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. 2022 Jan 17:9:100396.
doi: 10.1016/j.ejro.2022.100396. eCollection 2022.

Accuracy of non-gated low-dose non-contrast chest CT with tin filtration for coronary artery calcium scoring

Ying Liu  1 , Xuezhi Chen  1 , Xianchen Liu  1 , Hao Yu  1 , Lianjun Zhou  1 , Xiaoling Gao  1 , Qinglin Li  1 , Shujun Su  1 , Lin Wang  1 , Jia Zhai  1
Affiliations

Accuracy of non-gated low-dose non-contrast chest CT with tin filtration for coronary artery calcium scoring

Ying Liu et al. Eur J Radiol Open. .

Abstract

Objective: The study investigated the accuracy of coronary artery calcium scores (CACS) and the potential for reducing radiation dose using non-gated low-dose non-contrast chest computed tomography (CT) scanning with tin filtration for one-stop screening of the lungs and heart.

Methods: A prospective study was conducted,193 Patients received two scans for determining CACS, including an ECG-gated CT at 120 kV (ECG-gated CT), followed by a non-gated low-dose chest CT using 100 kV with tin filtration (non-gated Sn100 kV-LDCT). The Agatston score (AS), risk stratification, and radiation dose were compared between the scan types.

Results: There was good consistency in the AS from both an ECG-gated CT and a non-gated low-dose chest CT scan, which had a high correlation (r = 0.970). The Kappa value of risk stratification of the two scan types was 0.549. The area under the ROC curve (AUC) of the CACS was used to develop a new risk stratification standard for non-gated Sn100 kV-LDCT evaluation of CACS. In comparison to the CACS measured by ECG-gated CT, non-gated Sn100 kV-LDCT had an AUC of 0.951 and an optimal critical value of 4.6 in the low-risk category. The AUC of low-medium risk was 0.966, and the optimal critical value was 41.2. The AUC of the medium-high risk category was 0.968, and the optimal critical value was 230. The consistency in CACS measured by ECG-gated CT and non-gated Sn100 kV-LDCT had a Kappa value of 0.831. The Effective dose (ED) of non-gated Sn100 kV-LDCT and ECG-gated CT was 0.056 ± 0.017 mSv and 0.685 ± 0.455 mSv, respectively (p < 0.05).

Conclusion: The Agatston score of CACS using non-gated low-dose chest CT was accurate, but there was an underestimation in risk stratification. This study developed a new risk stratification standard for non-gated Sn100 kV-LDCT evaluation of CACS, which is in closer agreement with CACS derived from ECG-gated CT scans.

Keywords: Chest; Computed tomography; Coronary Artery Calcium Scoring; Low dose; Tin Filtration.

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Figures

Fig. 1
Fig. 1
ROC curve, AUC of very minimal-mild risk group: 0.951.
Fig. 2
Fig. 2
ROC curve, AUC: 0.966 In mild-moderate risk group.
Fig. 3
Fig. 3
ROC curve, AUC of moderate-severe risk group: 0.968.
Fig. 4
Fig. 4
Bland-Altman plot comparison of Agatston scores using Sn100 kV-LDCT and ECG-CT.Results are presented as average differences between Sn100 kV-LDCT and ECG-CT.The average difference value is illustrated as a green line with corresponding double SD intervals (red dotted lines).
Fig. 5
Fig. 5
Agatston score categories and Agatston score percentile-based risk categorization,Arrows and numbers regresent the number of patients reclassified to a different category.
Fig. 6
Fig. 6
a-b The CACS Agatston score measured by ECG gating method is 198.6 (located in the 101–400 interval, which is a moderate risk group).
Fig. 7
Fig. 7
a-b The CACS Agatston integral measured in non-ECG-gated chest low dose image is 90.1 (located in the new standard 41.3–230 interval, which is a moderate risk group).
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