Key result
Non-ECG-gated CT volume scoring outperforms Agatston scoring with ~0.98 AUC for severe aortic stenosis.
Why the study?
To evaluate whether non-ECG-gated CT reliably quantifies aortic valve calcification for diagnosing severe aortic stenosis and compare the agreement of Agatston versus volume scoring.
Does volume scoring on non-ECG-gated CT improve diagnostic agreement and performance for aortic valve calcification compared to Agatston scoring in patients with severe aortic stenosis?
Does volume scoring on non-ECG-gated CT improve diagnostic agreement and performance for aortic valve calcification compared to Agatston scoring in patients with severe aortic stenosis?
Volume scoring on non-ECG-gated CT provides superior agreement and diagnostic performance for aortic valve calcification compared to Agatston scoring, enabling reliable opportunistic assessment on routine chest CT.
Volume scoring may aid opportunistic AVC assessment on non-gated CT; extends observational data but leaves open prospective validation.
Objectives To assess whether non–ECG-gated computed tomography (CT) reliably quantifies aortic valve calcification (AVC) for diagnosing severe aortic stenosis and to compare the agreement and diagnostic performance of Agatston versus volume scoring. Methods In this retrospective single-centre study, 129 consecutive patients with echocardiographically confirmed severe aortic stenosis (mean age, 83.1 ± 6.3 years; 46 men, 83 women) underwent same-session ECG-gated (3 mm) and Non–ECG-gated (5 mm) non-contrast CT between 21 March 2020 and 16 April 2025. AVC was quantified using Agatston and volume methods. Agreement between non-gated and gated scores was assessed by Pearson correlation, Bland–Altman analysis, and Deming regression. Diagnostic performance for sex-specific Agatston thresholds (≥2000 units men, ≥1300 units women) was evaluated using receiver operating characteristic (ROC) analysis. Results Volume scores on non–ECG-gated CT correlated more strongly with ECG-gated CT scores than Agatston scores ( r = 0.95 vs. 0.69, P < 0.001). Bland–Altman analysis demonstrated substantial negative bias and proportional error for Agatston scores (mean difference, −921.1 units; limits of agreement, −2900.8 to +1058.6), while volume scores showed minimal bias and no proportional error (+16.5 mm 3 ; −648.5 to +681.4). Deming regression confirmed closer agreement for volume scores (slope, 1.02; R 2 = 0.90). ROC analysis showed higher area under the curve values for volume scores (0.976 for men, 0.975 for women) than for Agatston scores (0.946 and 0.967, respectively). Conclusion Non–ECG-gated CT enables reliable quantification of aortic valve calcium in severe aortic stenosis. Volume scoring demonstrates superior agreement and diagnostic performance compared with Agatston scoring, supporting its use as a robust, density-independent metric for opportunistic assessment of AVC on routine chest CT.
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Ouchi et al. (2026) studied this question. Volume scoring on non-ECG-gated CT correlated strongly with ECG-gated CT (r=0.95) and had higher diagnostic accuracy (AUC ~0.975) than Agatston scoring for severe aortic stenosis.
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