Coronary calcium score and emphysema extent on different CT radiation dose protocols in lung cancer screening

Abstract Objectives To assess the consistency of automated measurements of coronary artery calcification (CAC) burden and emphysema extent on computed tomography (CT) images acquired with different radiation dose protocols in a lung cancer screening (LCS) population. Materials and methods The patient cohort comprised 361 consecutive screenees who underwent a low-dose CT (LDCT) scan and an ultra-low-dose CT (ULDCT) scan at an incident screening round. Exclusion criteria for CAC measurements were software failure and previous history of CVD, including coronary stenting, whereas for emphysema assessment, software failure only. CT images were retrospectively analyzed by a fully automated AI software for CAC scoring, using three predefined Agatston score categories (0–99, 100–399, and ≥ 400), and emphysema quantification, using the percentage of low attenuation areas (%LAA). Demographic and clinical data were obtained from the written questionnaire completed by each participant at the first visit. Agreement for CAC and %LAA categories was measured by the k-Cohen Index with Fleiss-Cohen weights (K w ) and Intraclass Correlation Coefficient (ICC) with 95% Confidence Interval (CI). Results An overlap of CAC strata was observed in 275/327 (84%) volunteers, with an almost perfect agreement (K w = 0.86, 95% CI 0.82–0.90; ICC = 0.86, 95% CI 0.79–0.90), while an overlap of %LAA strata was found in 204/356 (57%) volunteers, with a moderate agreement (K w = 0.57, 95% CI 0.51–0.63; ICC = 0.57, 95% CI 0.21–0.75). Conclusion Automated CAC quantification on ULDCT seems feasible, showing similar results to those obtained on LDCT, while the quantification of emphysema tended to be overestimated on ULDCT images. Key Points Question Evidence demonstrating that coronary artery calcification and emphysema can be automatedly quantified on ultra-low-dose chest CT is still awaited. Findings Coronary artery calcification and emphysema measurements were similar among different CT radiation dose protocols; their automated quantification is feasible on ultra-low-dose CT. Clinical relevance Ultra-low-dose CT-based LCS might offer an opportunity to improve the secondary prevention of cardiovascular and respiratory diseases through automated quantification of both CAC burden and emphysema extent.