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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

[Diagnosis of coronary artery disease - part 4: Computed tomography and coronary angiography]

M T Maeder1, M J Zellweger

  • 1Baker IDI Heart and Diabetes Institute/Heart Center, Alfred Hospital, Melbourne, Victoria, Australien. micha.maeder@bluewin.ch

Praxis
|September 24, 2009
PubMed

Insights

Computed tomography (CT) coronary angiography effectively rules out coronary artery disease but often yields false positives. Coronary artery calcium score (CACS) is useful for asymptomatic individuals but not for diagnosing symptomatic patients.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Invasive coronary angiography and CT coronary angiography visualize coronary anatomy but not inducible myocardial ischemia.
  • CT coronary angiography has a high negative predictive value for excluding coronary artery disease.
  • CT coronary angiography has a high false positive rate, especially with coronary calcification, limiting its use as an alternative to invasive angiography.

Purpose of the Study:

  • To evaluate the diagnostic utility of CT coronary angiography and coronary artery calcium score (CACS) in assessing coronary artery disease.
  • To compare the effectiveness of CT coronary angiography and CACS in symptomatic versus asymptomatic patients.

Main Methods:

  • Review of current literature on CT coronary angiography and CACS.
  • Analysis of diagnostic performance, including negative and positive predictive values.
  • Comparison of findings in symptomatic and asymptomatic patient cohorts.

Main Results:

  • CT coronary angiography is effective in excluding significant coronary artery disease due to its high negative predictive value.
  • High rates of false positive results in CT coronary angiography, particularly with significant coronary calcification, limit its clinical application.
  • A coronary artery calcium score (CACS) of zero indicates a low likelihood of significant stenosis and good prognosis in asymptomatic patients.
  • CACS is not a significant factor in the diagnostic work-up of symptomatic patients.

Conclusions:

  • CT coronary angiography is valuable for excluding coronary artery disease but less so for definitive diagnosis due to false positives.
  • Coronary artery calcium score (CACS) is a prognostic marker in asymptomatic individuals but lacks diagnostic utility in symptomatic patients.
  • Neither CT coronary angiography nor CACS fully replaces invasive coronary angiography in clinical practice for symptomatic patients.

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