Cardiac Suite for Calcium Scoring

Calcium Scoring

Cardiac Suite’s Calcium page offers multiple tools to score lesions and compute an Agatston score for coronary calcium. The page offers both a region-growing option and a polygon, with both tools available in 3D as well as in 2D – this allows for fine-tuning of lesions, including splitting lesions between multiple vessels (e.g., between left main and left anterior descending) if so desired.

Patient with multivessel lesions in the Calcium page
Patient with multivessel lesions in the Calcium page

The Calcium page’s user interface includes a histogram of lesion scores on the left where each horizontal bar visually indicates the calcium burden in each CT slice. Double-clicking any histogram bar navigates directly to that slice. Below the histogram, a loupe magnifies the view for easier scoring of small lesions. Sagittal and coronal slices provide a visual reference.

In addition to coronary calcium lesions, lesions in other structures may optionally be scored, such as in the aorta (separated into ascending, descending, and arch) and cardiac valves.

Annotations

Annotation tools, also available in all other pages, can be used here to measure average liver Hounsfield units or aortic diameters, for example.

Example use of annotations to measure liver attenuation
Example use of annotations to measure liver attenuation
Example use of annotations to measure ascending and descending aortic diameters
Example use of annotations to measure ascending and descending aortic diameters

Requirements

While SCCT calcium scoring guidelines require ECG-gated CT scans reconstructed with a slice thickness of 2.5mm or 3mm, it may also be possible to visually assess coronary calcifications using attenuation scans acquired during PET/CT or SPECT/CT imaging protocols.

References

  • Agatston et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15(3):827-832.
  • Hecht et al. 2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. J Cardiovasc Comput Tomogr 2017; 11(1):74-84.
  • Einstein et al. 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. J Am Coll Cardiol 2010 Nov 30; 56(23):1914-21.