Cardiovascular magnetic resonance for the detection of descending thoracic aorta calcification in patients with end-stage renal disease

Edy, E. et al. (2021) Cardiovascular magnetic resonance for the detection of descending thoracic aorta calcification in patients with end-stage renal disease. Journal of Cardiovascular Magnetic Resonance, 23(1), 85. (doi: 10.1186/s12968-021-00769-6) (PMID:34162405) (PMCID:PMC8223384)

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Abstract

Background: Vascular calcification is an independent predictor of cardiovascular disease in patients with chronic kidney disease. Computed tomography (CT) is the gold-standard for detecting vascular calcification. Radial volumetric-interpolated breath-hold examination (radial-VIBE), a free-breathing gradient-echo cardiovascular magnetic resonance (CMR) sequence, has advantages over CT as it is ionising radiation-free. However, its capability in detecting thoracic aortic calcification (TAC) has not been investigated. This study aims to compare radial-VIBE to CT for the detection of TAC in the descending aorta of patients with end-stage renal disease (ESRD) using semi-automated methods, and to investigate the association between TAC and coronary artery calcification (CAC). Methods: Paired cardiac CT and radial-VIBE CMR scans from ESRD patients participating in 2 prospective studies were obtained. Calcification volume was quantified using semi-automated methods in a 9 cm segment of the thoracic aorta. Correlation and agreement between TAC volume measured on CMR and CT were assessed with Spearman’s correlation coefficient (ρ), linear regression, Bland–Altman plots and intraclass correlation coefficient (ICC). Association between CAC Agatston score and TAC volume determined by CT and CMR was measured with Spearman’s correlation coefficient. Results: Scans from 96 participants were analysed. Positive correlation was found between CMR and CT calcification volume [ρ = 0.61, 95% confidence interval (CI) 0.45–0.73]. ICC for consistency was 0.537 (95% CI 0.378–0.665). Bland–Altman plot revealed that compared to CT, CMR volumes were systematically higher at low calcification volume, and lower at high calcification volume. CT did not detect calcification in 41.7% of participants, while radial-VIBE CMR detected signal which the semi-quantitative algorithm reported as calcification in all of those individuals. Instances of suboptimal radial-VIBE CMR image quality were deemed to be the major contributors to the discrepancy. Correlations between CAC Agatston score and TAC volume measured by CT and CMR were ρ = 0.404 (95% CI 0.214–0.565) and ρ = 0.211 (95% CI 0.008–0.396), respectively. Conclusion: Radial-VIBE CMR can detect TAC with strong positive association to CT, albeit with the presence of proportional bias. Quantification of vascular calcification by radial-VIBE remains a promising area for future research, but improvements in image quality are necessary.

Item Type:Articles
Additional Information:Dr Alastair Rankin is personally funded by a Clinical Academic Training Fellowship from The Chief Scientist Office (Scotland) (CAF/18/02). Dr Jennifer Lees was personally funded by a Kidney Research UK Training Fellowship (TF_013_20161125) for the ViKTORIES study and was supported by a British Heart Foundation Centre of Excellence Award (RE/13/5/30177) and Chief Scientist Office (Scotland) Lectureship (PCL/20/10).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Rankin, Dr Alastair and Mark, Professor Patrick and Stoumpos, Dr Sokratis and Woodward, Miss Rosemary and Lees, Jennifer and Radjenovic, Dr Aleksandra and Hall Barrientos, Dr Pauline
Authors: Edy, E., Rankin, A. J., Lees, J. S., Hall Barrientos, P., Woodward, R., Stoumpos, S., Koktzoglou, I., Edelman, R. R., Radjenovic, A., Mark, P. B., and Roditi, G. H.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of Cardiovascular Magnetic Resonance
Publisher:BioMed Central
ISSN:1097-6647
ISSN (Online):1532-429X
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Journal of Cardiovascular Magnetic Resonance 23(1):85
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303352INTERROGATION OF THE CARDIOMYOPATHY OF CHRONIC KIDNEY DISEASE WITH ADVANCED CARDIAC IMAGINGAlastair RankinOffice of the Chief Scientific Adviser (CSO)CAF/18/02CAMS - Cardiovascular Science
300923Vitamin K in Transplanted Kidney Organ Recipients: Investigating vEssel Stiffness (ViKTORIES)Jennifer LeesKidney Research UK (KIDNEYRE)TF_013_20161125CAMS - Cardiovascular Science
190814BHF centre of excellenceRhian TouyzBritish Heart Foundation (BHF)RE/13/5/30177Institute of Cardiovascular & Medical Sciences