Deep Learning-Based Automated Quantification of Coronary Artery Calcification for Contrast-Enhanced Coronary Computed Tomographic Angiography

Background: We evaluated the accuracy of a deep learning-based automated quantification algorithm for coronary artery calcium (CAC) based on enhanced ECG-gated coronary CT angiography (CCTA) with dedicated coronary calcium scoring CT (CSCT) as the reference. Methods: This retrospective study included 315 patients who underwent CSCT and CCTA on the same day, with 200 in the internal and 115 in the external validation sets. The calcium volume and Agatston scores were calculated using both the automated algorithm in CCTA and the conventional method in CSCT. The time required for computing calcium scores using the automated algorithm was also evaluated. Results: Our automated algorithm extracted CACs in less than five minutes on average with a failure rate of 1.3%. The volume and Agatston scores by the model showed high agreement with those from CSCT with concordance correlation coefficients of 0.90-0.97 for the internal and 0.76-0.94 for the external. The accuracy for classification was 92% with a 0.94 weighted kappa for the internal and 86% with a 0.91 weighted kappa for the external set. Conclusions: The deep learning-based and fully automated algorithm efficiently extracted CACs from CCTA and reliably assigned categorical classification for Agatston scores without additional radiation exposure.