Accuracy Evaluation of Coronary Artery Calcification Score Based on AI chest CT Plain Scan
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摘要: 目的：探讨基于人工智能（AI）的非门控胸部低剂量CT（LDCT）平扫与心电门控CT血管造影（ECG gated-CTA）对冠状动脉钙化积分（CACS）危险度分层的一致性。方法：回顾性分析行冠状动脉CTA扫描的100例患者，所有患者均行冠脉ECG gated-CTA扫描和常规非门控胸部LDCT平扫。在Siemens后处理工作站采用Agatston钙化积分软件记录ECG gated-CTA钙化积分，采用数坤人工智能分析软件记录非门控胸部CT平扫的钙化积分。采用原标准界值，对非门控胸部LDCT平扫与ECG gated-CTA评估的CACS值危险度分层进行Kappa检验；采用受试者工作特征曲线（ROC）检验非门控胸部LDCT平扫的诊断效能并获取最佳诊断新界值，采用新界值的非门控胸部LDCT与ECG gated-CTA评估的CACS值危险度分层进行进一步Kappa检验；比较两种方法的钙化积分的Pearson相关性，P<0.001为有统计学显著差异。结果：对非门控胸部LDCT平扫的CACS值按原界值进行危险度分层，与ECG gated-CTA的CACS值危险度分层进行一致性检验，Kappa值为0.804，P<0.001。非门控胸部LDCT平扫测得的CACS值与ECG gated-CTA测得的CACS值比较，低危-中危组的ROC曲线下面积（AUC）为0.910，P<0.001，最佳诊断界值为112.35；中危-高危组AUC为0.988，P<0.001，最佳诊断界值为398.31。对非门控胸部LDCT平扫测得的CACS值按最佳新诊断界值进行危险度分层，与ECG-gated CTA平扫测得的CACS值的按原有界值危险度分层进行一致性检验，Kappa值为0.850，P<0.001。两种方法所测Pearson相关系数为0.985，P<0.001，存在显著相关性。结论：基于人工智能技术的非门控胸部CT平扫与ECG-gated CTA对冠状动脉钙化积分的评估具有较高的一致性；本研究制定了非门控条件下CACS值危险度分层新标准，进一步提高了非门控胸部LDCT评估CACS值的准确性，有助于冠心病风险的早期筛查。Abstract: Objective: To explore the consistency of artificial intelligence-based non-gated low-dose CT(LDCT) plain scanning with ECG gated-CTA on risk stratification of coronary artery calcification score(CACS). Methods: A total of 100 patients with coronary artery CTA scan were analyzed retrospectively. All patients were selected for both coronary ECG gated-CTA scan and routine non-gated chest LDCT plain scan. Agatston calcification score software was applied to record ECG gated-CTA calcification score in Siemens post-processing workstation, and Shukun artificial intelligence analysis software was applied to record non-gated chest CT plain scan calcification score. With the original standard threshold, Kappa test was applied to stratify the risk of non-gated chest LDCT plain scan and ECG gated-CTA assessed CACS. The subject operating characteristic(ROC) curve was adopted to test the diagnostic efficacy of non-gated chest LDCT plain scan and to obtain the optimal new threshold value. The CACS value evaluated by the non-gated chest LDCT with the new threshold value and by ECG gated CTA with old threshold value were selected for further Kappa test. Pearson correlation of calcification integral between the two methods was compared. P<0.001 was set as statistically significant difference. Results: On non-gated chest LDCT plain scan, the risk of CACS was stratified according to the original threshold value, and it was consistent with the ECG-gated CACS value. Kappa value was 0.804 with P<0.001. When comparing the non-gated chest with CACS measured by chest LDCT and that measured by ECG gated-CTA, The area under ROC curve(AUC) of low-medium risk group was 0.910 with P<0.001, and the optimal diagnostic threshold was 112.35. The AUC of the medium-high risk group was 0.988 with P<0.001, and the best diagnostic threshold was 398.31. Consistency test was performed on the risk stratification of CACS measured by non-gated chest LDCT plain scan according to the optimal diagnostic threshold, and the risk stratification of CACS measured with ECG-gated CTA scan according to the original threshold. The Kappa value was 0.850, P<0.001. The Pearson correlation coefficient measured by the two methods was 0.985 and P<0.001, showing a significant correlation. Conclusion: The evaluation of coronary artery calcification by non-gated CT scan based on artificial intelligence and ECG-gated CTA technology is highly consistent. In this study, a new standard for risk stratification of CACS values under non-gated conditions was established, which further improved the accuracy of CACS values evaluated by non-gated chest LDCT and contributed to the early detection of coronary heart disease.
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期刊类型引用(5)
1. 王佩，胡晓恒，王晓娜，刘洋. 冠状动脉钙化积分与冠心病危险因素的相关性分析. 中国老年保健医学. 2023(01): 68-71 . 
百度学术
2. 闫玉辰，胡磊，王焰，彭宙锋，孙建清，查云飞. 基于深度学习技术的非门控胸部CT冠脉钙化积分系统的准确性评价. 放射学实践. 2023(03): 273-278 . 百度学术
3. 贺华安，杨伟兴，吴雄，陈志龙，刘得志. 低剂量胸部CT肺癌筛查同时进行胸主动脉及冠状动脉钙化评估的可行性研究. 实用医学影像杂志. 2023(05): 350-353 . 百度学术
4. 施丽萍，张亚平，唐倩韵，解学乾. 人工智能辅助冠状动脉CT血管成像处理系统对临床工作效率影响的研究. 中国医学创新. 2022(26): 163-166 . 百度学术
5. 陈钦，唐劲松，郑春红，张中萍，金佳熙. 探讨DE-CCTA虚拟平扫评价老年冠状动脉钙化积分的应用准确性. 中国老年保健医学. 2022(05): 33-35 . 百度学术
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