European Radiology

, Volume 28, Issue 11, pp 4607–4614 | Cite as

Coronary artery calcium assessed with calibrated mass scoring in asymptomatic individuals: results from the Copenhagen General Population Study

  • Andreas D. KnudsenEmail author
  • Andreas Fuchs
  • J. Tobias Kühl
  • Ben A. Arnold
  • Børge G. Nordestgaard
  • Lars V. Køber
  • Klaus F. Kofoed



Coronary artery calcification (CAC) is commonly assessed with Agatston score (AS). A higher sensitivity and precision for the detection of CAC has been demonstrated with calibrated mass score (cMS). We hypothesized that cMS would detect low-level CAC not detectable with AS in a large asymptomatic background population.


Participants (N = 2985) from the Copenhagen General Population Study were evaluated for CAC using both conventional AS and cMS. The population was grouped according to number of traditional risk factors and heart score was used to assess the risk of event for those with no CAC, those with only cMS > 0 and those with both AS and cMS > 0.


In participants with an AS = 0, 11% had cMS > 0. The risk profile of this cMS-only group was between that of the CAC-negative participants and those with AS > 0 and cMS > 0. Overall, 6% of the population belonged to the cMS-only group independent of the number of risk factors.


In individuals with AS = 0, a fraction was found to have cMS > 0. Based on traditional risk factors, this group has a higher 10-year risk than individuals with both AS = 0 and cMS = 0; cMS might offer very early cardiovascular risk assessment in asymptomatic individuals.

Key Points

• In individuals with AS=0, a fraction has CAC with highly sensitive cMS.

• This fraction has a higher 10-year risk of cardiovascular disease.

• Regardless of risk factors, 6% has CAC detectable only with cMS.

• cMS might offer very early cardiovascular risk assessment in asymptomatic individuals.


Multidetector computed tomography Risk assessment Cardiac imaging techniques Coronary artery disease Cross-sectional studies 



Agatston score


Body mass index


Coronary artery calcification


Copenhagen General Population Study


Calibrated mass score


Computed tomography


The European Society of Cardiology


Region of interest


Systematic coronary risk evaluation


CAC-negative group

cMS = 0 and AS = 0

cMS-only group

cMS > 0 and AS = 0

AS-only group

AS > 0 and cMS = 0

(cMS+AS) group

both AS > 0 and cMS > 0



The authors wish to thank chief radiographer Kim Madsen, Department of Radiology, and his staff of radiographers and nurses working at the scanner for their enthusiastic technical and logistical support.


This study has received funding by The John and Birthe Meyer Foundation; A.P. Møller og Hustru Chastine Mc-Kinney Møllers Fond Til Almene Formaal; Pfizer Inc; The Research Fund at Rigshospitalet.

Compliance with ethical standards


The scientific guarantor of this publication is Professor Klaus F. Kofoed, MD, DMSc.

Conflict of interest

Ben Arnold is the president and owner of Image Analysis Inc. and owns the Nvivo software used to measure cMS. He was not involved with study protocol, data acquisition or analysis.

All other authors have no conflict of interest to declare.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained from the Regional Ethics Committee of Copenhagen (H-KF-01-144/01).


• Cross-sectional study

• Performed at one institution

Supplementary material

330_2018_5446_MOESM1_ESM.bmp (900 kb)
ESM 1 (BMP 900 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Andreas D. Knudsen
    • 1
    Email author
  • Andreas Fuchs
    • 1
  • J. Tobias Kühl
    • 1
  • Ben A. Arnold
    • 2
  • Børge G. Nordestgaard
    • 3
  • Lars V. Køber
    • 1
  • Klaus F. Kofoed
    • 1
    • 4
  1. 1.Department of Cardiology, The Heart CentreRigshospitaletCopenhagenDenmark
  2. 2.Image AnalysisColumbiaUSA
  3. 3.Department of Clinical Biochemistry and the Copenhagen General Population StudyHerlev Hospital, University of CopenhagenCopenhagenDenmark
  4. 4.Department of Radiology, The Diagnostic Centre, RigshospitaletUniversity of CopenhagenCopenhagenDenmark

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