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Coronary artery calcium severity grading on non-ECG-gated low-dose chest computed tomography: a multiple-observer study in a nationwide lung cancer screening registry

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Abstract

Objectives

To identify the optimal method for evaluation of coronary artery calcium (CAC) severity on non-electrocardiogram-gated low-dose chest computed tomography (LDCT) in a nationwide lung cancer screening registry.

Methods

A total of 256 subjects were retrospectively enrolled from participants of the Korean Lung Cancer Screening (K-LUCAS) project (an LDCT lung cancer screening registry for high-risk individuals). Four board-certified cardiothoracic radiologists independently assessed CAC severity using four different scoring methods (visual assessment, artery-based grading, segment-involvement grading, and segment-based grading) and classified severity for each case using all four methods as none, mild, moderate, or severe. Agreements between the four observers for CAC category classification and between the four different scoring methods for the same observer were assessed by Fleiss kappa statistics. Evaluation time for CAC grading was compared between observers and between grading methods.

Results

Interobserver agreement was moderate for visual assessment (Fleiss kappa 0.451) and substantial for the other three methods (Fleiss kappa 0.673–0.704). Agreement between the four grading methods for the same observer was substantial for three observers (Fleiss kappa 0.610–0.705) and moderate for one (Fleiss kappa 0.578). Mean evaluation time differed significantly between methods (visual assessment, 14.3 ± 11.8 s; artery-based grading, 17.6 ± 22.3 s, segment-involvement grading, 19.2 ± 6.8 s; segment-based grading, 34.2 ± 37.4 s; p < 0.01).

Conclusion

Artery-based grading could be appropriate with substantial interobserver agreement and an acceptable mean evaluation time.

Key Points

• CAC severity grading methods on LDCT show moderate to substantial agreements between grading methods and observers.

• Artery-based grading could be appropriate with substantial interobserver agreement and a mean evaluation time of 17.6 s.

• Visual assessment is disadvantaged by high interobserver variability despite having the shortest evaluation time.

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Abbreviations

ACR:

American College of Radiology

CAC:

Coronary artery calcium

CAD:

Coronary artery disease

CI:

Confidence interval

ECG:

Electrocardiogram

K-LUCAS:

Korean Lung Cancer Screening

LAD:

Left anterior descending

LCx:

Left circumflex

LDCT:

Low-dose computed tomography

LM:

Left main

Lung-RADS:

Lung CT Screening Reporting and Data System

NLST:

National Lung Screening Trial

RCA:

Right coronary artery

SCCT:

Society of Cardiovascular Computed Tomography

STR:

Society of Thoracic Radiology

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Funding

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry for Health and Welfare (1720310, 1520230), and National Cancer Center (1760810-1), Republic of Korea.

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea

    Young Joo Suh & Jin Mo Goo

  2. Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Young Joo Suh

  3. Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea

    Ji Won Lee

  4. Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea

    So Youn Shin

  5. Cancer Early Detection Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea

    Yeol Kim

  6. Department of Radiology, College of Medicine, Korea University Guro Hospital, Korea University, Gurodong-ro 148, Guro-gu, Seoul, 08308, Republic of Korea

    Hwan Seok Yong

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  1. Young Joo Suh
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Correspondence to Hwan Seok Yong.

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The scientific guarantor of this publication is Hwan Seok Yong.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational study

• Multicenter study

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Suh, Y.J., Lee, J.W., Shin, S.Y. et al. Coronary artery calcium severity grading on non-ECG-gated low-dose chest computed tomography: a multiple-observer study in a nationwide lung cancer screening registry. Eur Radiol 30, 3684–3691 (2020). https://doi.org/10.1007/s00330-020-06707-x

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  • DOI: https://doi.org/10.1007/s00330-020-06707-x

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