Elsevier

Academic Radiology

Volume 11, Issue 3, March 2004, Pages 286-292
Academic Radiology

Original investigation
Is coronary artery calcium mass related to Agatston score?1

https://doi.org/10.1016/S1076-6332(03)00714-1Get rights and content

Abstract

Rationale and objectives

The objective of this study was to investigate the relationship between the coronary calcium mass and Agatston score measured on multidetector row computed tomography.

Materials and methods

Eighty-three consecutive subjects (60 men and 23 women) referred for coronary screening were examined by prospectively electrocardiogram-triggered sequential multidetector row computed tomography scan (4 × 2.5-mm collimation). Their coronary calcium was quantitated by means of the Agatston scoring and mass method. The values of score and mass were transformed by taking the natural logarithm (ln(value+1)) to reduce skewness. The relationship between the mass and score was analyzed with multiple regression analysis.

Results

Fifty-one subjects had a total of 328 calcified lesions detected and measured. The relationship between the calcium mass and score in 51 subjects conformed well to a linear relationship (r2 = 0.96). When analyzed in the total of 328 lesions, the relationship had a good empiric fit with a nonlinear (quadratic) model (r2 = 0.96). The best-fit equation was ln(lesion mass+1)=−0.87+0.67×ln(lesion score+1)+0.10×(ln(lesion score+1)−2.86)2. This relationship was consistent in different coronary vessels and at different heart levels (r2 = 0.96 − 0.99), although there was a higher image noise at lower heart levels (paired t-tests, P < .0001).

Conclusion

A nonlinear (quadratic) relationship existed strongly and consistently between coronary calcium mass and score, demonstrating a possible cross-sectional conversion between the two measurements.

Section snippets

Subject selection

Eighty-three subjects (60 men and 23 women) who were referred to our clinical CT screening program for the detection and quantification of coronary artery calcifications were included. The study protocol was approved by our institutional review committee, and the subjects gave informed consent. All subjects were asymptomatic and with no histories of coronary stents, cardiac pacemakers, or cardiac surgery. The age of the subjects ranged from 45 to 78 years with a mean of 57 ± 10 years; the mean

Results

Coronary CT screening was successful in all 83 subjects. Fifty-one subjects (36 males, 15 females) had at least one measurable calcified lesion. The ranges of calcium score and mass in the subjects were 1.3 to 3034.4 and 0.2 to 400.9 mg, respectively. There were 328 lesions detected and measured. The ranges for the lesions’ calcium score and mass were 0.3 to 603.0 and 0.1 to 88.1 mg, respectively. The means, SDs, and medians of the score and mass in the subjects and lesions are listed in Table 1

Discussion

Given the epidemic of coronary artery disease afflicting our aging population, it is important not only to understand the pathobiology of calcified vasculopathy, but also to develop and validate noninvasive imaging techniques that can detect and quantify calcification in coronary arteries. The Agatston score method has been the standard approach for the quantification of coronary artery calcium. In recent years, however, coronary calcium mass quantitative method has attracted a growing

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