Relative predictive value of lung cancer screening CT versus myocardial perfusion attenuation correction CT in the evaluation of coronary calcium

• Published in: PloS one Vol. 12; no. 4; p. e0175678
• Main Authors: Bailey, Grant, Healy, Abigail, Young, Bryan D, Sharma, Esseim, Meadows, Judith, Chun, Hyung J, Wu, Wen-Chih, Choudhary, Gaurav, Morrison, Alan R
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24-04-2017; Public Library of Science (PLoS)
• Subjects: Aged; Algorithms; Angiography; Arches; Arteriosclerosis; Atherosclerosis; Attenuation coefficients; Biology and Life Sciences; Calcification; Calcification (ectopic); Calcium; Calcium - analysis; Cancer; Cancer screening; Cardiology; Cardiovascular disease; Cardiovascular diseases; Chest; Chronic obstructive pulmonary disease; Circulation; Computation; Computed tomography; Coronary artery; Coronary artery disease; Coronary Vessels - diagnostic imaging; Correlation; Death; Decision making; Early Detection of Cancer; EKG; Female; Health risks; Heart rate; Humans; Image processing; Information dissemination; Ionizing radiation; Ischemia; Lung cancer; Lung diseases; Lung Neoplasms - diagnostic imaging; Male; Meadows; Medical imaging; Medical screening; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Myocardial Perfusion Imaging - methods; Physicians; Positron emission tomography; Predictive Value of Tests; Radiology; Reliability; Research and Analysis Methods; Retrospective Studies; Risk Assessment; Risk Factors; Single photon emission computed tomography; Thorax; Tomography; Tomography, X-Ray Computed - methods; Vascular Calcification - diagnostic imaging; Rhode Island; United States > US; Connecticut
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0175678

Coronary artery calcium scores (CACS) from lung cancer screening computed tomography (LCSCT) or myocardial perfusion attenuation correction computed tomography (ACCT) are not routinely performed or reported. CACS from LCSCT and ACCT have not been directly compared in the same patient population. We identified 66 patients who underwent both LCSCT (non-gated) and ECG-gated cardiac CT (CCT) within a 2-year span. Of this population, 40 subjects had also undergone ACCT. Using the Agatston method, CACS for 264 individual vessels from the LCSCT population and for 160 vessels from ACCT population were calculated and evaluated for agreement with ECG-gated CCT as the gold standard. Secondary analysis included a comparison of individual vessel contribution to variations in agreement and a comparison of total CACS from CCT, LCSCT, and ACCT for respective MACE prediction. CACS from LCSCT demonstrated a strong Pearson correlation, r = 0.9017 (0.876-0.9223), with good agreement when compared to CACS from CCT. CACS from ACCT demonstrated a significantly (P < 0.00001) weaker correlation, r = 0.5593 (0.4401-0.6592). On an individual vessel basis, CACS from all major vessels (LM, LAD, LCX, and RCA) contributed to the weaker correlation. For total vessel CACS, LCSCT demonstrated comparable area under the curve (AUC) for the receiver operating characteristic (ROC) curve (LCSCT AUC = 0.8133 and CCT AUC = 0.8302, P = 0.691) for prediction of MACE. Although ACCT demonstrated a similar AUC (ACCT AUC = 0.7969, P = 0.662) for MACE prediction the cutoff value for elevated risk was extremely low. In conclusion, LCSCT outperformed ACCT at calcium scoring by providing better agreement and comparable risk assessment to CCT despite the absence of ECG-gating. It is therefore reasonable to use LCSCT images to derive and report Agatston-based CACS for cardiovascular risk assessment, whereas the use of ACCT images to report Agatston-based CACS is not currently practical.