the total CT calcification score and the number of stenotic coronary arteries at angiography (Pearson's correlation coefficient, .43; p = 0.5 [analysis of variance]). The accuracy and the area under the receiver operating characteristic curve were higher with the new threshold and the new algorithm. Interobserver agreement in calcification scoring was high (intraclass correlation coefficient, .99 [n = 85]), as was reproducibility (intraclass correlation coefficient, .94 [n = 17]). Reproducibility was higher when scoring was based on the new threshold and the new algorithm. CONCLUSION. The quantity of coronary artery calcifications as measured by helical CT correlated positively with obstructive coronary artery disease as measured by angiography. Interobserver agreement and reproducibility were excellent. A new scoring method showed promise.

Original languageEnglish (US)
Pages (from-to)439-444
Number of pages6
JournalAmerican Journal of Roentgenology
Volume167
Issue number2
StatePublished - 1996

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Observer Variation
Spiral Computed Tomography
Coronary Angiography
Coronary Vessels
Research Design
Calcium
Coronary Artery Disease
Angiography
ROC Curve
Analysis of Variance
Sensitivity and Specificity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Measurement of coronary artery calcium with dual-slice helical CT compared with coronary angiography : Evaluation of CT scoring methods, interobserver variations, and reproducibility. / Broderick, Lynn S.; Shemesh, Joseph; Wilensky, Robert L.; Eckert, George J.; Zhou, Xiao Hua; Torres, William E.; Balk, Michael A.; Rogers, Wendy J.; Conces, Dewey; Kopecky, Kenyon K.

In: American Journal of Roentgenology, Vol. 167, No. 2, 1996, p. 439-444.

Research output: Contribution to journalArticle

Broderick, LS, Shemesh, J, Wilensky, RL, Eckert, GJ, Zhou, XH, Torres, WE, Balk, MA, Rogers, WJ, Conces, D & Kopecky, KK 1996, 'Measurement of coronary artery calcium with dual-slice helical CT compared with coronary angiography: Evaluation of CT scoring methods, interobserver variations, and reproducibility', American Journal of Roentgenology, vol. 167, no. 2, pp. 439-444.
Broderick, Lynn S. ; Shemesh, Joseph ; Wilensky, Robert L. ; Eckert, George J. ; Zhou, Xiao Hua ; Torres, William E. ; Balk, Michael A. ; Rogers, Wendy J. ; Conces, Dewey ; Kopecky, Kenyon K. / Measurement of coronary artery calcium with dual-slice helical CT compared with coronary angiography : Evaluation of CT scoring methods, interobserver variations, and reproducibility. In: American Journal of Roentgenology. 1996 ; Vol. 167, No. 2. pp. 439-444.
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title = "Measurement of coronary artery calcium with dual-slice helical CT compared with coronary angiography: Evaluation of CT scoring methods, interobserver variations, and reproducibility",
abstract = "OBJECTIVE. This study was performed to evaluate new scoring methods for quantitating coronary artery calcifications with helical CT and to compare the results with those of quantitative coronary angiography in patients with suspected coronary artery disease. SUBJECTS AND METHODS. Unenhanced dual- slice helical CT and coronary angiography were performed within 24 hr of each other in 101 patients with symptoms of coronary artery disease. Coronary artery calcifications with a density above 90 H were identified on each slice and, with the same regions of interest, quantitative scoring was performed at thresholds of 90 H (new) and 130 H (old). Two mathematical algorithms (one new and one old) were evaluated for both thresholds (yielding four scoring systems). By CT imaging, we defined disease as a score of greater than zero. By angiography, we defined disease as a 50{\%} or greater reduction in the luminal diameter of any major vessel. Interobserver variations in calcification scoring were evaluated. Seventeen of our patients also underwent a second, consecutive CT scan to determine reproducibility. RESULTS. With the new threshold and the new algorithm, the sensitivity, specificity, and accuracy of helical CT in predicting disease were 88{\%}, 52{\%}, and 76{\%}, respectively. We found a moderate positive association between the total CT calcification score and the number of stenotic coronary arteries at angiography (Pearson's correlation coefficient, .43; p = 0.5 [analysis of variance]). The accuracy and the area under the receiver operating characteristic curve were higher with the new threshold and the new algorithm. Interobserver agreement in calcification scoring was high (intraclass correlation coefficient, .99 [n = 85]), as was reproducibility (intraclass correlation coefficient, .94 [n = 17]). Reproducibility was higher when scoring was based on the new threshold and the new algorithm. CONCLUSION. The quantity of coronary artery calcifications as measured by helical CT correlated positively with obstructive coronary artery disease as measured by angiography. Interobserver agreement and reproducibility were excellent. A new scoring method showed promise.",
author = "Broderick, {Lynn S.} and Joseph Shemesh and Wilensky, {Robert L.} and Eckert, {George J.} and Zhou, {Xiao Hua} and Torres, {William E.} and Balk, {Michael A.} and Rogers, {Wendy J.} and Dewey Conces and Kopecky, {Kenyon K.}",
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T1 - Measurement of coronary artery calcium with dual-slice helical CT compared with coronary angiography

T2 - Evaluation of CT scoring methods, interobserver variations, and reproducibility

AU - Broderick, Lynn S.

AU - Shemesh, Joseph

AU - Wilensky, Robert L.

AU - Eckert, George J.

AU - Zhou, Xiao Hua

AU - Torres, William E.

AU - Balk, Michael A.

AU - Rogers, Wendy J.

AU - Conces, Dewey

AU - Kopecky, Kenyon K.

PY - 1996

Y1 - 1996

N2 - OBJECTIVE. This study was performed to evaluate new scoring methods for quantitating coronary artery calcifications with helical CT and to compare the results with those of quantitative coronary angiography in patients with suspected coronary artery disease. SUBJECTS AND METHODS. Unenhanced dual- slice helical CT and coronary angiography were performed within 24 hr of each other in 101 patients with symptoms of coronary artery disease. Coronary artery calcifications with a density above 90 H were identified on each slice and, with the same regions of interest, quantitative scoring was performed at thresholds of 90 H (new) and 130 H (old). Two mathematical algorithms (one new and one old) were evaluated for both thresholds (yielding four scoring systems). By CT imaging, we defined disease as a score of greater than zero. By angiography, we defined disease as a 50% or greater reduction in the luminal diameter of any major vessel. Interobserver variations in calcification scoring were evaluated. Seventeen of our patients also underwent a second, consecutive CT scan to determine reproducibility. RESULTS. With the new threshold and the new algorithm, the sensitivity, specificity, and accuracy of helical CT in predicting disease were 88%, 52%, and 76%, respectively. We found a moderate positive association between the total CT calcification score and the number of stenotic coronary arteries at angiography (Pearson's correlation coefficient, .43; p = 0.5 [analysis of variance]). The accuracy and the area under the receiver operating characteristic curve were higher with the new threshold and the new algorithm. Interobserver agreement in calcification scoring was high (intraclass correlation coefficient, .99 [n = 85]), as was reproducibility (intraclass correlation coefficient, .94 [n = 17]). Reproducibility was higher when scoring was based on the new threshold and the new algorithm. CONCLUSION. The quantity of coronary artery calcifications as measured by helical CT correlated positively with obstructive coronary artery disease as measured by angiography. Interobserver agreement and reproducibility were excellent. A new scoring method showed promise.

AB - OBJECTIVE. This study was performed to evaluate new scoring methods for quantitating coronary artery calcifications with helical CT and to compare the results with those of quantitative coronary angiography in patients with suspected coronary artery disease. SUBJECTS AND METHODS. Unenhanced dual- slice helical CT and coronary angiography were performed within 24 hr of each other in 101 patients with symptoms of coronary artery disease. Coronary artery calcifications with a density above 90 H were identified on each slice and, with the same regions of interest, quantitative scoring was performed at thresholds of 90 H (new) and 130 H (old). Two mathematical algorithms (one new and one old) were evaluated for both thresholds (yielding four scoring systems). By CT imaging, we defined disease as a score of greater than zero. By angiography, we defined disease as a 50% or greater reduction in the luminal diameter of any major vessel. Interobserver variations in calcification scoring were evaluated. Seventeen of our patients also underwent a second, consecutive CT scan to determine reproducibility. RESULTS. With the new threshold and the new algorithm, the sensitivity, specificity, and accuracy of helical CT in predicting disease were 88%, 52%, and 76%, respectively. We found a moderate positive association between the total CT calcification score and the number of stenotic coronary arteries at angiography (Pearson's correlation coefficient, .43; p = 0.5 [analysis of variance]). The accuracy and the area under the receiver operating characteristic curve were higher with the new threshold and the new algorithm. Interobserver agreement in calcification scoring was high (intraclass correlation coefficient, .99 [n = 85]), as was reproducibility (intraclass correlation coefficient, .94 [n = 17]). Reproducibility was higher when scoring was based on the new threshold and the new algorithm. CONCLUSION. The quantity of coronary artery calcifications as measured by helical CT correlated positively with obstructive coronary artery disease as measured by angiography. Interobserver agreement and reproducibility were excellent. A new scoring method showed promise.

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