Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
J Cardiovasc Comput Tomogr. 2022 Mar-Apr;16(2):150-154. doi: 10.1016/j.jcct.2021.10.004. Epub 2021 Oct 19.
A coronary artery calcium score (CACS) of 0 is associated with a very low risk of cardiac event. However, the Agatston CACS may fail to detect very small or less dense calcifications. We investigated if an alteration of the Agatston criteria would affect the ability to detect such plaques.
We evaluated 322 patients, 161 who had a baseline scan with CACS = 0 and a follow-up scan with CACS>0 and 161 with two serial CACS = 0 scans (control group), to identify subtle calcification not detected in the baseline scan because it was not meeting the Agatston size and HU thresholds (≥1 mm and ≥130HU). Size threshold was set to <1 mm and the HU threshold modified in a stepwise manner to 120, 110, 100 and 90. New lesions were classified as true positive or false positive(noise) using the follow-up scan.
We identified 69 visually suspected subtle calcified lesions in 65/322 (20.2%) patients with CAC = 0 by the Agatston criteria. When size threshold was set as <1 mm and HU ≥ 130, 36 lesions scored CACS>0, 34 (94.4%) true positive and 2 (5.6%) false positive. When decrease in HU (120HU, 110HU, 100HU, and 90HU) threshold was added to the reduced size threshold, the number of lesions scoring>0 increased (46, 55, 59, and 69, respectively) at a cost of increased false positive rate (8.7%, 20%, 22%, and 30.4% respectively). Eliminating size or both size and HU threshold to ≥120HU correctly reclassified 9.6% and 12.1% of patients respectively.
Eliminating size and reducing HU thresholds to ≥120HU improved the detection of subtle calcification when compared to the Agatston CACS method.
冠状动脉钙评分（CACS）为 0 与心脏事件的极低风险相关。然而，Agatston CACS 可能无法检测到非常小或密度较低的钙化。我们研究了改变 Agatston 标准是否会影响检测此类斑块的能力。
我们评估了 322 名患者，其中 161 名患者在基线扫描时 CACS=0，在随访扫描时 CACS>0，161 名患者连续两次 CACS=0 扫描（对照组），以识别在基线扫描中未检测到的微小钙化，因为它不符合 Agatston 大小和 HU 阈值（≥1mm 和≥130HU）。大小阈值设定为<1mm，HU 阈值逐步调整为 120、110、100 和 90。使用随访扫描对新病变进行分类为真阳性或假阳性（噪声）。
我们通过 Agatston 标准在 322 名 CACS=0 的患者中识别出 69 名存在可疑微小钙化的病变，其中 65 名患者（20.2%）存在微小钙化。当大小阈值设定为<1mm 且 HU≥130 时，36 个病变的 CACS>0，其中 34 个（94.4%）为真阳性，2 个（5.6%）为假阳性。当降低 HU（120HU、110HU、100HU 和 90HU）阈值添加到减小的大小阈值时，评分>0 的病变数量增加（分别为 46、55、59 和 69），但假阳性率增加（分别为 8.7%、20%、22%和 30.4%）。消除大小或大小和 HU 阈值均≥120HU 可正确重新分类 9.6%和 12.1%的患者。
与 Agatston CACS 方法相比，消除大小和降低 HU 阈值至≥120HU 可提高对微小钙化的检测能力。
