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Reproducibility of Coronary Artery Calcified Plaque with Cardiac 64-MDCT: The Multi-Ethnic Study of Atherosclerosis

¹ Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, 1124 W Carson St., RB2, Torrance, CA 90502.
² Department of Biostatistics, University of Washington, Seattle, WA.
³ Division of Cardiology, University of California at Irvine, Irvine, CA.
⁴ Departments of Radiology, Cardiology and Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
⁵ Department of Physics, University of California at Los Angeles, Los Angeles, CA.
⁶ Ciccarone Preventive Cardiology Center, Johns Hopkins University, Baltimore, MD.

OBJECTIVE. The Multi-Ethnic Study of Atherosclerosis is a longitudinal study evaluating determinants of future cardiac events and progression of atherosclerosis. Emerging data are showing that coronary artery calcification (CAC) is a robust independent predictor of future cardiac events and that measurement of progression depends on reproducibility of the measure. Reproducibility previously was reported on baseline scans obtained with both electron-beam tomography (EBT) and MDCT. The aim of this study was to compare the interscan variability for both Agatston and volume scores derived with newer (16- and 64-MDCT) scanners with that derived with older scanners in the Multi-Ethnic Study of Atherosclerosis.

SUBJECTS AND METHODS. The participants in this study were 4,054 persons who underwent dual scanning with EBT (n = 1,716), 4-MDCT (n = 370), 16-MDCT (n = 1,245), or 64-MDCT (n = 723). Agreement on the presence or absence of CAC was assessed with logistic regression models adjusted for age, sex, body mass index, and scanner type. Among participants with CAC, the log-transformed interscan difference was regressed on log-transformed amount of CAC, age, sex, and body mass index.

RESULTS. The percentage agreement for the presence or absence of CAC was high and similar across scanner groups (EBT, 16-MDCT, and 64-MDCT). The greatest adjusted average absolute CAC differences between scans were found with the Aquilion 64 (24%; 95% CI, 20.9–27.6) and LightSpeed Pro 16 (19%; 95% CI, 17.4–21.0) scanners, both differences being significantly greater than with the EBT scanner (16%; 95% CI, 15.4–17.5) (p < 0.05). No differences were found between the EBT, Sensation 16, and Sensation 64 scanners. For volume score, the Aquilion 64 was the only scanner with significantly greater average absolute interscan differences than the EBT scanner (p < 0.001). Volume scoring resulted in lower rescan differences for all scanners.

CONCLUSION. For CAC scoring, interscan variability with newer-generation MDCT scanners was similar to but not superior to that with the EBT scanner.

Keywords: atherosclerosis • cardiac CT • coronary calcium • electron beam tomography • MDCT • reproducibility

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