Highly Accurate Multi-vendor AI-based Algorithm For Coronary Artery Calcium Scoring
Introduction: Artificial intelligence (AI)-based coronary artery calcification (CAC) scoring algorithm applied to cardiac computed tomography (CT) scans can standardize image interpretation and quantification as well as improve clinical efficiency and accuracy. Methods: An automated CAC scoring algorithm, based on the recognition of cardiac structures, was developed and trained using a dataset of 293 cardiac CT scans (Graylight Imaging, Gliwice, Poland). The algorithm was tested on independent 434 non-contrast cardiac CT scans (seven scanner models, four manufacturers: 383 Siemens, 19 Canon, 17 GE, 15 Philips). We compared automated CAC scores to manual expert reader assessments. CAC scores were categorized into four risk categories following SCCT recommendations. Results: In assessing 434 scans (mean age 62.0±10.6 years, 49.5% males), the AI-model detected CAC in 361 scans (82.7%), which was comparable to the human reader’s detection rate of CAC in 360 scans (82.5%) (p = 1.0). There was an excellent correlation between AI-model and manual CAC scores, both for total score (Spearman’s r = 0.99, 95% CI 0.99-1.0, p \textless 0.001) and individual coronary arteries (Spearman’s r = 0.91, 0.98, 0.92, and 0.98 for left main, left anterior descending, left circumflex, and right coronary artery, respectively). Bland-Altman analysis revealed minimal bias of 7.1 AU with 95% limits of agreement ranging from -96.6 to 110.7 AU. The model correctly classified 426 patients (98.6%) into the same CAC risk category as the human reader. Among 74 patients (17.1%) with a CAC score of zero, only 2 patients (2.7%) were reclassified with a non-zero CAC score by the AI-model. The Cohen’s kappa value for CAC score risk categorization was 0.98 (95% CI 0.97-1.0), indicating excellent agreement. Conclusions: The developed multi-vendor, fully automated CAC scoring algorithm demonstrated almost perfect concordance with assessments by expert reader. Leveraging AI, novel high-precision algorithms have the potential to significantly reduce the time required for repetitive tasks in clinical practice.