{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:10:48Z","timestamp":1792033848581,"version":"4.4.0"},"reference-count":30,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,4,19]],"date-time":"2024-04-19T00:00:00Z","timestamp":1713484800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Freiburg"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The goal of our study is to evaluate a method to quantify aortic valve calcification (AVC) in contrast-enhanced computed tomography for patients with suspected severe aortic stenosis pre-interventionally. Methods: A total of sixty-five patients with aortic stenosis underwent both a native and a contrast-enhanced computed tomography (CECT) scan of the aortic valve (45 in the training cohort and 20 in the validation cohort) using a standardized protocol. Aortic valve calcification was semi-automatically quantified via the Agatston score method for the native scans and was used as a reference. For contrast-enhanced computed tomography, a calcium threshold of the Hounsfield units of the aorta plus four times the standard deviation was used. Results: For the quantification of aortic valve calcification in contrast-enhanced computed tomography, a conversion formula (691 + 1.83 x AVCCECT) was derived via a linear regression model in the training cohort. The validation in the second cohort showed high agreement for this conversion formula with no significant proportional bias (Bland\u2013Altman, p = 0.055) and with an intraclass correlation coefficient in the validation cohort of 0.915 (confidence interval 95% 0.786\u20130.966) p &lt; 0.001. Conclusions: Calcium scoring in patients with aortic valve stenosis can be performed using contrast-enhanced computed tomography with high validity. Using a conversion factor led to an excellent agreement, thereby obviating an additional native computed tomography scan. This might contribute to a decrease in radiation exposure.<\/jats:p>","DOI":"10.3390\/jcm13082386","type":"journal-article","created":{"date-parts":[[2024,4,19]],"date-time":"2024-04-19T06:28:09Z","timestamp":1713508089000},"page":"2386","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Quantification of Aortic Valve Calcification in Contrast-Enhanced Computed Tomography"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3499-7932","authenticated-orcid":false,"given":"Danai","family":"Laohachewin","sequence":"first","affiliation":[{"name":"Department of Cardiology and Angiology, Medical Center\u2014University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Ruile","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Medical Center\u2014University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7390-5287","authenticated-orcid":false,"given":"Philipp","family":"Breitbart","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Medical Center\u2014University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Minners","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Medical Center\u2014University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaus","family":"Jander","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Medical Center\u2014University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Soschynski","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, Medical Center\u2014University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Stra\u00dfe 55, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1576-1481","authenticated-orcid":false,"given":"Christopher L.","family":"Schlett","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, Medical Center\u2014University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Stra\u00dfe 55, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franz-Josef","family":"Neumann","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Medical Center\u2014University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Westermann","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Medical Center\u2014University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0430-7184","authenticated-orcid":false,"given":"Manuel","family":"Hein","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Medical Center\u2014University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e007146","DOI":"10.1161\/CIRCIMAGING.117.007146","article-title":"Computed Tomography Aortic Valve Calcium Scoring in Patients with Aortic Stenosis","volume":"11","author":"Pawade","year":"2018","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1016\/j.jcmg.2019.01.045","article-title":"Why and How to Measure Aortic Valve Calcification in Patients With Aortic Stenosis","volume":"12","author":"Pawade","year":"2019","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1056\/NEJM200008313430903","article-title":"Predictors of outcome in severe, asymptomatic aortic stenosis","volume":"343","author":"Rosenhek","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.jcmg.2011.12.023","article-title":"Aortic valve calcium independently predicts coronary and cardiovascular events in a primary prevention population","volume":"5","author":"Owens","year":"2012","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1093\/ehjci\/jev343","article-title":"Calcium distribution patterns of the aortic valve as a risk factor for the need of permanent pacemaker implantation after transcatheter aortic valve implantation","volume":"17","author":"Fujita","year":"2016","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"732","DOI":"10.4244\/EIJV10I6A126","article-title":"Extent and distribution of calcification of both the aortic annulus and the left ventricular outflow tract predict aortic regurgitation after transcatheter aortic valve replacement","volume":"10","author":"Buellesfeld","year":"2014","journal-title":"EuroIntervention"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.ijcard.2016.06.145","article-title":"Prognostic value of aortic regurgitation after TAVI in patients with chronic kidney disease","volume":"221","author":"Possner","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1093\/eurheartj\/ehm543","article-title":"Inconsistencies of echocardiographic criteria for the grading of aortic valve stenosis","volume":"29","author":"Minners","year":"2008","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/0735-1097(90)90282-T","article-title":"Quantification of coronary artery calcium using ultrafast computed tomography","volume":"15","author":"Agatston","year":"1990","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1161\/01.CIR.0000135469.82545.D0","article-title":"Evaluation and clinical implications of aortic valve calcification measured by electron-beam computed tomography","volume":"110","author":"Aubry","year":"2004","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1097\/01.rli.0000208224.93467.87","article-title":"Quantification of aortic valve calcification using multislice spiral computed tomography: Comparison with atomic absorption spectroscopy","volume":"41","author":"Koos","year":"2006","journal-title":"Investig. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1016\/S0735-1097(18)32526-9","article-title":"Strong Correlation between Aortic Valve Calcification Score by Cardiac Computed Tomography and Total Valve Calcium in Patients with Severe Aortic Valve Stenosis","volume":"71","author":"Linde","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"921","DOI":"10.4244\/EIJ-D-17-00060","article-title":"Quantification of aortic valve calcification on contrast-enhanced CT of patients prior to transcatheter aortic valve implantation","volume":"13","author":"Eberhard","year":"2017","journal-title":"EuroIntervention"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jcct.2017.01.007","article-title":"Quantifying Aortic Valve Calcification using Coronary Computed Tomography Angiography","volume":"11","author":"Alqahtani","year":"2017","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1093\/ehjci\/jey195","article-title":"Fusion imaging of pre- and post-procedural computed tomography angiography in transcatheter aortic valve implantation patients: Evaluation of prosthesis position and its influence on new conduction disturbances","volume":"20","author":"Ruile","year":"2019","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S0140-6736(86)90837-8","article-title":"Statistical methods for assessing agreement between two methods of clinical measurement","volume":"1","author":"Bland","year":"1986","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1136\/hrt.2010.198853","article-title":"Measurement of aortic valve calcification using multislice computed tomography: Correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction","volume":"97","author":"Cueff","year":"2011","journal-title":"Heart"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1016\/j.jcmg.2023.02.011","article-title":"Patterns and Structure of Calcification in Aortic Stenosis: An Approach on Contrast-Enhanced CT Images","volume":"16","author":"Abdelkhalek","year":"2023","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.21037\/qims-23-778","article-title":"Regional assessment of aortic valve calcification using topographic maps in contrast-enhanced CT: In-vivo sex and severity-based differences in calcific presentation","volume":"14","author":"Abdelkhalek","year":"2024","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1007\/s00380-018-1236-z","article-title":"Predictors of permanent pacemaker implantation after transcatheter aortic valve implantation for aortic stenosis using Medtronic new generation self-expanding CoreValve Evolut R","volume":"34","author":"Kaneko","year":"2019","journal-title":"Heart Vessel."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e009570","DOI":"10.1161\/CIRCIMAGING.119.009570","article-title":"Impact of Aortomitral Continuity Calcification on Need for Permanent Pacemaker After Transcatheter Aortic Valve Replacement","volume":"12","author":"Katchi","year":"2019","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1016\/j.jcmg.2016.11.020","article-title":"A Highly Predictive Risk Model for Pacemaker Implantation After TAVR","volume":"10","author":"Maeno","year":"2017","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.ijcard.2014.10.117","article-title":"Predictors of paravalvular aortic regurgitation following self-expanding Medtronic CoreValve implantation: The role of annulus size, degree of calcification, and balloon size during pre-implantation valvuloplasty and implant depth","volume":"179","author":"Ali","year":"2015","journal-title":"Int. J. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1991","DOI":"10.1016\/j.jtcvs.2014.02.048","article-title":"High Agatston aortic valve calcium score predicts transcatheter paravalvular aortic regurgitation","volume":"147","author":"Greason","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_26","first-page":"140","article-title":"Temporal Change in Paravalvular Leakage after Transcatheter Aortic Valve Replacement with a Self-Expanding Valve: Impact of Aortic Valve Calcification","volume":"36","author":"Ko","year":"2020","journal-title":"Acta Cardiol. Sin."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.amjcard.2016.05.053","article-title":"Impact of Different Iterations of Devices and Degree of Aortic Valve Calcium on Paravalvular Regurgitation after Transcatheter Aortic Valve Implantation","volume":"118","author":"Kong","year":"2016","journal-title":"Am. J. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1148\/radiol.2016151982","article-title":"CT Angiography of the Aorta: Prospective Evaluation of Individualized Low-Volume Contrast Media Protocols","volume":"280","author":"Higashigaito","year":"2016","journal-title":"Radiology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1097\/RLI.0b013e3182266448","article-title":"Automated attenuation-based tube potential selection for thoracoabdominal computed tomography angiography: Improved dose effectiveness","volume":"46","author":"Winklehner","year":"2011","journal-title":"Invest Radiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.jcct.2023.08.010","article-title":"A systematic review of contrast-enhanced computed tomography calcium scoring methodologies and impact of aortic valve calcium burden on TAVI clinical outcomes","volume":"17","author":"Keshvara","year":"2023","journal-title":"J. Cardiovasc. Comput. Tomogr."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/8\/2386\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:30:59Z","timestamp":1760106659000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/8\/2386"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,19]]},"references-count":30,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["jcm13082386"],"URL":"https:\/\/doi.org\/10.3390\/jcm13082386","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,19]]}}}