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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
[Comparison between coronary angiography with multislice computed tomography and by cardiac catheterisation for
Birna Jónsdóttir1, Ragnar Danielsen
1Röntgen Domus, Domus Medica, 101 Reykjavík, Iceland. birna@rd.is
Insights
Multislice computed tomography (MSCT) shows good agreement with invasive coronary angiography for detecting significant stenosis in coronary arteries over 2.0 mm. However, coronary calcification in older individuals reduces MSCT accuracy, making it more suitable for younger patients.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Atherosclerotic lesions and stenosis are key indicators of coronary artery disease.
- Invasive coronary angiography and multislice computed tomography (MSCT) are diagnostic modalities for evaluating coronary arteries.
Purpose of the Study:
- To compare the diagnostic utility and reliability of MSCT versus cardiac catheterization in assessing atherosclerotic lesions and stenosis.
- To evaluate the accuracy of MSCT in identifying significant coronary artery stenosis.
Main Methods:
- Retrospective analysis of 44 subjects who underwent both MSCT and invasive coronary angiography within one year.
- Segmental analysis of coronary angiograms to grade atherosclerotic severity.
- Assessment of coronary calcification frequency using MSCT in 150 subjects.
Main Results:
- MSCT correctly identified 83% of significant stenoses (> or = 50%) in vessel segments over 2.0 mm diameter.
- MSCT overestimated significant stenosis in four cases.
- Coronary calcification frequency on MSCT increased with age, reaching 96% in males and 71% in females aged 60+.
Conclusions:
- MSCT demonstrates good agreement with invasive coronary angiography for significant stenosis in coronary segments >2.0 mm.
- Age-related coronary calcification can decrease MSCT accuracy, particularly in older populations.
- MSCT is most valuable in younger patients to potentially avoid unnecessary cardiac catheterization.
Aim Of Study:
To compare the utility and reliability of coronary angiography with multislice computed tomography (MSCT) and by cardiac catheterisation in assessing atherosclerotic lesions and stenosis.
Material And Methods:
Data were assessed from 44 subjects (25 men, 19 women) (mean age 63 years; range 34-80 years) referred to MSCT who also had undergone invasive coronary angiography within a time frame of one year. Coronary angiograms from both studies were assessed by segmental analysis and the atherosclerotic severity graded. The frequency of coronary calcification on MSCT was separately assessed in 150 subjects.
Results:
By retrospective evaluation, 29 segments were found to have significant stenosis (> or = 50%) on the invasive coronary angiogram. Of these 17 had a diameter over 2.0 mm and 14 (83%) thereof were correctly diagnosed by MSCT. On the other hand, MSCT assessed four stenosis to be significant that were not judged so on the invasive angiogram. On MSCT, the frequency of coronary calcifications increased with age and in those 60 years and older it was 96% in males and 71% in females (p=0.025).
Conclusion:
Good agreement was found between MSCT and invasive coronary angiography in assessing significant stenosis in vessel segments over 2.0 mm. In older subjects coronary calcification on MSCT is frequent and diminishes its accuracy. MSCT seems most useful in relatively young subjects in whom the coronary arteries need to be evaluated to avoid unnecessary cardiac catheterisation.
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