Department of Radiology, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Eur Heart J Cardiovasc Imaging. 2024 Aug 26;25(9):1186-1196. doi: 10.1093/ehjci/jeae081.
The study aimed, firstly, to validate automatically and visually scored coronary artery calcium (CAC) on low-dose computed tomography (CT) (LDCT) scans with a dedicated calcium scoring CT (CSCT) scan and, secondly, to assess the added value of CAC scored from LDCT scans acquired during [15O]-water-positron emission tomography (PET) myocardial perfusion imaging (MPI) on prediction of major adverse cardiac events (MACE).
Five hundred seventy-two consecutive patients with suspected coronary artery disease, who underwent [15O]-water-PET MPI with LDCT and a dedicated CSCT scan were included. In the reference CSCT scans, manual CAC scoring was performed, while LDCT scans were scored visually and automatically using deep learning approach. Subsequently, based on CAC score results from CSCT and LDCT scans, each patient's scan was assigned to one out of five cardiovascular risk groups (0, 1-100, 101-400, 401-1000, >1000), and the agreement in risk group classification between CSCT and LDCT scans was investigated. MACE was defined as a composite of all-cause death, non-fatal myocardial infarction, coronary revascularization, and unstable angina. The agreement in risk group classification between reference CSCT manual scoring and visual/automatic LDCT scoring from LDCT was 0.66 [95% confidence interval (CI): 0.62-0.70] and 0.58 (95% CI: 0.53-0.62), respectively. Based on visual and automatic CAC scoring from LDCT scans, patients with CAC > 100 and CAC > 400, respectively, were at increased risk of MACE, independently of ischaemic information from the [15O]-water-PET scan.
There is a moderate agreement in risk classification between visual and automatic CAC scoring from LDCT and reference CSCT scans. Visual and automatic CAC scoring from LDCT scans improve identification of patients at higher risk of MACE.
本研究的主要目的是，首先，利用专用钙评分 CT（CSCT）扫描对低剂量计算机断层扫描（LDCT）扫描进行自动和直观的冠状动脉钙（CAC）评分验证，其次，评估在 [15O]-水正电子发射断层扫描（PET）心肌灌注成像（MPI）期间获得的 LDCT 扫描上进行 CAC 评分对主要不良心脏事件（MACE）预测的附加价值。
本研究纳入了 572 例疑似冠心病患者，这些患者接受了 [15O]-水-PET MPI 检查，并进行了 LDCT 和专用 CSCT 扫描。在参考 CSCT 扫描中，进行了手动 CAC 评分，而 LDCT 扫描则使用深度学习方法进行了直观和自动评分。随后，根据 CSCT 和 LDCT 扫描的 CAC 评分结果，将每位患者的扫描分为五个心血管风险组之一（0、1-100、101-400、401-1000、>1000），并研究了 CSCT 和 LDCT 扫描在风险组分类方面的一致性。MACE 定义为全因死亡、非致死性心肌梗死、冠状动脉血运重建和不稳定型心绞痛的复合终点。参考 CSCT 手动评分与 LDCT 视觉/自动评分在风险组分类方面的一致性分别为 0.66（95%置信区间[CI]：0.62-0.70）和 0.58（95% CI：0.53-0.62）。基于 LDCT 扫描的视觉和自动 CAC 评分，CAC>100 和 CAC>400 的患者分别具有较高的 MACE 风险，这与 [15O]-水-PET 扫描的缺血信息无关。
LDCT 与参考 CSCT 扫描的视觉和自动 CAC 评分在风险分类方面具有中等一致性。LDCT 扫描的视觉和自动 CAC 评分可提高对 MACE 风险较高患者的识别能力。
