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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Identification of unexpected nonatherosclerotic cardiovascular disease with coronary CT angiography
Thomas Knickelbine1, John R Lesser, Tammy S Haas
1Cardiovascular Services, Minneapolis Heart Institute, Minneapolis, Minnesota 55407, USA.
Insights
Multidetector computed tomography (MDCT) angiography frequently identifies nonatherosclerotic cardiovascular diseases in patients suspected of coronary artery disease (CAD). About 1% of patients had unsuspected, clinically relevant conditions, prompting new management strategies in nearly a third of those cases.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Multidetector computed tomography (MDCT) angiography is primarily used to diagnose coronary artery disease (CAD).
- This imaging modality has the potential to reveal other significant cardiovascular abnormalities during routine scans.
- Identifying these incidental findings is crucial for comprehensive patient care.
Purpose of the Study:
- To evaluate the frequency and effectiveness of identifying nonatherosclerotic cardiovascular diseases using MDCT angiography.
- To assess the clinical relevance and impact on management of these unexpected findings in a general cardiology cohort.
Main Methods:
- A consecutive series of 4,543 patients underwent 64-slice MDCT angiography between 2005 and 2007.
- Patients were screened for suspected obstructive coronary artery disease (CAD).
- All scans were analyzed for nonatherosclerotic cardiovascular abnormalities.
Main Results:
- Nonatherosclerotic cardiovascular abnormalities of potential clinical relevance were found in 201 patients (4.4%).
- Of these, 50 patients (1.1%) had previously unrecognized conditions, including congenital coronary anomalies, aortic aneurysms, hypertrophic cardiomyopathy, and valvular heart disease.
- New management strategies were initiated in 30% of these 50 patients based on MDCT findings.
Conclusions:
- MDCT angiography is valuable for detecting unsuspected, clinically relevant cardiovascular abnormalities beyond CAD.
- Approximately 1% of patients undergoing MDCT for CAD suspicion have significant, unrelated conditions.
- Careful review of MDCT scans is essential for recognizing diverse cardiovascular diseases and guiding patient therapy.
Objectives:
The aim of this study was to assess, in a general cardiology cohort screened for obstructive coronary artery disease (CAD), the effectiveness and frequency with which multidetector computed tomography (MDCT) angiography unexpectedly imaged and identified other nonatherosclerotic cardiovascular diseases.
Background:
MDCT angiography is a novel imaging strategy employed primarily to diagnose CAD that, in the course of these studies, can also potentially identify other important but previously unrecognized cardiovascular abnormalities.
Methods:
Consecutive 64-slice MDCT angiography studies were obtained in 4,543 patients with suspected atherosclerotic CAD at the Minneapolis Heart Institute, over a 29-month period (2005 to 2007).
Results:
Nonatherosclerotic-related cardiovascular abnormalities judged to be of potential clinical relevance were identified in 201 patients (4.4%). In 50 of these patients (1.1% of 4,543) the abnormality was previously unrecognized despite other imaging studies performed in 40%. Most common among the 50 patients were: congenital coronary artery anomalies (38%; largely right coronary artery from the left aortic sinus); ascending aortic aneurysms > or = 45 mm (22%); hypertrophic cardiomyopathy with apical left ventricular (LV) wall thickening (14%); valvular heart diseases (8%), congenital heart diseases, including ventricular septal defect (6%); pulmonary embolus (6%); as well as LV noncompaction, left atrial myxoma, and LV apical aneurysm (2% each). As a consequence of MDCT angiography findings, new management strategies were instituted in 15 of 50 patients (30%), including surgical correction of coronary artery anomalies of wrong sinus origin, ascending aneurysm graft repair, thrombolytic therapy for pulmonary embolism, and myxoma resection.
Conclusions:
Approximately 1% of patients undergoing MDCT angiography for suspicion of CAD proved to have otherwise unsuspected, but clinically relevant, cardiovascular abnormalities unrelated to coronary atherosclerosis. Almost one-third of these patients had cardiovascular diseases with major clinical implications for subsequent therapy. These findings underscore the value of MDCT angiography and the importance of careful assessment of scans for the recognition of a variety of cardiovascular abnormalities.
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