Elsevier

Academic Radiology

Volume 16, Issue 6, June 2009, Pages 689-699
Academic Radiology

Original investigation
Reproducibility and Validity of Lung Density Measures from Cardiac CT Scans—The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study1

https://doi.org/10.1016/j.acra.2008.12.024Get rights and content

Rationale and Objectives

Cardiac computed tomographic (CT) scans for the assessment of coronary calcium scores include approximately 70% of the lung volume and may be useful for the quantitative assessment of emphysema. The reproducibility of lung density measures from cardiac computed tomography and their validity compared to lung density measures from full-lung scans is unknown.

Materials and Methods

The Multi-Ethnic Study of Atherosclerosis (MESA) performed paired cardiac CT scans for 6814 participants at baseline and at follow-up. The MESA-Lung Study assessed lung density measures in the lung fields of these cardiac scans, counting voxels below −910 HU as moderate-to-severe emphysema-like lung regions. We evaluated: 1) the reproducibility of lung density measures among 120 randomly selected participants; 2) the comparability of measures acquired on electron beam CT (EBCT) and multidetector CT (MDCT) scanners among 10 participants; and 3) the validity of these measures compared to full-lung scans among 42 participants. Limits of agreement were determined using Bland-Altman approaches.

Results

Percent emphysema measures from paired cardiac scans were highly correlated (r = 0.92–0.95) with mean difference of −0.05% (95% limits of agreement: −8.3, 8.4%). Measures from EBCT and MDCT scanners were comparable (mean difference −0.9%; 95% limits of agreement: −5.1, 3.3%). Percent emphysema measures from MDCT cardiac and MDCT full-lung scans were highly correlated (r = 0.93) and demonstrated reasonable agreement (mean difference 2.2%; 95% limits of agreement: −9.2, 13.8%).

Conclusions

Although full-lung imaging is preferred for the quantification of emphysema, the lung imaging from paired cardiac computed tomography provided a reproducible and valid quantitative assessment of emphysema in a population-based sample.

Section snippets

Study Sample

The Multi-Ethnic Study of Atherosclerosis (MESA) is a multicenter prospective cohort study to investigate the prevalence, correlates, and progression of subclinical cardiovascular disease in individuals without clinical cardiovascular disease. The protocol and recruitment has been previously described (18). MESA recruited 6814 participants, ages 45–84 years old, of non-Hispanic white, African-American, Hispanic, or Chinese race/ethnicity from six United States communities in 2000–2002. Major

Results

Table 2 shows the characteristics of participants in the reproducibility study of cardiac CT scans, the comparability study of EBCT versus MDCT cardiac CT scans, and the validation study of cardiac versus full-lung CT scans. One participant selected for the reproducibility study underwent one instead of two baseline scans and was excluded from baseline analyses; two participants were excluded from follow-up analyses for the same reason. Participants ranged in age from 45 to 84 years. A majority

Discussion

Percent emphysema and alpha ascertained from cardiac CT scans were reproducible and yielded similar results, on average, to lung density measures from full-lung scans among relatively healthy participants. Reproducibility did not differ consistently by scanner type and values of percent emphysema and alpha from cardiac scans acquired on an EBCT scanner were comparable to those acquired on an MDCT scanner.

The reproducibility of lung density measures from paired cardiac scans in this multicenter

Acknowledgment

The authors thank the other investigators, the staff, and the participants of the MESA and MESA-Lung studies for their valuable contributions, and particularly acknowledge the assistance of Matthew Budoff, MD, PhD, W. Craig Johnson, MS, and Angel Solano for assistance with the completion of the study. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

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    Conflict of interest: Drs. Hoffman and Reinhardt are founders and shareholders of VIDA Diagnostics Inc., a company that is commercializing portions of the image analysis software used in this study.

    Supported by contracts R01 HL-077612, R01 HL-075476, N01-HC-95159 through N01-HC-95165 and N01-HC-95169 from the National Heart, Lung, and Blood Institute, Bethesda, MD.

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