Coronary artery calcification on low-dose computed tomography: comparison of Agatston and Ordinal Scores



      To compare Agatston with Ordinal Scores for the extent of coronary artery calcification (coronary artery calcium) using nongated low-dose computed tomography (CT) scans.

      Materials and Methods

      A total of 631 asymptomatic participants had CT scans from 2010 to 2013. Their Ordinal and Agatston Score were classified into categories.


      The Ordinal Score Categories showed excellent agreement (weighted kappa of 0.83; 95% confidence interval: 0.79–0.88) with the Agatston Score Categories.


      The use of the Ordinal Score is readily obtained on low-dose CT scans that are used for CT screening for lung cancer and these scores are useful for risk stratification of coronary artery disease.


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      1. WHO methods and data sources for global causes of death 2000–2011.
        (Global Health Estimates Technical Paper WHO/HIS/HIS/GHE/2013.3) ([Accessed February 17, 2015])
        • Greenland P
        • Bonow RO
        • Brundage BH
        • Budoff MJ
        • Eisenberg MJ
        • Grundy SM
        • et al.
        ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American college of cardiology foundation clinical expert consensus task force (ACCF/AHA writing committee to update the 2000 expert consensus document on electron beam computed tomography) developed in collaboration with the society of atherosclerosis imaging and prevention and the society of cardiovascular computed tomography.
        J Am Coll Cardiol. 2007; 49: 378-402
        • Arad Y
        • Goodman KJ
        • Roth M
        • Newstein D
        • Guerci AD
        Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis heart study.
        J Am Coll Cardiol. 2005; 46: 158-165
        • LaMonte MJ
        • FitzGerald SJ
        • Church TS
        • Barlow C.E.
        • Radford NB
        • Levine BD
        • et al.
        Coronary artery calcium score and coronary heart disease events in a large cohort of asymptomatic men and women.
        Am J Epidemiol. 2005; 162: 421-429
        • Kondos GT
        • Hoff JA
        • Sevrukov A
        • Daviglus ML
        • Garside DB
        • Devries SS
        • et al.
        Electron-beam tomography coronary artery calcium and cardiac events: a 37-month follow-up of 5635 initially asymptomatic low-to intermediate-risk adults.
        Circulation. 2003; 107: 2571-2576
        • Raggi P
        • Berman DS
        Computed tomography coronary calcium screening and myocardial perfusion imaging.
        J Nucl Cardiol. 2005; 12: 96-103
        • Agatston AS
        • Janowitz WR
        • Hildner FJ
        • Zusmer NR
        • Viamonte M
        • Detrano R
        Quantification of coronary artery calcium using ultrafast computed tomography.
        J Am Coll Cardiol. 1990; 15: 827-832
        • Falk E
        • Shah PK
        The SHAPE Guideline: ahead of its time or just in time?.
        Curr Atheroscler Rep. 2011; 13: 345-352
        • Shemesh J
        • Henschke C
        • Farooqi A
        • Yip R
        • Yankelevitz DF
        • Shaham D
        • et al.
        Frequency of coronary artery calcification on low-dose computer tomography screening for lung cancer.
        Clin Imaging. 2006; 30: 181-185
        • Shemesh J
        • Henschke CL
        • Shaham D
        • Yip R
        • Farooqi AO
        • Cham MD
        • et al.
        Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease.
        Radiology. 2010; 257: 541-548
        • Kim SM
        • Chung JM
        • Lee KS
        • Choe YH
        • Yi CA
        • Choe BK
        Coronary calcium screening using low-dose lung cancer screening: effectiveness of MDCT with retrospective reconstruction.
        AJR Am J Roentgenol. 2008; 190: 917-922
        • Jacobs PC
        • Isgum I
        • Gondrie MJ
        • Mali WP
        • van Ginneken B
        • Prokop M
        • et al.
        Coronary artery calcification scoring in low-dose ungated CT screening for lung cancer: interscan agreement.
        AJR Am J Roentgenol. 2010; 194: 1244-1249
        • Jacobs PC
        • Gondrie MJ
        • van der Graaf Y
        • de Koning HJ
        • Isgum I
        • van Ginneken B
        • et al.
        Coronary artery calcium can predict all-cause mortality and cardiovascular events on low-dose CT screening for lung cancer.
        AJR Am J Roentgenol. 2012; 198: 505-511
        • Blair KJ
        • Allison MA
        • Morgan C
        • Wassel CL
        • Rifkin DE
        • Wright CM
        • et al.
        Comparison of ordinal versus Agatston coronary calcification scoring for cardiovascular disease mortality in community-living individuals.
        Int J Cardiovasc Imaging. 2014; 30: 813-818
        • Budoff MJ
        • Nasir K
        • Kinney GL
        • Hokanson JE
        • Barr RG
        • Steiner R
        • et al.
        Coronary artery and thoracic calcium on noncontrast thoracic CT scans: comparison of ungated and gated examinations in patients from the COPD gene cohort.
        J Cardiovasc Comput Tomogr. 2011; 5: 113-118
        • Einstein AJ
        • Johnson LL
        • Bokhari S
        • Son J
        • Thompson RC
        • Bateman TM
        • 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; 56: 1914-1921
        • Huang YL
        • Wu FZ
        • Wang YC
        • Ju YJ
        • Mar GY
        • Chuo CC
        • et al.
        Reliable categorization of visual scoring of coronary artery calcification on low-dose CT for lung cancer screening: validation with the standard Agatston score.
        Eur Radiol. 2013; 23: 1226-1233
        • Shemesh J
        • Motro M
        • Grossman C
        • Morag-Koren N
        • Apter S
        • Grossman E
        Progression of coronary artery calcification is associated with long-term cardiovascular events in hypertensive adults.
        J Hypertens. 2013; 31: 1886-1892
        • Abunassar JG
        • Yam Y
        • Chen L
        • D’Mello N
        • Chow BJ
        Usefulness of the Agatston score = 0 to exclude ischemic cardiomyopathy in patients with heart failure.
        Am J Cardiol. 2011; 107: 428-432
        • Hong C
        • Pilgram T
        • Zhu F
        • Bae K
        Coronary artery calcification: effect of size of field of view on multi-detector row CT measurements.
        Radiology. 2004; 233: 281-285
        • Mahnken AH
        • Muhlenbruch G
        • Koos R
        • Das M
        • Pohl S
        • Stanzel S
        • et al.
        Influence of a small field-of-view size on the detection of coronary artery calcifications with MSCT: in vitro and in vivo study.
        Eur Radiol. 2006; 16: 358-364