What question did this study set out to answer?

To assess the accuracy and inter-reader reproducibility of visual coronary artery calcium estimation from low-dose CT attenuation correction scans obtained during hybrid PET/CT and SPECT/CT myocardial perfusion imaging.

May 17, 2026Journal of the American College of CardiologyOpen Access

Agreement of Visual Estimation of Coronary Artery Calcium From Low-Dose CT Attenuation Correction Scans in Hybrid PET/CT and SPECT/CT With Standard Agatston Score

Q: What are the key findings of this study?

Visual estimation of coronary artery calcium from low-dose CT attenuation correction scans showed high agreement with standard Agatston scores (weighted kappa 0.89; 95% CI 0.88-0.91; p<0.0001).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Patients undergoing myocardial perfusion imaging (n=492). Intervention: Visual estimation of coronary artery calcium from CT attenuation correction scans vs. Standard Agatston score on ECG-gated scans. Primary outcome: Agreement between visually-estimated CAC on CTAC and standard Agatston score (Weighted kappa 0.89, 95% CI 0.88 to 0.91, p=<0.0001).

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Key result

Visual CAC on low-dose CTAC achieves high agreement with standard Agatston scores at kappa ~0.89.

Weighted kappa 0.89
95% CI 0.88 to 0.91
P<0.0001
n=492

Why the study?

Does visual estimation of coronary artery calcium from low-dose CT attenuation correction scans agree with standard Agatston score in patients undergoing myocardial perfusion imaging?

Key Points

To assess the accuracy and inter-reader reproducibility of visual coronary artery calcium estimation from low-dose CT attenuation correction scans obtained during hybrid PET/CT and SPECT/CT myocardial perfusion imaging.
Analyzed 492 patients across 3 clinical centers who underwent myocardial perfusion imaging with CT attenuation correction alongside a standard coronary artery calcium scan.
Experienced readers blinded to the standard Agatston score visually classified coronary calcium on CT attenuation correction scans into 6 tiers (0, 1–9, 10–99, 100–300, 400–999, ≥1000).
Visual calcium scores matched the standard Agatston score category in 63% of cases and were within one category in 93%, with a weighted kappa of 0.89 (95% CI, 0.88–0.91; p < 0.0001).
High agreement persisted regardless of study site, scanner type, or patient sex.
Inter-reader evaluation showed identical categorization in 65% of patients and agreement within one category in 93% of patients.

Study Design

Type

Cross-Sectional (n=492)

Blinding

Blinded

Multicenter

Yes

Structured PICO

Does visual estimation of coronary artery calcium from low-dose CT attenuation correction scans agree with standard Agatston score in patients undergoing myocardial perfusion imaging?

Population

492 patients from 3 centers receiving both myocardial perfusion imaging with CT attenuation correction and a standard coronary artery calcium scan.

Exposure

Visual estimation of coronary artery calcium (VECAC) on a six-level scale from low-dose, non-ECG-gated CT attenuation correction (CTAC) scans

Comparator

Standard Agatston score (AS) measured on standard ECG-gated scans, converted to the same six-level scale

Outcome

Agreement between visually-estimated CAC (VECAC) on CTAC and standard Agatston score (AS)surrogate

Main Result

Effect estimate: Weighted kappa 0.89 (95% CI 0.88 to 0.91)

p-value: p=<0.0001

Discussion

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Implication

Visual estimation of coronary artery calcium from low-dose CT attenuation correction scans during MPI shows high agreement with standard Agatston scoring, allowing for opportunistic CAC assessment.

Cite This Study

Einstein et al. (2010) conducted a cross-sectional in Patients undergoing myocardial perfusion imaging (n=492). Visual estimation of coronary artery calcium from CT attenuation correction scans vs. Standard Agatston score on ECG-gated scans was evaluated on Agreement between visually-estimated CAC on CTAC and standard Agatston score (Weighted kappa 0.89, 95% CI 0.88 to 0.91, p=<0.0001). Visual estimation of coronary artery calcium from low-dose CT attenuation correction scans showed high agreement with standard Agatston scores (weighted kappa 0.89; 95% CI 0.88-0.91; p<0.0001).

synapsesocial.com/papers/6a09dc6a4b6ade4638cab08e https://doi.org/10.1016/j.jacc.2010.05.057

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Implication

Visual estimation of coronary artery calcium from low-dose CT attenuation correction scans during MPI shows high agreement with standard Agatston scoring, allowing for opportunistic CAC assessment.

Agreement of Visual Estimation of Coronary Artery Calcium From Low-Dose CT Attenuation Correction Scans in Hybrid PET/CT and SPECT/CT With Standard Agatston Score

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Agreement of Visual Estimation of Coronary Artery Calcium From Low-Dose CT Attenuation Correction Scans in Hybrid PET/CT and SPECT/CT With Standard Agatston Score

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

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