Coronary artery calcium scoring: Can we do better?

Sanne G. M. van Velzen, Bob D. de Vos, Helena M. Verkooijen, Tim Leiner, Max A. Viergever, Ivana Išgum

Research output: Chapter in Book/Report/Conference proceedingConference contributionAcademicpeer-review

Abstract

Coronary artery calcification (CAC) is a strong and independent predictor of cardiovascular disease (CVD) that can be quantified in CT scans showing the heart. CAC lesions are defined as lesions in the coronary arteries with image intensity above 130 HU. The use of a threshold may lead to under- or over-estimation of the amount of CAC and, hence, to incorrect cardiovascular categorization of patients. This is especially pronounced in CT scans without ECG-synchronization where lesions are more subject to cardiac motion and partial volume effects. To address this, we propose a method for quantification of CAC without a threshold. A set of 373 cardiac and 1181 chest CT scans was included to develop the method and a set of 21 scan-rescan pairs (42 scans) was included for final evaluation. Assuming that the attenuation of CAC is superimposed on the attenuation of the artery, we aimed to separate the CAC from the coronary arteries by employing a CycleGAN to generate a synthetic image without CAC from an image containing CAC and vice versa. By subtracting the synthetic image without CAC from the image with CAC, a CAC map is created. The CAC-map can subsequently be used to identify and quantify CAC. The ground truth, i.e. the true amount of CAC, can not be established, therefore, in this work the results generated by the method are compared with clinical calcium scoring in terms of reproducibility. The average relative difference between the calcium scores in scan-rescan pairs of scans was 50% with the proposed method and 86% for the conventional method. Moreover, the correlation between CAC pseudo masses in scan-rescan pairs was 0.92 with the proposed method and 0.89 with conventional calcium scoring. Our proposed method is able to identify and quantify CAC lesions in CT scans without using an intensity level thresholding. This might allow for more reproducible quantification of CAC in CT scans made without ECG synchronization, and, therefore, it might allow more accurate CVD risk prediction.
Original languageEnglish
Title of host publicationMedical Imaging 2020
Subtitle of host publicationImage Processing
EditorsIvana Isgum, Bennett A. Landman
PublisherSPIE
Volume11313
ISBN (Electronic)9781510633933
DOIs
Publication statusPublished - 2020
EventMedical Imaging 2020: Image Processing - Houston, United States
Duration: 17 Feb 202020 Feb 2020

Publication series

NameProgress in Biomedical Optics and Imaging - Proceedings of SPIE
Volume11313

Conference

ConferenceMedical Imaging 2020: Image Processing
CountryUnited States
CityHouston
Period17/02/2020/02/20

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