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Potential Clinical Impact of Variability in the Measurement of Coronary Artery Calcification with Sequential MDCT

¹ Section of Cardiovascular Imaging, Division of Radiology/ Hb6, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195.
² Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, OH 44195.

View larger version (10K): [in a new window]   Fig. 1. —Bar graph shows distribution of percentage of interscan variability in estimation of Agatston, volume, and mass scores by observer 1 for 56 patients. Bottom of box defines first quartile (Q1) and top of box defines third quartile (Q3), whereas horizontal line represents median. Vertical lines indicate lower and upper data limits (upper limit = Q3 + 1.5[Q3 – Q1]). Outliers are marked with asterisk.

View larger version (91K): [in a new window]   Fig. 2A. —Corresponding axial MDCT images obtained in 60-year-old woman imaged twice with an identical prospectively ECG-triggered sequential scanning protocol. Measurement of total calcification was highly variable (62%) between scan 1 (A) and scan 2 (B) primarily because of differences in amount of calcium detected in left anterior descending coronary artery (arrow). Resulting difference in total Agatston score (10.3 for scan 1) and (5.4 for scan 2) did not correspond to difference in patient's risk stratification.

View larger version (89K): [in a new window]   Fig. 2B. —Corresponding axial MDCT images obtained in 60-year-old woman imaged twice with an identical prospectively ECG-triggered sequential scanning protocol. Measurement of total calcification was highly variable (62%) between scan 1 (A) and scan 2 (B) primarily because of differences in amount of calcium detected in left anterior descending coronary artery (arrow). Resulting difference in total Agatston score (10.3 for scan 1) and (5.4 for scan 2) did not correspond to difference in patient's risk stratification.

View larger version (9K): [in a new window]   Fig. 3. —Graph shows distribution of percentage of interobserver variability between observers 1 and 2 in estimation of Agatston, volume, and mass scores from scan 1 in 56 patients. Bottom of box defines first quartile (Q1) and top of box defines third quartile (Q3), whereas horizontal line represents median. Vertical lines indicate lower and upper data limits (upper limit = Q3 + 1.5[Q3 – Q1]). Outliers are marked with asterisk.

View larger version (9K): [in a new window]   Fig. 4. —Graph shows distribution of percentage of intraobserver variability in estimation of Agatston, volume, and mass scores for scan 1 in observer 1 for 56 patients. Horizontal line represents first quartile, median, and third quartile all equaling zero. Outliers are marked with asterisk.

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