Background: Traditionally, quantification of aortic valve calcium (AVC) has been performed with noncontrast computed tomography (NCCT) using the Agatston method. This study sought to derive and validate a systematic method enabling AVC quantification using computed tomographic angiography (CTA) in patients with aortic stenosis (AS).
Methods: The study included 134 consecutive patients with AS who underwent both NCCT and CTA and were subdivided into derivation (n = 71) and validation cohorts (n = 63). AVC on NCCT (AVC) was quantified using the Agatston method using the software developed for semiautomatic assessment of coronary calcium. On CTA, the mean contrast attenuation of the aorta in Hounsfield units (Aorta) and SD was measured in the region of interest at the level of the sinotubular junction.
Results: Using an adjusted calcium detection threshold of Aorta + 2 SD, we calculated AVC on CTA (AVC) using the same software without modifying other variables. Correlation between AVC and AVC in the derivation cohort was excellent (r = 0.9679; P < .001). We used a linear regression model to derive a formula for predicting AVC that enabled conversion of AVC to AVC (AVC = 1.821 × AVC). Applying this formula in validation cohort, we calculated AVC, which showed excellent agreement with AVC (intraclass correlation coefficient, 0.9648; 95% confidence interval, 0.9427-0.9782). Excellent correlation was also found between categorized AVC and AVC scores (κ = 0.9044; 95% confidence interval, 0.7989-1.0000), with 95.24% (60 of 63) of scores falling within the same severity category.
Conclusions: AVC quantification on CTA is feasible with high accuracy and reliability and shows excellent agreement with the standard AVC score. With the systematic approach using "dynamic thresholds" being largely independent of the scan acquisition protocol, AVC can potentially replace AVC, eliminating the need for separate NCCT acquisition solely for AVC quantification.
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