Coronary artery calcium detection using flat panel digital cinefluoroscopy: comparison to coronary artery calcium score assessed with multiple detector computerized tomography

Abstract

Background: The diagnostic accuracy of flat panel digital detector (FPDD) cinefluoroscopy for coronary artery calcium (CAC) detection, compared to multiple detector computed tomography (MDCT), is not known.

Methods: CAC was assessed by FPDD cinefluoroscopy (graded as 0,1, 2 and 3) and calcium score (CACS) was determined by MDCT in 151 asymptomatic individuals of low to intermediate cardiovascular risk, 40-60 years old (mean age 53.1 ± 7.4, men 76.5%).

Results: CAC was detected by MDCT and cinefluoroscopy in 79 (52.3%) and 69 (45.7%) of cases respectively. Agreement between MDCT and cinefluoroscopy was 77.5% (weighted kappa coefficient 0.75). Cinefluoroscopy was able to detect CAC in 50% of subjects with minimal CACS (<10). For CACS=0, area under the curve (AUC) was 0.89 (95% CI 0.83-0.93, p=0.0001) with sensitivity 82.3% and specificity 94.4%. For CACS=10, AUC was 0.91 (95% CI 0.86-0.95, p=0.0001) with sensitivity 91.8% and specificity 85.6%. For CACS=400, AUC was 0.97 (95% CI 0.94-0.99, p=0.0001) with sensitivity 100% and specificity 88.7%. The effective radiation dose was 1.8 ± 0.09 mSv for CT and 0.26 ± 0.13 mSv for cinefluoroscopy.

Conclusions: Cinefluoroscopy performed with 'state-of-the art' FPDD technology has an excellent diagnostic accuracy compared to the 'gold standard' MDCT for CAC detection in middle aged, low to intermediate cardiovascular risk, asymptomatic individuals, with the advantage of lower radiation exposure.