Assessment of Agatston Coronary Artery Calcium Score Using Contrast-Enhanced CT Coronary Angiography

The purpose of this article is to evaluate to what extent Agatston scores may be derived from CT coronary angiography (CTA) examinations, compared with traditional unenhanced CT calcium scores. Fifty patients with a CT calcium score-Agatston score of zero and 50 patients with a CT calcium score-Agatston score of 1 or greater whose CT calcium scores had been calculated and who had undergone CTA using volumetric 320-MDCT were included. Agatston scores were obtained at 3.0-mm slices for CT calcium score and CTA. Method agreement, interobserver agreement, and diagnostic performance of CTA for detecting coronary calcium were evaluated. Of 50 patients with a positive CT calcium score-Agatston score, coronary artery calcium was detected with CTA in 43 patients by observer 1 (mean CTA score, 102 ± 202; mean CT calcium score, 254 ± 501) and in 46 patients by observer 2 (mean CTA score, 94 ± 147; mean CT calcium score, 272 ± 531). Of the 50 patients with a CT calcium score-Agatston score of zero, 49 (98%, observer 1) and 50 (100%, observer 2) had a zero score with CTA as well. An intraclass correlation of 0.78 and 0.62 was found between CT calcium score and CTA (p < 0.01), whereas higher Agatston scores were underestimated with CTA. For observer 1, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for detection of coronary calcium with CTA were 86%, 98%, 98%, 88%, and 92%, respectively, and the corresponding values for observer 2 were 92%, 100%, 100%, 93%, and 96%, respectively. Interobserver agreement was 0.996 for CT calcium score and 0.93 for CTA. Coronary artery calcium can be detected on CTA images with high accuracy. The Agatston calcium score derived from CTA images shows good correlation with unenhanced CT calcium score and is highly reproducible. However, higher Agatston scores are systematically underestimated when derived from CTA images.