Deep Learning of Coronary Calcium Scores From PET/CT Attenuation Maps Accurately Predicts Adverse Cardiovascular Events

Elsevier

Available online 14 September 2022

JACC: Cardiovascular ImagingAbstractBackground

Assessment of coronary artery calcium (CAC) by computed tomographic (CT) imaging provides an accurate measure of atherosclerotic burden. CAC is also visible in CT attenuation correction (CTAC) scans, always acquired with cardiac positron emission tomographic (PET) imaging.

Objectives

The aim of this study was to develop a deep-learning (DL) model capable of fully automated CAC definition from PET CTAC scans.

Methods

The novel DL model, originally developed for video applications, was adapted to rapidly quantify CAC. The model was trained using 9,543 expert-annotated CT scans and was tested in 4,331 patients from an external cohort undergoing PET/CT imaging with major adverse cardiac events (MACEs) (follow-up 4.3 years), including same-day paired electrocardiographically gated CAC scans available in 2,737 patients. MACE risk stratification in 4 CAC score categories (0, 1-100, 101-400, and >400) was analyzed and CAC scores derived from electrocardiographically gated CT scans (standard scores) by expert observers were compared with automatic DL scores from CTAC scans.

Results

Automatic DL scoring required <6 seconds per scan. DL CTAC scores provided stepwise increase in the risk for MACE across the CAC score categories (HR up to 3.2; P < 0.001). Net reclassification improvement of standard CAC scores over DL CTAC scores was nonsignificant (−0.02; 95% CI: −0.11 to 0.07). The negative predictive values for MACE of zero CAC with standard (85%) and DL CTAC (83%) CAC scores were similar (P = 0.19).

Conclusions

DL CTAC scores predict cardiovascular risk similarly to standard CAC scores quantified manually by experienced operators from dedicated electrocardiographically gated CAC scans and can be obtained almost instantly, with no changes to PET/CT scanning protocol.

Key Words

attenuation correction

computed tomography

coronary artery disease

coronary calcium score

positron emission tomography

Abbreviations and AcronymsCAC

coronary artery calcium

CAD

coronary artery disease

CTAC

computed tomographic attenuation correction

MACE

major adverse cardiac event

MPI

myocardial perfusion imaging

NRI

net reclassification index

PET

positron emission tomographic

View full text

© 2022 by the American College of Cardiology Foundation. Published by Elsevier.

留言 (0)

沒有登入
gif