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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Discrepancies between Coronary Artery Calcium Score and Coronary Artery Disease Severity in Computed Tomography
Paweł Gać1,2, Arkadiusz Jaworski1, Agnieszka Parfianowicz1
1Centre for Diagnostic Imaging, 4th Military Hospital, 50-981 Wroclaw, Poland.
Insights
The coronary artery calcium score (CACS) is useful for population risk assessment of coronary artery disease (CAD). However, for individual patient evaluation, a comprehensive coronary computed tomography angiography (CCTA) assessment is crucial for determining CAD severity.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Coronary artery calcium score (CACS) and coronary computed tomography angiography (CCTA) are used to assess coronary artery disease (CAD).
- CACS quantifies calcified plaque, while CCTA provides detailed anatomical and plaque information.
Purpose of the Study:
- To compare the utility of CACS versus comprehensive CCTA assessment in evaluating CAD.
- To highlight the discrepancies between population risk stratification by CACS and individual disease severity by CCTA.
Main Methods:
- Analysis of two CCTA cases illustrating different scenarios.
- Case 1: Patient with CACS of 0 but significant non-calcified stenosis in the left descending artery (LAD).
- Case 2: Patient with high CACS but non-significant stenosis, featuring calcified and mixed plaques in multiple coronary arteries.
Main Results:
- A CACS of 0 does not exclude significant non-calcified coronary artery stenosis.
- A high CACS can be associated with non-significant stenosis, with numerous calcified and mixed plaques.
- CCTA imaging revealed significant stenosis (70%) in LAD with CACS=0, and non-significant stenosis (<50%) in LAD, LCx, and RCA with high CACS (622.7).
Conclusions:
- CACS is valuable for population-based risk assessment of significant CAD.
- Comprehensive assessment of CAD severity using the angiographic phase of CCTA is essential for individual patient management.
- CCTA offers a more detailed evaluation of coronary artery stenosis than CACS alone.
Abstract:
The aim of this paper is to demonstrate the difference in usefulness of the coronary artery calcium score (CACS) and the full assessment of the severity of coronary artery disease in coronary computed tomography angiography (CCTA) studies. The difference between the population risk of coronary artery disease (CAD) assessed by the CACS and the severity of CAD was demonstrated in images from two CCTA studies. The first image is from a patient with a CACS of 0 and significant coronary artery stenosis. In the native phase of CCTA examination, no calcified changes were detected in the topography of the coronary arteries. In the middle section of the left descending artery (LAD), at the level of the second diagonal branch (Dg2), a large non-calcified atherosclerotic plaque was visible. Mid-LAD stenosis was estimated to be approximately 70%. The second image features a patient with a high CACS but no significant coronary artery stenosis. The calcium score of individual coronary arteries calculated using the Agatston method was as follows: left main (LM) 0, LAD 403, left circumflex (LCx) 207.7, right coronary artery (RCA) 12. CACS was 622.7, representing a significant population risk of significant CAD. In the proximal and middle sections of the LAD, numerous calcified and mixed atherosclerotic plaques with positive remodeling were visible, causing stenosis of 25-50%. Similarly, in the proximal and middle sections of the LCx, numerous calcified and mixed atherosclerotic plaques with positive remodeling were visualized, causing stenoses of 25-50%. Calcified atherosclerotic plaques were found in the RCA, causing stenosis <25%. The entire CCTA image met CAD-RADS 2 (coronary artery disease reporting and data system) criteria. In summary, CACS may be applicable in population-based studies to assess the risk of significant CAD. In the evaluation of individual patients, a comprehensive assessment of CAD severity based on the angiographic phase of the CCTA examination should be used.
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