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Updated: Jun 26, 2025
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary calcifications as assessed on routine non-gated chest CT; a gatekeeper to tailor downstream additional
Roos A Groen1, Paul R M van Dijkman1, J Wouter Jukema1,2
1Leiden University Medical Center, Department of Cardiology, The Netherlands.
Insights
Coronary artery calcium (CAC) scoring on non-gated CT scans can accurately rule out obstructive coronary artery disease (CAD) in symptomatic patients. This method serves as a radiation-free tool to guide further cardiac imaging decisions.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Current coronary artery disease (CAD) risk assessment methods may overestimate obstructive CAD risk.
- Coronary artery calcium (CAC) assessment can improve risk stratification.
- Non-gated computed tomography (CT) scans, often performed for other reasons, can be utilized for CAC assessment.
Purpose of the Study:
- To investigate the clinical utility of CAC assessment on non-gated CT for risk assessment of obstructive CAD in symptomatic patients.
- To determine if CAC scoring on existing non-gated CT scans can reliably identify patients without obstructive CAD.
Main Methods:
- Patients referred for coronary computed tomography angiography (CCTA) with prior non-gated chest CT were included.
- CAC was assessed on non-gated CT and scored ordinally.
- Obstructive CAD (≥70% stenosis) was assessed via CCTA and compared across CAC severity groups.
Main Results:
- A total of 170 patients (32-88 years, 35% male) were analyzed.
- Significant differences in obstructive CAD prevalence were found between CAC groups (p < 0.01).
- A CAC score of 0 definitively ruled out obstructive CAD (100% certainty). Mild CAC also ruled out obstructive CAD in low-intermediate risk patients with non-anginal complaints (100% certainty).
Conclusions:
- CAC assessment on non-gated CT is a valuable tool for ruling out obstructive CAD.
- This approach can act as a radiation-free and cost-free gatekeeper for further cardiac imaging.
- Utilizing existing non-gated CT for CAC scoring can optimize patient management for stable chest pain.
Background And Aims:
Currently applied methods for risk-assessment in coronary artery disease (CAD) often overestimate patients' risk for obstructive CAD. To enhance risk estimation, assessment of coronary artery calcium (CAC) can be applied. In 10 % of patients presenting with stable chest pain a previous non-gated computed tomography (CT) has been performed, suitable for CAC-assessment. This study is the first to investigate the clinical utility of CAC-assessment on non-gated CT for risk-assessment of obstructive CAD in symptomatic patients.
Methods:
For this analysis, all patients referred for coronary computed tomography angiography (CCTA), in whom a previous non-gated chest CT was performed were included. The extent of CAC was assessed on chest CT and ordinally scored. CAD was assessed on CCTA and obstructive CAD defined as stenosis of ≥70 %. Patients were stratified according to CAC-severity and percentages of patients with obstructive CAD were compared between the CAC groups.
Results:
In total, 170 patients of 32-88 years were included and 35 % were male. The percentage of obstructive CAD between the CAC groups differed significantly (p < 0.01). A calcium score of 0 ruled out obstructive CAD irrespective of sex, pre-test probability, type of complaints and number of risk factors with a 100 % certainty. Furthermore, a mild CAC score ruled out obstructive CAD in patients with low - intermediate PTP or non-anginal complaints with 100 % certainty.
Conclusion:
When available, CAC on non-gated chest CT can accurately rule out obstructive CAD and can therefore function as a radiation-free and cost-free gatekeeper for additional imaging in patients presenting with stable chest pain.
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