Coronary artery calcium: A technical argument for a new scoring method

J Cardiovasc Comput Tomogr. 2019 Nov-Dec;13(6):347-352. doi: 10.1016/j.jcct.2018.10.014. Epub 2018 Oct 19.


Coronary artery calcium (CAC) is a strong predictor for future cardiovascular events. Traditionally CAC has been quantified using the Agatston score, which was developed in the late 1980s for electron beam tomography (EBT). While EBT has been completely replaced by modern multiple-detector row CT technology, the traditional CAC scoring method by Agatston remains in use, although the literature indicates suboptimal reproducibility and subjects being incorrectly classified. The traditional Agatston scoring method counteracts the technical advances of CT technology, and prevents the use of thinner sections, obtained at lower tube voltage and overall decreased radiation exposure that has become available to other CT applications. Moreover, recent studies have shown that not only the total amount of CAC, but also its density and distribution in the coronary arterial tree may be of prognostic value. Acquisition and reconstruction techniques thus need to be adapted for modern CT technology and optimized for CAC quantification. In this review we describe the technical limitations of the Agatston score followed by our suggestions for developing a new and more robust CAC quantification method.

Keywords: Agatston score; Computed tomography; Coronary artery calcium; Radiation dose.

Publication types

  • Review

MeSH terms

  • Computed Tomography Angiography*
  • Coronary Angiography / methods*
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Vessels / diagnostic imaging*
  • Humans
  • Multidetector Computed Tomography*
  • Predictive Value of Tests
  • Prognosis
  • Radiation Dosage
  • Radiation Exposure
  • Reproducibility of Results
  • Severity of Illness Index
  • Vascular Calcification / diagnostic imaging*