Korean J Radiol.  2021 Jul;22(7):1034-1043. 10.3348/kjr.2020.1047.

Reliability of Coronary Artery Calcium Severity Assessment on Non-Electrocardiogram-Gated CT: A Meta-Analysis

  • 1Department of Radiology, Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
  • 2Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea


The purpose of this meta-analysis was to investigate the pooled agreements of the coronary artery calcium (CAC) severities assessed by electrocardiogram (ECG)-gated and non-ECG-gated CT and evaluate the impact of the scan parameters.
Materials and Methods
PubMed, EMBASE, and the Cochrane library were systematically searched. A modified Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to evaluate the quality of the studies. Meta-analytic methods were utilized to determine the pooled weighted bias, limits of agreement (LOA), and the correlation coefficient of the CAC scores or the weighted kappa for the categorization of the CAC severities detected by the two modalities. The heterogeneity among the studies was also assessed. Subgroup analyses were performed based on factors that could affect the measurement of the CAC score and severity: slice thickness, reconstruction kernel, and radiation dose for non-ECG-gated CT.
A total of 4000 patients from 16 studies were included. The pooled bias was 62.60, 95% LOA were -36.19 to 161.40, and the pooled correlation coefficient was 0.94 (95% confidence interval [CI] = 0.89–0.97) for the CAC score. The pooled weighted kappa of the CAC severity was 0.85 (95% CI = 0.79–0.91). Heterogeneity was observed in the studies (I2 > 50%, p < 0.1). In the subgroup analysis, the agreement between the CAC categorizations was better when the two CT examinations had reconstructions based on the same slice thickness and kernel.
The pooled agreement of the CAC severities assessed by the ECG-gated and non-ECG-gated CT was excellent; however, it was significantly affected by scan parameters, such as slice thickness and the reconstruction kernel.


Coronary artery calcium; Computed tomography; Reliability; Meta-analysis
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