{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:53:20Z","timestamp":1791813200904,"version":"4.3.4"},"reference-count":28,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T00:00:00Z","timestamp":1763769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Institute of Information and Communications Technology Planning and Evaluation","award":["RS-2021-II212068"],"award-info":[{"award-number":["RS-2021-II212068"]}]},{"name":"Ministry of Education and National Research Foundation of Korea","award":["GLOCAL-202406260001"],"award-info":[{"award-number":["GLOCAL-202406260001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Visual assessment of coronary artery calcium (CAC) on ungated chest CT has been described previously. However, its reliability and clinical utility remain uncertain, particularly in PET\/CT studies that use low-dose, low-slice CT and are susceptible to respiratory artifacts. Methods: We retrospectively analyzed 106 patients (median age, 66 years [interquartile range, 60\u201375 years]; 67 men [63.2%]) who underwent PET\/CT and electrocardiogram (ECG)-gated chest CT within a 90-day interval. Six readers (three radiologists and three nuclear medicine physicians) independently assessed CAC on PET\/CT using a standard four-point visual scale and a 0\u201312 ordinal scale based solely on written instructions. Agatston scoring was also performed. Interobserver agreement and concordance with ECG-gated chest CT Agatston score categories were calculated. Major adverse cardiovascular events (MACE) were recorded over a median follow-up of 3.5 years. Results: Interobserver agreement was good for both the standard visual (\u03ba = 0.761) and ordinal (\u03ba = 0.779) scales. Concordance with ECG-gated CT Agatston categories was higher for standard visual (\u03ba = 0.849) and ordinal (\u03ba = 0.750) scoring than for PET\/CT Agatston categories (\u03ba = 0.464). Both qualitative scales tended to underestimate CAC categories compared with ECG-gated CT; however, severe CAC on PET\/CT predicted MACE (hazard ratios: 4.41 standard visual; 6.59 ordinal), and the ordinal scale significantly stratified MACE-free survival (p = 0.047). Conclusions: Standard visual and ordinal CAC scoring on the ungated CT portion of PET\/CT is quick, reproducible, closely mirrors ECG-gated-CT Agatston grading, and offers prognostic value for future MACE in cancer patients.<\/jats:p>","DOI":"10.3390\/diagnostics15232969","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T10:24:17Z","timestamp":1763979857000},"page":"2969","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Standard Visual and Ordinal Coronary Calcium Scoring on PET\/CT: Agreement with Agatston Scoring and Prognostic Implications"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6763-0674","authenticated-orcid":false,"given":"Sehyun","family":"Pak","sequence":"first","affiliation":[{"name":"Department of Medicine, Hallym University College of Medicine, Chuncheon 24252, Gangwon, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye Joo","family":"Son","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Dankook University Medical Center, Cheonan 31116, Chungnam, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongwoo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si 14068, Gyeonggi, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung Won","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoo Na","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6200-0159","authenticated-orcid":false,"given":"Ji Young","family":"Woo","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Kyung","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2839-6524","authenticated-orcid":false,"given":"Dong-Ok","family":"Won","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hallym University College of Medicine, Chuncheon 24252, Gangwon, Republic of Korea"},{"name":"Department of Artificial Intelligence Convergence, Hallym University, Chuncheon 24252, Gangwon, Republic of Korea"},{"name":"Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4580-3918","authenticated-orcid":false,"given":"Suk Hyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jacc.2022.04.042","article-title":"Cardiovascular Disease Risk Among Cancer Survivors: The Atherosclerosis Risk in Communities (ARIC) Study","volume":"80","author":"Florido","year":"2022","journal-title":"J. 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