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. 2023 Jun;30(3):1191-1198.
doi: 10.1007/s12350-022-03120-3. Epub 2022 Oct 26.

Low-dose coronary artery calcium scoring compared to the standard protocol

Ileana Rosely Allio #  1 , Federico Caobelli #  2 , Cristina Elena Popescu  3 , Philip Haaf  1 , Ian Alberts  4 , Simon M Frey  1 , Michael J Zellweger  5
Affiliations

Low-dose coronary artery calcium scoring compared to the standard protocol

Ileana Rosely Allio et al. J Nucl Cardiol. 2023 Jun.

Abstract

Background: We aimed to compare coronary artery calcium scoring (CACS) with computed tomography (CT) with 80 and 120 kVp in a large patient population and to establish whether there is a difference in risk classification between the two scores.

Methods: Patients with suspected CAD undergoing MPS were included. All underwent standard CACS assessment with 120-kVp tube voltage and with 80 kVp. Two datasets (low-dose and standard) were generated and compared. Risk classes (0 to 25, 25 to 50, 50 to 75, 75 to 90, and > 90%) were recorded.

Results: 1511 patients were included (793 males, age 69 ± 9.1 years). There was a very good correlation between scores calculated with 120 and 80 kVp (R = 0.94, R2 = 0.88, P < .001), with Bland-Altman limits of agreement of - 563.5 to 871.9 and a bias of - 154.2. The proportion of patients assigned to the < 25% percentile class (P = .03) and with CACS = 0 differed between the two protocols (n = 264 vs 437, P < .001).

Conclusion: In a large patient population, despite a good correlation between CACS calculated with standard and low-dose CT, there is a systematic underestimation of CACS with the low-dose protocol. This may have an impact especially on the prognostic value of the calcium score, and the established "power of zero" may no longer be warranted if CACS is assessed with low-dose CT.

Keywords: Coronary calcium score; attenuation correction; coronary CT; low-dose CT; myocardial perfusion imaging.

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Conflict of interest statement

The authors report no disclosures relevant to the manuscript. Federico Caobelli received academic grant support in the past from Mallinckrodt AG and Tillots AG and speaker honoraria from Siemens Healthineers and Bracco, for matters not related to the current study.

Figures

Figure 1
Figure 1
Correlation between CACS obtained with standard and very low-dose protocols
Figure 2
Figure 2
Bland–Altman analysis comparing CACS obtained with standard and low-dose protocol
Figure 3
Figure 3
Proportion of patients in the different CACS classes. (*) indicates statistical significance
See this image and copyright information in PMC

Comment in

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