Automatic determination of cardiovascular risk by CT attenuation correction maps in Rb-82 PET/CT

Ivana Išgum*, Bob D. de Vos, Jelmer M. Wolterink, Damini Dey, Daniel S. Berman, Mathieu Rubeaux, Tim Leiner, Piotr J. Slomka

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

42 Citations (Scopus)
49 Downloads (Pure)


Background: We investigated fully automatic coronary artery calcium (CAC) scoring and cardiovascular disease (CVD) risk categorization from CT attenuation correction (CTAC) acquired at rest and stress during cardiac PET/CT and compared it with manual annotations in CTAC and with dedicated calcium scoring CT (CSCT).

Methods and Results: We included 133 consecutive patients undergoing myocardial perfusion 82Rb PET/CT with the acquisition of low-dose CTAC at rest and stress. Additionally, a dedicated CSCT was performed for all patients. Manual CAC annotations in CTAC and CSCT provided the reference standard. In CTAC, CAC was scored automatically using a previously developed machine learning algorithm. Patients were assigned to a CVD risk category based on their Agatston score (0, 1-10, 11-100, 101-400, >400). Agreement in CVD risk categorization between manual and automatic scoring in CTAC at rest and stress resulted in Cohen’s linearly weighted κ of 0.85 and 0.89, respectively. The agreement between CSCT and CTAC at rest resulted in κ of 0.82 and 0.74, using manual and automatic scoring, respectively. For CTAC at stress, these were 0.79 and 0.70, respectively.

Conclusion: Automatic CAC scoring from CTAC PET/CT may allow routine CVD risk assessment from the CTAC component of PET/CT without any additional radiation dose or scan time.

Original languageEnglish
Pages (from-to)2133-2142
Number of pages10
JournalJournal of nuclear cardiology
Issue number6
Publication statusPublished - 15 Dec 2018
Externally publishedYes


  • Automatic calcium scoring
  • Cardiac CT
  • Cardiovascular risk
  • Coronary calcium
  • CT attenuation correction map


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