Advanced imaging modalities provide new insights into coronary artery calcification

Coronary calcification plays a major role as a key surrogate measure of plaque burden, providing powerful risk stratification and influencing preventive therapy. Depending on its location and density, microcalcifications may directly result in plaque rupture and adverse clinical events. Although macroscopic calcifications are frequently linked to advanced and stable plaques, the fact that a small number of thrombotic events are caused by plaques that possess a substantial amount of calcification should not be overlooked. Early and accurate assessment of calcium content in atherosclerotic plaques potentially enhances the identification of high-risk patients requiring preventive treatments. Non-invasive imaging allows for the visualization, detection, and quantification of calcific lesions, whereas intravascular imaging has the unique advantage of providing real-time and accurate information during calcium modification interventions. Simultaneously, emerging molecular imaging modalities aid in the investigation of calcification activity. This review summarizes advanced techniques for coronary artery calcification imaging, including their merits and limitations, in addition to their potential applications in both experimental and clinical settings.