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A Modified Length-Based Grading Method for Assessing Coronary Artery Calcium Severity on Non-Electrocardiogram-Gated Chest Computed Tomography: A Multiple-Observer Study

 Suh Young Kim  ;  Young Joo Suh  ;  Na Young Kim  ;  Suji Lee  ;  Kyungsun Nam  ;  Jeongyun Kim  ;  Hwan Kim  ;  Hyunji Lee  ;  Kyunghwa Han  ;  Hwan Seok Yong 
 KOREAN JOURNAL OF RADIOLOGY, Vol.24(4) : 284-293, 2023-04 
Journal Title
Issue Date
Calcium* ; Coronary Angiography / methods ; Coronary Artery Disease* / diagnostic imaging ; Coronary Vessels ; Humans ; Male ; Reproducibility of Results ; Retrospective Studies ; Tomography, X-Ray Computed / methods
Calcium ; Coronary vessels ; Thorax ; Tomography, X ray computed
Objective: To validate a simplified ordinal scoring method, referred to as modified length-based grading, for assessing coronary artery calcium (CAC) severity on non-electrocardiogram (ECG)-gated chest computed tomography (CT).

Materials and Methods: This retrospective study enrolled 120 patients (mean age ± standard deviation [SD], 63.1 ± 14.5 years; male, 64) who underwent both non-ECG-gated chest CT and ECG-gated cardiac CT between January 2011 and December 2021. Six radiologists independently assessed CAC severity on chest CT using two scoring methods (visual assessment and modified length-based grading) and categorized the results as none, mild, moderate, or severe. The CAC category on cardiac CT assessed using the Agatston score was used as the reference standard. Agreement among the six observers for CAC category classification was assessed using Fleiss kappa statistics. Agreement between CAC categories on chest CT obtained using either method and the Agatston score categories on cardiac CT was assessed using Cohen’s kappa. The time taken to evaluate CAC grading was compared between the observers and two grading methods.

Results: For differentiation of the four CAC categories, interobserver agreement was moderate for visual assessment (Fleiss kappa, 0.553 [95% confidence interval {CI}: 0.496–0.610]) and good for modified length-based grading (Fleiss kappa, 0.695 [95% CI: 0.636–0.754]). The modified length-based grading demonstrated better agreement with the reference standard categorization with cardiac CT than visual assessment (Cohen’s kappa, 0.565 [95% CI: 0.511–0.619 for visual assessment vs. 0.695 [95% CI: 0.638–0.752] for modified length-based grading). The overall time for evaluating CAC grading was slightly shorter in visual assessment (mean ± SD, 41.8 ± 38.9 s) than in modified length-based grading (43.5 ± 33.2 s) (P < 0.001).

Conclusion: The modified length-based grading worked well for evaluating CAC on non-ECG-gated chest CT with better interobserver agreement and agreement with cardiac CT than visual assessment.
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1. College of Medicine (의과대학) > Research Institute (부설연구소) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Na Young(김나영)
Nam, Kyungsun(남경선) ORCID logo https://orcid.org/0000-0002-1673-0935
Suh, Young Joo(서영주) ORCID logo https://orcid.org/0000-0002-2078-5832
Lee, Suji(이수지) ORCID logo https://orcid.org/0000-0002-8770-622X
Han, Kyung Hwa(한경화)
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