Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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A Modified Length-Based Grading Method for Assessing Coronary Artery Calcium Severity on Non-Electrocardiogram-Gated Chest Computed Tomography: A Multiple-Observer Study

  • Suh Young Kim (Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Young Joo Suh (Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Na Young Kim (Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Suji Lee (Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Kyungsun Nam (Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Jeongyun Kim (Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Hwan Kim (Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Hyunji Lee (Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Kyunghwa Han (Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Hwan Seok Yong (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine)
  • Received : 2022.09.01
  • Accepted : 2023.02.04
  • Published : 2023.04.01
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Abstract

Objective: To validate a simplified ordinal scoring method, referred to as modified length-based grading, for assessing coronary artery calcium (CAC) severity on non-electrocardiogram (ECG)-gated chest computed tomography (CT). Materials and Methods: This retrospective study enrolled 120 patients (mean age ± standard deviation [SD], 63.1 ± 14.5 years; male, 64) who underwent both non-ECG-gated chest CT and ECG-gated cardiac CT between January 2011 and December 2021. Six radiologists independently assessed CAC severity on chest CT using two scoring methods (visual assessment and modified length-based grading) and categorized the results as none, mild, moderate, or severe. The CAC category on cardiac CT assessed using the Agatston score was used as the reference standard. Agreement among the six observers for CAC category classification was assessed using Fleiss kappa statistics. Agreement between CAC categories on chest CT obtained using either method and the Agatston score categories on cardiac CT was assessed using Cohen's kappa. The time taken to evaluate CAC grading was compared between the observers and two grading methods. Results: For differentiation of the four CAC categories, interobserver agreement was moderate for visual assessment (Fleiss kappa, 0.553 [95% confidence interval {CI}: 0.496-0.610]) and good for modified length-based grading (Fleiss kappa, 0.695 [95% CI: 0.636-0.754]). The modified length-based grading demonstrated better agreement with the reference standard categorization with cardiac CT than visual assessment (Cohen's kappa, 0.565 [95% CI: 0.511-0.619 for visual assessment vs. 0.695 [95% CI: 0.638-0.752] for modified length-based grading). The overall time for evaluating CAC grading was slightly shorter in visual assessment (mean ± SD, 41.8 ± 38.9 s) than in modified length-based grading (43.5 ± 33.2 s) (P < 0.001). Conclusion: The modified length-based grading worked well for evaluating CAC on non-ECG-gated chest CT with better interobserver agreement and agreement with cardiac CT than visual assessment.

Keywords

Acknowledgement

The authors would like to thank Sunggoo Kwon from Coreline Soft, Co.Ltd., for the technical support. Minju Kim (Department of Medical Statistics, Asan Medical Center, University of Ulsan College of Medicine) kindly provided statistical advice for this manuscript.

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