狼牙棒
医学
衰减校正
核医学
冠状动脉钙
正电子发射断层摄影术
放射科
计算机断层摄影
队列
心脏病学
内科学
计算机断层摄影术
心肌梗塞
传统PCI
作者
Konrad Pieszko,Aakash Shanbhag,Aditya Killekar,Robert J.H. Miller,Mark Lemley,Yuka Otaki,Ananya Singh,Jacek Kwieciński,Heidi Gransar,Serge D. Van Kriekinge,Paul Kavanagh,Edward J. Miller,Piotr J. Slomka,Jiaming Liang,Daniel S. Berman,Damini Dey,Piotr J. Slomka
标识
DOI:10.1016/j.jcmg.2022.06.006
摘要
Assessment of coronary artery calcium (CAC) by computed tomographic (CT) imaging provides an accurate measure of atherosclerotic burden. CAC is also visible in computed tomographic attenuation correction (CTAC) scans, always acquired with cardiac positron emission tomographic (PET) imaging.The aim of this study was to develop a deep-learning (DL) model capable of fully automated CAC definition from PET CTAC scans.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.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).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.
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