Key result
Contrast-enhanced computed tomography increased the measured Agatston score of aortic valve calcification by 56.2% compared to non-enhanced imaging (P<0.05), making quantification unreliable.
Why the study?
Does contrast-enhanced MSCT provide reliable calcium scoring of aortic valve calcification compared to non-enhanced MSCT in patients with suspected aortic valve stenosis?
Cross-Sectional (n=19)
Does contrast-enhanced MSCT provide reliable calcium scoring of aortic valve calcification compared to non-enhanced MSCT in patients with suspected aortic valve stenosis?
Effect estimate: 56.2% increase
p-value: p=<0.05
Quantification of aortic valve calcification from contrast-enhanced CT images is not reliable because contrast material simulates calcification, leading to artificially increased scores.
Clinicians should avoid contrast-enhanced CT for aortic valve Agatston scoring; leaves open need for standardized non-contrast protocols in research.
PURPOSE: Previous studies have shown a positive correlation between amount of aortic valve calcification (AVC) and degree of aortic valve stenosis (AVS). We have investigated whether calcium scoring of AVC from contrast-enhanced images is reliable. MATERIAL AND METHODS: Nineteen patients with suspected AVS underwent retrospectively ECG-gated multislice computed tomography (MSCT). Standardized scan protocols were applied prior to (120 KV, 133 mAseff) and after (120 KV, 500 mAseff) the administration of non-ionic contrast material. Image reconstruction was performed at 60% of the RR interval (slice thickness 3 mm, reconstruction increment 2 mm). AVC was quantified using Agatston score and calcium mass. The number of lesions was calculated. All nonenhanced images were scored using thresholds of 130 HU and 350 HU. Contrast-enhanced images were assessed with a threshold of 350 HU exclusively. RESULTS: Fifteen patients with AVCs were included in the statistical analysis. The mean Agatston score (calcium mass) in non-enhanced images was 2888.4 +/- 2844.4 (694.2 mg +/- 869.3 mg). Altering the threshold from 130 HU to 350 HU led to a 58.2% (30.5%) decrease in the AVC score (P values < 0.001). Contrast-enhanced images showed an increased Agatston score (calcium mass) of 56.2% (33.5%) compared to non-enhanced images (P values <0.05) with the same threshold of 350 HU. CONCLUSION: Quantification of AVC from contrast-enhanced images is not reliable, as contrast material simulates calcification.
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Mühlenbruch et al. (2005) conducted a cross-sectional in Suspected aortic valve stenosis (n=19). Contrast-enhanced multislice computed tomography vs. Non-enhanced multislice computed tomography was evaluated on Agatston score of aortic valve calcification (56.2% increase, p=<0.05). Contrast-enhanced computed tomography increased the measured Agatston score of aortic valve calcification by 56.2% compared to non-enhanced imaging (P<0.05), making quantification unreliable.
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