Comparison of Agatston Score Calculation Between the Syngo.Via Automated Method and the Manual Method in Non-Contrast Cardiac CT

Authors

  • Agil Abdul Muaziz Universitas Muhammadiyah Purwokerto, Indonesia
  • Hernastiti Sedya Utami Universitas Muhammadiyah Purwokerto, Indonesia
  • Pradana Nur Oviyanti Universitas Muhammadiyah Purwokerto, Indonesia
  • Supriyadi Supriyadi Universitas Muhammadiyah Purwokerto, Indonesia
  • Fathur Rahman Nugraha Universitas Muhammadiyah Purwokerto, Indonesia

DOI:

https://doi.org/10.46799/jhs.v7i4.2826

Keywords:

agatston score, coronary arterial calcium, cardiac ct, syngo.via, measurement deal

Abstract

In clinical practice, the Agatston Score can be calculated manually or automatically using post-processing software such as Syngo.Via; However, the difference in absolute values between these methods can affect clinical interpretation. The study aimed to compare measurements of the Agatston Score obtained using the Syngo.Via automated method and manual calculations on non-contrast cardiac CT, with an emphasis on measurement differences, suitability, and reliability. A quantitative observational analytical study was conducted using retrospective no-contrast cardiac CT data from 20 subjects. The Agatston score is calculated automatically using Syngo.Via and manually using the Weasis software on the same image dataset. The difference in measurement was analyzed descriptively and tested for normality. Statistical differences were evaluated using the Wilcoxon Signed Rank Test, suitability was evaluated using Bland–Altman analysis, and reliability was evaluated using the Intraclass Correlation Coefficient (ICC) with a two-way mixed effect model and absolute suitability. Results showed that a difference between the method was not normally distributed and a statistically significant difference in the Agatston score was observed (p < 0.05). The Bland–Altman analysis showed that most of the differences were distributed around the zero line with a few outliers, while the ICC analysis revealed a very high reliability between the two methods (ICC = 1,000). In conclusion, the automatic and manual measurement of the Agatston Score showed excellent reliability and good agreement despite the statistically significant differences in absolute values, suggesting that the two methods could be compared.

References

Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Das, S. R.Delling, F. N., Djousse, L., Elkind, M. S. V., Ferguson, J. F., Fornage, M., Jordan, L. C., Khan, S. S., Kissela, B. M., & Knutson, K. L. (2019). American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics—2019 Update: A Report from the American Heart Association. Circulation, 139(10), E56–E528. https://doi.org/https://doi.org/10.1161/CIR.0000000000000659

Blaha, M. J., Cainzos-Achirica, M., Greenland, P., McEvoy, J. W., Nasir, K., Blumenthal, R. S., &, & Agatston, A. (2017). Role of coronary artery calcium score of zero in cardiovascular risk assessment in asymptomatic individuals. https://doi.org/https://doi.org/10.1161/CIRCULATIONAHA.116.027194

Budoff, M. J., Young, R., Lopez, V. A., Kronmal, R. A., Nasir, K., Blaha, M. J., & Miedema, M. D. (2018). Progression of coronary calcium and incident coronary heart disease events: The Multi-Ethnic Study of Atherosclerosis. https://doi.org/. https://doi.org/10.1016/j.jacc.2017.12.047

Chamberlin, J. H., Abrol, S., Munford, J., O’Doherty, J., Baruah, D., Schoepf, U. J., Burt, J. R., &, & Kabakus, I. M. (2025). Artificial intelligence-derived coronary artery calcium scoring saves time and achieves close to radiologist-level accuracy on routine ECG-gated CT. International Journal of Cardiovascular Imaging, 41(2), 269–278. https://doi.org/. https://doi.org/10.1007/s10554-024-03306-5

Czaja-Ziółkowska, M. Z., Wasilewski, J., Gąsior, M., &, & Głowacki, J. (2022). An update on the coronary calcium score: A review for clinicians. https://doi.org/https://doi.org/10.5114/aic.2022.121035

Enys, E. S. (2014). Evaluasi skor kalsium berdasarkan pemeriksaan CT cardiac non kontras pada pasien penyakit ginjal kronik hemodialisis (PGK-HD) [Tesis]. https://doi.org/https://repository.unhas.ac.id/25238/1/--enys-5158-1-14-dr.e-s.pdf

Healthineers, S. (2021). syngo.via - CT Calcium Scoring. https://doi.org/. https://academy.siemens-healthineers.com/_/en-us/syngo-via-ct-calcium-scoring/

Hecht, H. S. (2018). Coronary artery calcium testing for cardiovascular risk assessment: JACC focus seminar. Journal of the American College of Cardiology, 72(4), 429–440. https://doi.org/https://doi.org/10.1016/j.jacc.2018.05.018

Kang, D., Han, D., Lee, J., Kim, J., Kim, Y., &, & Cho, Y. (2022). Deep learning-based automated coronary calcium scoring in non-contrast chest CT: A validation study. Korean Journal of Radiology, 23(6), 612–621. https://doi.org/https://doi.org/10.3348/kjr.2022.0234

Koo, T. K., & Li, M. Y. (2016). A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of Chiropractic Medicine, 15(2), 155–163. https://doi.org/https://doi.org/10.1016/j.jcm.2016.02.012

Lessmann, N., van Ginneken, B., Ward, R. C., de Jong, P. A., &, & Isgum, I. (2018). Automatic coronary calcium scoring in low-dose chest CT using deep learning with dilated convolutional neural networks. Medical Image Analysis, 49, 237–248. https://doi.org/https://doi.org/10.1016/j.media.2018.07.007

Mori, H., Torii, S., Kutyna, M., Sakamoto, A., Finn, A. V., &, & Virmani, R. (2018). Coronary artery calcification: Its biological origin and clinical significance. JACC: Cardiovascular Imaging, 11(8), 1166–1178. https://doi.org/https://doi.org/10.1016/j.jcmg.2018.05.012

Patel, J., Sweigart, B., Lu, J., Pencina, K. M., Nwabuo, C., Ogunmoroti, O., Talaei-Khoei, M., Ndumele, C. E., &, & Blaha, M. J. (2021). Association of risk-enhancing factors with incident atherosclerotic cardiovascular disease by coronary artery calcium score. JAMA Cardiology, 7(2), 150–158. https://doi.org/https://doi.org/10.1001/jamacardio.2021.4309

Santoso, A. H. (2021). Distribusi skor kalsium arteri koroner berdasarkan usia dan jenis kelamin. Damianus Journal. https://doi.org/. https://ejournal.atmajaya.ac.id/index.php/damianus/article/download/2212/1202/7784

Shreya, D., Zamora, D. I., Patel, G. S., Grossmann, I., Rodriguez, K., Soni, M., ... &, & Sange, I. (2021). Coronary Artery Calcium Score - A Reliable Indicator of Coronary Artery Disease?. Cureus, 13(12), E20149. https://doi.org/https://doi.org/10.7759/cureus.20149

van Velzen, J. E., Witkowska, A. J., de Graaf, M. A., Bax, J. J., Jukema, J. W., Schuijf, J. D., & & Delgado, V. (2017). Impact of coronary calcium score on diagnostic accuracy of CT angiography beyond high-risk plaque morphology. JACC: Cardiovascular Imaging, 10(7), 784–793. https://doi.org/https://doi.org/10.1016/j.jcmg.2016.04.008

Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Das, S. R., Delling, F. N., Djousse, L., Elkind, M. S. V., Ferguson, J. F., Fornage, M., Khan, S. S., Kissela, B. M., Knutson, K. L., & Lackland, D. T. (2020). American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Circulation, 141(9), E139–E596. https://doi.org/https://doi.org/10.1161/CIR.0000000000000757

Wicaksono, S. H. (2024). Coronary atherosclerotic calcification. Medicinus, 37(3), 21. https://doi.org/https://medicinus.co/journal/article/view/medicinus-vol37-no3-6-21

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Published

2026-04-30

Issue

Vol. 7 No. 4 (2026): Journal Health Sains

Section

Articles

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Copyright (c) 2026 Agil Abdul Muaziz, Hernastiti Sedya Utami, Pradana Nur Oviyanti, Supriyadi Supriyadi, Fathur Rahman Nugraha

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