University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA; Parkland Health & Hospital System, Department of Internal Medicine, Dallas, TX, USA.
University of Texas Southwestern, Division of Cardiology, Dallas, TX, USA.
J Cardiovasc Comput Tomogr. 2023 Nov-Dec;17(6):453-458. doi: 10.1016/j.jcct.2023.10.001. Epub 2023 Oct 19.
CAC can be detected on routine chest computed tomography (CT) scans and may contribute to CVD risk estimation, but the accuracy of visual CAC scoring may be affected by the specialty of the interpreting radiologist and/or the use of contrast.
The accuracy of visual CAC estimation on non-gated CT scans was evaluated at UT Southwestern Medical Center (UTSW) and Parkland Health and Hospital System (PHHS). All adults who underwent CAC scanning and a non-gated CT scan within 6 months were identified and the scores from the two CTs were compared overall and stratified by type of reader and whether contrast was used. Visual CAC categories of none, small, moderate, and large were compared to CAC = 0, 1-99, 100-399, and ≥400, respectively.
From 2016 to 2021, 934 patients (mean age 60 ± 12 y, 43% male, 61% White, 34% Black, 24% Hispanic, 54% from PHHS) had both CT scans. Of these, 441 (47%) had no CAC, 278 (30%) small, 147 (16%) moderate, and 66 (7%) large CAC on non-gated CT. Visual CAC estimates were highly correlated with CAC scores (Kendalls tau-b = 0.76, p < 0.0001). Among those with no visual CAC, 76% had CAC = 0 (72% of contrast-enhanced vs 85% of non-contrast scans, 88% of scans interpreted by CT radiologist vs 78% of those interpreted by other radiologist). In those with moderate-to-large visual CAC, 99% had CAC >0 and 88% had CAC ≥100, including 89% of those with contrast, 90% of those without contrast, 80% of those read by a CT radiologist, and 88% of those read by a non-CT radiologist.
Visual CAC estimates on non-gated CT scans are concordant with Agatston score categories from cardiac CT scans. A lack of visual CAC on non-gated CT scans may not be sufficient to "de-risk" patients, particularly for contrast-enhanced scans and those read by non-CT radiologists. However, the presence of moderate-to-large CAC, including on contrasted scans and regardless of radiologist type, is highly predictive of CAC and may be used to identify high-risk patients for prevention interventions.
CAC 可在常规胸部计算机断层扫描（CT）上检测到，可能有助于 CVD 风险评估，但视觉 CAC 评分的准确性可能受到解释放射科医生的专业知识和/或对比剂的使用的影响。
在德克萨斯西南医学中心（UTSW）和帕克兰健康与医院系统（PHHS）评估非门控 CT 扫描上的视觉 CAC 估计的准确性。确定所有在 6 个月内接受 CAC 扫描和非门控 CT 扫描的成年人，并比较两次 CT 的评分，总体比较，并按阅读者类型和是否使用对比剂进行分层。无 CAC、小 CAC、中 CAC 和大 CAC 的视觉 CAC 类别分别与 CAC = 0、1-99、100-399 和 ≥400 进行比较。
2016 年至 2021 年，934 例患者（平均年龄 60 ± 12 岁，43%为男性，61%为白人，34%为黑人，24%为西班牙裔，54%来自 PHHS）进行了 CT 扫描。其中，441 例（47%）在非门控 CT 上无 CAC，278 例（30%）为小 CAC，147 例（16%）为中 CAC，66 例（7%）为大 CAC。视觉 CAC 估计值与 CAC 评分高度相关（Kendall's tau-b = 0.76，p < 0.0001）。在无视觉 CAC 的患者中，76%的患者 CAC = 0（增强对比剂的患者中为 72%，非增强对比剂的患者中为 85%，由 CT 放射科医生阅读的患者中为 88%，由其他放射科医生阅读的患者中为 78%）。在中到大视觉 CAC 患者中，99%的患者 CAC >0，88%的患者 CAC ≥100，包括 89%的有对比剂的患者，80%的无对比剂的患者，80%的由 CT 放射科医生阅读的患者和 88%的由非 CT 放射科医生阅读的患者。
非门控 CT 扫描上的视觉 CAC 估计值与心脏 CT 扫描的 Agatston 评分类别一致。非门控 CT 扫描上无视觉 CAC 可能不足以“降低”患者的风险，尤其是对于增强对比剂的扫描和由非 CT 放射科医生阅读的扫描。然而，中到大 CAC 的存在，包括增强对比剂扫描和无论放射科医生类型如何，均高度预测 CAC，可用于识别高风险患者进行预防干预。
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