The calcium volume score is referred to as a measure to quantify coronary artery calcium and is a variant to calculate coronary artery calcium 1-3.
Its calculation includes all voxels with a Hounsfield attenuation > 130 and this is done by multiplying the volume of each voxel, determined by the area and the slice thickness with the number of voxels showing calcification 1-3.
The calcium volume score has proven to be most robust and reproducible method but is more susceptible to partial volume effects and seems more prone to variability between examinations in regard to the position of the plaque in the axial slice 2. Unlike the Agatston score, the calcium volume score does not take factor calcium density into the calculation and measures merely the volume of calcified pixels 3.
It seems to be a significant and independent predictor of incidental major cardiovascular events (MACE) in symptomatic individuals within a two years period 4.
As per the American College of Cardiology Foundation/American Heart Association (ACCF/AHA), consensus paper increased amounts of coronary calcium is associated with an increased risk for major cardiovascular events (MACE) 5:
- CAC score of 1-112: low risk with a relative risk ratio of 1.9 (95 CI: 1.3-2.8)
- CAC score of 100-400: moderate risk with a relative risk ratio of 4.3 (95% CI:3.1-6.1)
- CAC score of 401-999: high risk with a relative risk ratio of 7.2 (95% CI:5.2-9.9)
- CAC score >1000: very high risk with a relative risk ratio of 10.8 (95% CI:4.2-27.7)
- 1. Neves PO, Andrade J, Monção H. Coronary artery calcium score: current status. (2017) Radiologia brasileira. 50 (3): 182-189. doi:10.1590/0100-3984.2015.0235 - Pubmed
- 2. McCollough CH, Ulzheimer S, Halliburton SS, Shanneik K, White RD, Kalender WA. Coronary artery calcium: a multi-institutional, multimanufacturer international standard for quantification at cardiac CT. (2007) Radiology. 243 (2): 527-38. doi:10.1148/radiol.2432050808 - Pubmed
- 3. Sandfort V, Bluemke DA. CT calcium scoring. History, current status and outlook. (2017) Diagnostic and interventional imaging. 98 (1): 3-10. doi:10.1016/j.diii.2016.06.007 - Pubmed
- 4. Lo-Kioeng-Shioe MS, Vavere AL, Arbab-Zadeh A, Schuijf JD, Rochitte CE, Chen MY, Rief M, Kofoed KF, Clouse ME, Scholte AJ, Miller JM, Betoko A, Blaha MJ, Cox C, Deckers JW, Lima JAC. Coronary Calcium Characteristics as Predictors of Major Adverse Cardiac Events in Symptomatic Patients: Insights From the CORE 320 Multinational Study. (2019) Journal of the American Heart Association. 8 (6): e007201. doi:10.1161/JAHA.117.007201 - Pubmed
- 5. Greenland P, Bonow RO, Brundage BH, Budoff MJ, Eisenberg MJ, Grundy SM, Lauer MS, Post WS, Raggi P, Redberg RF, Rodgers GP, Shaw LJ, Taylor AJ, Weintraub WS. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. (2007) Journal of the American College of Cardiology. 49 (3): 378-402. doi:10.1016/j.jacc.2006.10.001 - Pubmed
- 6. Wolk MJ, Bailey SR, Doherty JU, Douglas PS, Hendel RC, Kramer CM, Min JK, Patel MR, Rosenbaum L, Shaw LJ, Stainback RF, Allen JM. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. (2014) Journal of the American College of Cardiology. 63 (4): 380-406. doi:10.1016/j.jacc.2013.11.009 - Pubmed