Causes of interscan variability of coronary artery calcium measurements at electron-beam CT

Rationale and Objectives. The authors performed this study to investigate the causes of interscan variability of coronary artery calcium measurements at electron-beam computed tomography (CT). Materials and Methods. Two sets of electron-beam CT scans were obtained in 298 consecutive patients who under-went electron-beam CT to screen for coronary artery calcium. Interscan variations of coronary artery calcium characteristics and the effects of heart rate, electrocardiographic (ECG) triggering method, image noise, and coronary motion on interscan variability were analyzed. Results. The interscan mean variabilities were 21.6% (median, 11.7%) and 17.8% (median, 10.8%) with the Agatston and volumetric score, respectively (P < .01). Variability decreased with increasing calcification score (34.6% for a score of 11-50 and 9.4% for a score of 400-1,000, P < .0001). The absolute difference in Agatston score between scans was 44.1 +/- 95.6. The correlation coefficient between the first and second sets of scans was 0.99 (P < .0001). Lower interscan Variability was found in younger patients (<60 years), patients with stable heart rates (heart rate changing less than 10 beats per minute during scanning), patients with no visible coronary motion, and those with an optimal ECG triggering method (P < .05 for all). Results of multivariate logistic analysis showed that changes in calcium volume, mean attenuation, and peak attenuation were significant predictors of interscan variability and caused the interscan variations of the coronary artery calcium measurements (r(2) = 0.83, P < .0001). Conclusion. Coronary calcification at electron-beam CT varies from scan to scan. Volumetfic scoring and optimal ECG triggering should be used to reduce interscan variability. Baseline calcium score and interscan variability must be considered in the evaluation of calcium progression.