Alavi–Carlsen Calcification Score (ACCS): A Simple Measure of Global Cardiac Atherosclerosis Burden
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Date
2021-08-05
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Citation of Original Publication
Saboury, Babak et al.; Alavi–Carlsen Calcification Score (ACCS): A Simple Measure of Global Cardiac Atherosclerosis Burden; Diagnostics 2021, 11(8), 1421, 5 August, 2021; https://doi.org/10.3390/diagnostics11081421
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Attribution 4.0 International (CC BY 4.0)
Attribution 4.0 International (CC BY 4.0)
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Abstract
Multislice cardiac CT characterizes late stage macrocalcification in epicardial arteries as opposed to PET/CT, which mirrors early phase arterial wall changes in epicardial and transmural coronary arteries. With regard to tracer, there has been a shift from using mainly 18F-fluorodeoxyglucose (FDG), indicating inflammation, to applying predominantly 18F-sodium fluoride (NaF) due to its high affinity for arterial wall microcalcification and more consistent association with cardiovascular risk factors. To make NaF-PET/CT an indispensable adjunct to clinical assessment of cardiac atherosclerosis, the Alavi–Carlsen Calcification Score (ACCS) has been proposed. It constitutes a global assessment of cardiac atherosclerosis burden in the individual patient, supported by an artificial intelligence (AI)-based approach for fast observer-independent segmentation. Common measures for characterizing epicardial coronary atherosclerosis by NaF-PET/CT as the maximum standardized uptake value (SUV) or target-to-background ratio are more versatile, error prone, and less reproducible than the ACCS, which equals the average cardiac SUV. The AI-based approach ensures a quick and easy delineation of the entire heart in 3D to obtain the ACCS expressing ongoing global cardiac atherosclerosis, even before it gives rise to CT-detectable coronary calcification. The quantification of global cardiac atherosclerotic burden by the ACCS is suited for management triage and monitoring of disease progression with and without intervention.