Coronary Artery Calcification Measured at Electron-Beam CT: Agreement in Dual Scan Runs and Change over Time
Abstract
PURPOSE: To use a recently described regression approach to evaluate agreement in the quantity of coronary artery calcification (CAC) with two consecutive acquisitions (dual scan runs) at electron-beam computed tomography (CT) in a quality-control program and to assess the change in CAC quantity over time in an individual.
MATERIALS AND METHODS: A total of 1,376 asymptomatic research participants, who were not selected because they were at high risk for coronary artery disease, were examined for the quantity of CAC with dual scan runs at electron-beam CT. With these data, 95% limits of agreement were established and used to evaluate differences between scan runs performed approximately 3.5 years apart in 81 participants.
RESULTS: The 95% limits of agreement depended on the mean quantity of CAC in the dual scan runs. Of the 81 participants whose examinations were approximately 3.5 years apart, 59 (73%) had no apparent change in CAC between the two examinations, 21 (26%) had large increases suggesting progression of CAC, and one (1%) had a large decrease suggesting regression of CAC.
CONCLUSION: The demonstrated method can be used to evaluate both agreement in dual scan runs and change in quantity of CAC over time.
References
- 1 Breen J, Sheedy PF, II, Schwartz RS, et al. Coronary artery calcification detected with ultrafast CT as an indication of coronary artery disease: work in progress. Radiology 1992; 185:435-439.
- 2 Bielak LF, Kaufmann RB, Moll PP, McCollough CH, Schwartz RS, Sheedy PF, II, et al. Small lesions in the heart identified at electron beam CT: calcification or noise?. Radiology 1994; 192:631-636.
- 3 Mautner GC, Mautner SL, Froehlich J, et al. Coronary artery calcification: assessment with electron beam CT and histomorphometric correlation. Radiology 1994; 192:619-623.
- 4 Mautner SL, Mautner GC, Froehlich J, et al. Coronary artery disease: prediction with in vitro electron beam CT. Radiology 1994; 192:625-630.
- 5 Budoff MJ, Georgiou D, Brody A, et al. Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease: a multicenter study. Circulation 1996; 93:898-904.
- 6 Arad Y, Spadaro LA, Goodman K, et al. Predictive value of electron beam computed tomography of the coronary arteries: 19-month follow-up of 1173 asymptomatic subjects. Circulation 1996; 93:1951-1953.
- 7 Detrano R, Hsiai T, Wang S, et al. Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography. J Am Coll Cardiol 1996; 27:285-290.
- 8 Yang T, Doherty TM, Wong ND, Detrano RC. Alcohol consumption, coronary calcium, and coronary heart disease events. Am J Cardiol 1999; 84:802-806.
- 9 Kajinami K, Seki H, Takekoshi N, Mabuchi H. Quantification of coronary artery calcification using ultrafast computed tomography: reproducibility of measurements. Coron Artery Dis 1993; 4:1103-1108.
- 10 Devries S, Wolfkiel C, Shah V, Chomka E, Rich S. Reproducibility of the measurement of coronary calcium with ultrafast computed tomography. Am J Cardiol 1995; 75:973-975.
- 11 Shields JP, Mielke CH, Jr, Rockwood TH, Short RA, Viren FK. Reliability of electron beam computed tomography to detect coronary artery calcification. Am J Card Imaging 1995; 9:62-66.
- 12 Wang S, Detrano RC, Secci A, et al. Detection of coronary calcification with electron-beam computed tomography: evaluation of interexamination reproducibility and comparison of three image-acquisition protocols. Am Heart J 1996; 132:550-558.
- 13 Yoon HC, Greaser LE, III, Mather R, Sinha S, McNitt-Gray MF, Goldin JG. Coronary artery calcium: alternate methods for accurate and reproducible quantitation. Acad Radiol 1997; 4:666-673.
- 14 Callister TQ, Cooil B, Raya SP, Lippolis NJ, Russo DJ, Raggi P. Coronary artery disease: improved reproducibility of cal-cium scoring with an electron-beam CT volumetric method. Radiology 1998; 208:807-814.
- 15 Greaser LE, III, Yoon HC, Mather RT, McNitt-Gray MF, Goldin JG. Electron-beam CT: the effect of using a correction function on coronary artery calcium quantitation. Acad Radiol 1999; 6:40-48.
- 16 Yoon HC, Goldin JG, Greaser LE, III, Sayre J, Fonarow GC. Interscan variation in coronary artery calcium quantification in a large asymptomatic patient population. AJR Am J Roentgenol 2000; 174:803-809.
- 17 Janowitz WR, Agatston AS, Viamonte M, Jr. Comparison of serial quantitative evaluation of calcified coronary artery plaque by ultrafast computed tomography in persons with and without obstructive coronary artery disease. Am J Cardiol 1991; 68:1-6.
- 18 Callister TQ, Raggi P, Cooil B, Lippolis NJ, Russo DJ. Effect of HMG-CoA reductase inhibitors on coronary artery disease as assessed by electron-beam computed tomography. N Engl J Med 1998; 339:1972-1978.
- 19 Maher JE, Bielak LF, Raz JA, Sheedy PF, II, Schwartz RS, Peyser PA. Progression of coronary artery calcification: a pilot study. Mayo Clin Proc 1999; 74:347-355.
- 20 Wexler L, Brundage B, Crouse J, et al. Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications—a statement for health professionals from the American Heart Association Writing Group. Circulation 1996; 94:1175-1192.
- 21 Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res 1999; 8:135-160.
- 22 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1:307-310.
- 23 Bland JM, Altman DG. Comparing two methods of clinical measurement: a personal history. Int J Epidemiol 1995; 24(suppl 1):S7-S14.
- 24 Turner ST, Weidman WH, Michels VV, et al. Distribution of sodium-lithium countertransport and blood pressure in Caucasians five to eighty-nine years of age. Hypertension 1989; 13:378-391.
- 25 Kottke BA, Moll PP, Michels VV, Weidman WH. Levels of lipids, lipoproteins, and apolipoproteins in a defined population. Mayo Clin Proc 1991; 66:1198- 1208.
- 26 Maher JE, Raz JA, Bielak LF, Sheedy PF, II, Schwartz RS, Peyser PA. Potential of quantity of coronary artery calcification to identify new risk factors for asymptomatic atherosclerosis. Am J Epidemiol 1996; 144:943-953.
- 27 Reed JE, Rumberger JA, Davitt PJ, Kaufmann RB, Sheedy PF, II. System for quantitative analysis of coronary calcification via electron beam computed tomography. In: Hoffman EA, Acharya RS, eds. Medical imaging, 1994: physiology and function from multidimensional images. Bellingham, Wash: International Society for Optical Engineering, 1994; 43-53.
- 28 Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15:827-832.
- 29 Kaufmann RB, Sheedy PF, II, Breen JF, et al. Detection of heart calcification with electron beam CT: interobserver and intraobserver reliability for scoring quantification. Radiology 1994; 190:347-352.
- 30 Flamm SD. Coronary arterial calcium screening: ready for prime time?. Radiology 1998; 208:571-572.
- 31 Woolson RF. Statistical methods for the analysis of biomedical data New York, NY: Wiley, 1987; 205-213.