Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
J Cardiovasc Comput Tomogr. 2019 Nov-Dec;13(6):347-352. doi: 10.1016/j.jcct.2018.10.014. Epub 2018 Oct 19.
Coronary artery calcium (CAC) is a strong predictor for future cardiovascular events. Traditionally CAC has been quantified using the Agatston score, which was developed in the late 1980s for electron beam tomography (EBT). While EBT has been completely replaced by modern multiple-detector row CT technology, the traditional CAC scoring method by Agatston remains in use, although the literature indicates suboptimal reproducibility and subjects being incorrectly classified. The traditional Agatston scoring method counteracts the technical advances of CT technology, and prevents the use of thinner sections, obtained at lower tube voltage and overall decreased radiation exposure that has become available to other CT applications. Moreover, recent studies have shown that not only the total amount of CAC, but also its density and distribution in the coronary arterial tree may be of prognostic value. Acquisition and reconstruction techniques thus need to be adapted for modern CT technology and optimized for CAC quantification. In this review we describe the technical limitations of the Agatston score followed by our suggestions for developing a new and more robust CAC quantification method.
冠状动脉钙化 (CAC) 是未来心血管事件的强有力预测因子。传统上，CAC 的定量分析采用 Agatston 评分法，该方法由 20 世纪 80 年代末的电子束断层扫描 (EBT) 开发而来。虽然 EBT 已被现代多排探测器 CT 技术完全取代，但 Agatston 的传统 CAC 评分方法仍在使用，尽管文献表明其重现性不佳，且存在分类错误的情况。传统的 Agatston 评分方法与 CT 技术的进步背道而驰，阻碍了使用更薄的切片、更低的管电压以及整体辐射暴露量降低的方法，而这些方法在其他 CT 应用中已经得到了应用。此外，最近的研究表明，不仅 CAC 的总量，而且其在冠状动脉树中的密度和分布也可能具有预后价值。因此，采集和重建技术需要适应现代 CT 技术，并针对 CAC 定量进行优化。在这篇综述中，我们描述了 Agatston 评分的技术局限性，随后提出了开发新的、更稳健的 CAC 定量方法的建议。
