Abstract
Background
To determine the effect of low-dose, high-pitch non-electrocardiographic (ECG)-triggered
chest CT on coronary artery calcium (CAC) detection, quantification and risk stratification,
compared to ECG-triggered cardiac CT.
Methods
We selected 1,000 participants from the ImaLife study, 50% with coronary calcification
on cardiac CT. All participants underwent non-contrast cardiac CT followed by chest
CT using third-generation dual-source technology. Reconstruction settings were equal
for both acquisitions. CAC scores were determined by Agatston's method, and divided
dichotomously (0, >0), and into risk categories (0, 1–99, 100–399, ≥400). We investigated
the influence of heart rate and body mass index (BMI) on risk reclassification.
Results
Positive CAC scores on cardiac CT ranged from 1 to 6926 (median 39). Compared to cardiac
CT, chest CT had sensitivity of 0.96 (95%CI 0.94–0.98) and specificity of 0.99 (95%CI
0.97–0.99) for CAC detection (κ = 0.95). In participants with coronary calcification
on cardiac CT, CAC score on chest CT was lower than on cardiac CT (median 30 versus
40, p˂0.001). Agreement in CAC-based risk strata was excellent (weighted κ = 0.95).
Sixty-five cases (6.5%) were reclassified by one risk category in chest CT, with fifty-five
(84.6%) shifting downward. Higher BMI resulted in higher reclassification rate (13%
for BMI ≥30 versus 5.2% for BMI <30, p = 0.001), but there was no effect of heart
rate.
Conclusion
Low-dose, high-pitch chest CT, using third-generation dual-source technology shows
almost perfect agreement with cardiac CT in CAC detection and risk stratification.
However, low-dose chest CT mainly underestimates the CAC score as compared to cardiac
CT, and results in inaccurate risk categorization in BMI ≥30.
Keywords
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Article info
Publication history
Published online: May 12, 2020
Accepted:
April 30,
2020
Received in revised form:
April 28,
2020
Received:
October 21,
2019
Identification
Copyright
© 2021 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
