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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
04:40

Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans

Published on: August 28, 2018

Diagnostic value of cardiac 64-slice computed tomography: importance of coronary calcium

Axel C P Diederichsen1, Henrik Petersen, Lisette O Jensen

  • 1Department of Cardiology, Odense University Hospital, Denmark. a.diederichsen@dadlnet.dk

Scandinavian Cardiovascular Journal : SCJ
|March 7, 2009
PubMed

Insights

Coronary computed tomography angiography (CTA) is reliable for assessing coronary artery disease when the Agatston calcium score is 400 or less. Above this threshold, CTA accuracy decreases, suggesting alternative diagnostic methods are needed.

Area of Science:

  • Cardiovascular imaging
  • Radiology
  • Non-invasive diagnostics

Background:

  • Coronary computed tomography angiography (CTA) is a valuable tool for evaluating coronary artery disease.
  • Significant coronary calcification can compromise the diagnostic accuracy of CTA.
  • Defining a threshold for coronary calcium is crucial for determining CTA's reliability.

Purpose of the Study:

  • To identify a specific coronary calcium score threshold above which CTA's diagnostic value diminishes.
  • To compare the diagnostic performance of CTA with coronary angiography (CA) across varying levels of coronary calcification.

Main Methods:

  • Prospective study of 109 patients undergoing elective coronary angiography (CA).
  • Coronary calcium quantified using Agatston units (AU) via 64-slice CT scanner.
  • CTA diagnostic values calculated against quantitative CA for significant stenosis (>50% luminal reduction).

Main Results:

  • In patients without stents and a calcium score ≤400 AU, CTA demonstrated high diagnostic accuracy (sensitivity 100%, specificity 91%).
  • In patients with a calcium score >400 AU, CTA specificity significantly dropped to 17%, while sensitivity remained 100%.
  • A strong association between stent presence and coronary calcium severity was observed.

Conclusions:

  • CTA provides excellent diagnostic accuracy for coronary artery disease in patients with minimal or no coronary calcification (Agatston score ≤400 AU).
  • For patients with an Agatston score >400 AU, CTA's specificity declines markedly.
  • Patients with high coronary calcium scores (>400 AU) should be referred directly for coronary angiography (CA) rather than CTA.
Abstract

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