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Updated: Nov 11, 2025
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
An Update on Coronary Artery Calcium Interpretation at Chest and Cardiac CT
Olufunmilayo H Obisesan1, Albert D Osei1, S M Iftekhar Uddin1
1Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 733 N Broadway, Baltimore, MD 21205 (O.H.O., A.D.O., S.M.I.U., O.D., M.J.B.); American Heart Association Tobacco Regulation and Addiction Center, Dallas, Tex (O.H.O., A.D.O., S.M.I.U., M.J.B.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (O.D.).
Insights
Coronary artery calcium (CAC) scoring is vital for cardiovascular risk stratification in asymptomatic individuals. Updated guidelines emphasize CAC interpretation for preventive treatment decisions, aiding clinicians and patients.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Coronary artery calcium (CAC) quantifies atherosclerotic burden.
- CAC aids cardiovascular risk stratification in asymptomatic individuals.
- Guidelines recommend CAC testing for shared decision-making.
Purpose of the Study:
- Provide concise, updated information on CAC interpretation.
- Clarify reporting standards for gated and nongated thoracic scans.
- Highlight key elements for clinical decision-making.
Main Methods:
- Review of current clinical management guidelines and CAC testing recommendations.
- Analysis of essential CAC reporting components: Agatston score, percentiles, rescan intervals, and specific findings (e.g., left main CAC, high scores).
- Integration of risk calculators (e.g., MESA) for 10-year CHD risk assessment.
Main Results:
- Key interpretation points include Agatston score, age/sex/race-specific percentiles, and rescan recommendations for CAC=0.
- Reporting should detail the number of vessels with CAC, left main involvement, and very high scores (>1000).
- Standardized reporting systems (e.g., CAC Data and Reporting System) improve clinical utility.
Conclusions:
- Accurate CAC interpretation is crucial for preventive cardiology.
- Standardized reporting enhances the clinical value of CAC scans.
- CAC testing supports personalized cardiovascular risk management.
Abstract:
Coronary artery calcium (CAC) is a marker of overall coronary atherosclerotic burden in an individual. As such, it is an important tool in cardiovascular risk stratification and preventive treatment of asymptomatic patients with unclear cardiovascular disease risk. Several guidelines have recommended the use of CAC testing in shared decision making between the clinician and patient. With recent updates in clinical management guidelines and broad recommendations for CAC, there is a need for concise updated information on CAC interpretation on traditional electrocardiographically gated scans and nongated thoracic scans. Important points to report when interpreting CAC scans include: the absolute Agatston score and the age, sex, and race-specific CAC percentile; general recommendations on time-to-rescan for individuals with a CAC score of 0; the number of vessels with CAC; the presence of CAC in the left main coronary artery; and specific highlighting of individuals with very high CAC scores of greater than 1000. When risk factor information is available, the 10-year coronary heart disease risk can also be easily assessed using the free online Multi-Ethnic Study of Atherosclerosis risk score calculator. Recent improvements in standardizing the reporting of CAC findings across gated and nongated studies, such as the CAC Data and Reporting System, show promise for improving the widespread clinical value of CAC in clinical practice. © RSNA, 2021.
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