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Updated: Sep 20, 2025

Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
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Discrepancy Between Optical Coherence Tomography-Based and Intravascular Ultrasound-Based Calcium Scoring for Heavily

Wataru Sasaki1, Masaru Ishida1, Yuya Taguchi1,2

  • 1Division of Cardiology, Department of Internal Medicine, Iwate Medical University.

Circulation Journal : Official Journal of the Japanese Circulation Society
|May 28, 2025
PubMed

Insights

Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) yield different calcium scores for heavily calcified coronary lesions. This discrepancy may impact treatment decisions, including the use of intravascular lithotripsy (IVL).

Area of Science:

  • Interventional Cardiology
  • Medical Imaging

Background:

  • Intravascular lithotripsy (IVL) is indicated for severe coronary calcification, typically defined by optical coherence tomography (OCT) or intravascular ultrasound (IVUS) calcium scores of 3 or 4.
  • Accurate calcium scoring is crucial for guiding treatment strategies in complex coronary lesions.

Purpose of the Study:

  • To compare calcium scores derived from OCT and IVUS in heavily calcified coronary lesions.
  • To assess the potential impact of score discrepancies on treatment decisions, particularly for IVL.

Main Methods:

  • Retrospective analysis of 52 heavily calcified coronary lesions requiring plaque modification.
  • Simultaneous assessment of calcium scores using both OCT and IVUS imaging modalities.

Main Results:

  • A significant difference was observed between OCT- and IVUS-based calcium scores (mean OCT: 3.96 vs. mean IVUS: 2.15, P<0.001).
  • The mean OCT score was substantially higher than the mean IVUS score, indicating a potential overestimation of calcification severity by IVUS or underestimation by OCT in this cohort.

Conclusions:

  • There is a significant discrepancy in calcium scoring between OCT and IVUS for heavily calcified coronary lesions.
  • These findings highlight the need to consider the imaging modality when interpreting calcium scores and may influence the selection and utilization of therapies like IVL.
Abstract

Keywords:
Coronary calciumIntravascular ultrasoundOptical coherence tomography

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