S G M van Velzen1,2,3, M M Dobrolinska4, P Knaapen5, R L M van Herten6,7,8, R Jukema5, I Danad5, R H J A Slart4,9, M J W Greuter4,10, I Išgum6,7,8,11. 1. Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Meibergdreef 123, 1105 AZ, Amsterdam, the Netherlands. s.g.m.vanvelzen@amsterdamumc.nl. 2. Informatics Institute, University of Amsterdam, Amsterdam, the Netherlands. s.g.m.vanvelzen@amsterdamumc.nl. 3. Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands. s.g.m.vanvelzen@amsterdamumc.nl. 4. Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands. 5. Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands. 6. Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Meibergdreef 123, 1105 AZ, Amsterdam, the Netherlands. 7. Informatics Institute, University of Amsterdam, Amsterdam, the Netherlands. 8. Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands. 9. Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands. 10. Department of Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands. 11. Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
Abstract
BACKGROUND: We present an automatic method for coronary artery calcium (CAC) quantification and cardiovascular risk categorization in CT attenuation correction (CTAC) scans acquired at rest and stress during cardiac PET/CT. The method segments CAC according to visual assessment rather than the commonly used CT-number threshold. METHODS: The method decomposes an image containing CAC into a synthetic image without CAC and an image showing only CAC. Extensive evaluation was performed in a set of 98 patients, each having rest and stress CTAC scans and a dedicated calcium scoring CT (CSCT). Standard manual calcium scoring in CSCT provided the reference standard. RESULTS: The interscan reproducibility of CAC quantification computed as average absolute relative differences between CTAC and CSCT scan pairs was 75% and 85% at rest and stress using the automatic method compared to 121% and 114% using clinical calcium scoring. Agreement between automatic risk assessment in CTAC and clinical risk categorization in CSCT resulted in linearly weighted kappa of 0.65 compared to 0.40 between CTAC and CSCT using clinically used calcium scoring. CONCLUSION: The increased interscan reproducibility achieved by our method may allow routine cardiovascular risk assessment in CTAC, potentially relieving the need for dedicated CSCT.
BACKGROUND: We present an automatic method for coronary artery calcium (CAC) quantification and cardiovascular risk categorization in CT attenuation correction (CTAC) scans acquired at rest and stress during cardiac PET/CT. The method segments CAC according to visual assessment rather than the commonly used CT-number threshold. METHODS: The method decomposes an image containing CAC into a synthetic image without CAC and an image showing only CAC. Extensive evaluation was performed in a set of 98 patients, each having rest and stress CTAC scans and a dedicated calcium scoring CT (CSCT). Standard manual calcium scoring in CSCT provided the reference standard. RESULTS: The interscan reproducibility of CAC quantification computed as average absolute relative differences between CTAC and CSCT scan pairs was 75% and 85% at rest and stress using the automatic method compared to 121% and 114% using clinical calcium scoring. Agreement between automatic risk assessment in CTAC and clinical risk categorization in CSCT resulted in linearly weighted kappa of 0.65 compared to 0.40 between CTAC and CSCT using clinically used calcium scoring. CONCLUSION: The increased interscan reproducibility achieved by our method may allow routine cardiovascular risk assessment in CTAC, potentially relieving the need for dedicated CSCT.
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