Quantification of coronary artery calcium using ultrafast computed tomography

Mount Sinai Medical Center, Miami Beach, Florida 33140.

Ultrafast computed tomography was used to detect and quantify coronary artery calcium levels in 584 subjects (mean age 48 +/- 10 years) with (n = 109) and without (n = 475) clinical coronary artery disease. Fifty patients who underwent fluoroscopy and ultrafast computed tomography were also evaluated. Twenty contiguous 3 mm slices were obtained of the proximal coronary arteries. Total calcium scores were calculated based on the number, areas and peak Hounsfield computed tomographic numbers of the calcific lesions detected. In 88 subjects scored by two readers independently, interobserver agreement was excellent with identical total scores obtained in 70. Ultrafast computed tomography was more sensitive than fluoroscopy, detecting coronary calcium in 90% versus 52% of patients. There were significant differences (p less than 0.0001) in mean total calcium scores for those with versus those without clinical coronary artery disease by decade: 5 versus 132, age 30 to 39 years; 27 versus 291, age 40 to 49 years; 83 versus 462, age 50 to 59 years; and 187 versus 786, age 60 to 69 years. Sensitivity, specificity and predictive values for clinical coronary artery disease were calculated for several total calcium scores in each decade. For age groups 40 to 49 and 50 to 59 years, a total score of 50 resulted in a sensitivity of 71% and 74% and a specificity of 91% and 70%, respectively. For age group 60 to 69 years, a total score of 300 gave a sensitivity of 74% and a specificity of 81%. The negative predictive value of a 0 score was 98%, 94% and 100% for age groups 40 to 49, 50 to 59 and 60 to 69 years, respectively. Ultrafast computed tomography is an excellent tool for detecting and quantifying coronary artery calcium.

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				N. Matsuura, J. Horiguchi, H. Yamamoto, N. Hirai, T. Tonda, N. Kohno, and K. Ito Optimal Cardiac Phase for Coronary Artery Calcium Scoring on Single-Source 64-MDCT Scanner: Least Interscan Variability and Least Motion Artifacts Am. J. Roentgenol., June 1, 2008; 190(6): 1561 - 1568. [Abstract] [Full Text] [PDF]

				R. Shroff, M. Egerton, M. Bridel, V. Shah, A. E. Donald, T. J. Cole, M. P. Hiorns, J. E. Deanfield, and L. Rees A Bimodal Association of Vitamin D Levels and Vascular Disease in Children on Dialysis J. Am. Soc. Nephrol., June 1, 2008; 19(6): 1239 - 1246. [Abstract] [Full Text] [PDF]

				R. See, J. B. Lindsey, M. J. Patel, C. R. Ayers, A. Khera, D. K. McGuire, S. M. Grundy, and J. A. de Lemos Application of the Screening for Heart Attack Prevention and Education Task Force Recommendations to an Urban Population: Observations From the Dallas Heart Study Arch Intern Med, May 26, 2008; 168(10): 1055 - 1062. [Abstract] [Full Text] [PDF]

				R. J. Guzman, D. M. Brinkley, P. M. Schumacher, R. M.J. Donahue, H. Beavers, and X. Qin Tibial Artery Calcification as a Marker of Amputation Risk in Patients With Peripheral Arterial Disease J. Am. Coll. Cardiol., May 20, 2008; 51(20): 1967 - 1974. [Abstract] [Full Text] [PDF]

				G. L. Burke, A. G. Bertoni, S. Shea, R. Tracy, K. E. Watson, R. S. Blumenthal, H. Chung, and M. R. Carnethon The Impact of Obesity on Cardiovascular Disease Risk Factors and Subclinical Vascular Disease: The Multi-Ethnic Study of Atherosclerosis Arch Intern Med, May 12, 2008; 168(9): 928 - 935. [Abstract] [Full Text] [PDF]

				L. F. Tops, D. A. Wood, V. Delgado, J. D. Schuijf, J. R. Mayo, S. Pasupati, F. P.L. Lamers, E. E. van der Wall, M. J. Schalij, J. G. Webb, et al. Noninvasive evaluation of the aortic root with multislice computed tomography implications for transcatheter aortic valve replacement. J. Am. Coll. Cardiol. Img., May 1, 2008; 1(3): 321 - 330. [Abstract] [Full Text] [PDF]

				E J HALL and D J BRENNER Cancer risks from diagnostic radiology Br. J. Radiol., May 1, 2008; 81(965): 362 - 378. [Abstract] [Full Text] [PDF]

				P. D. Reaven, N. Emanuele, T. Moritz, R. Klein, M. Davis, K. Glander, W. Duckworth, C. Abraira, and for the Veterans Affairs Diabetes Trial (VADT) Proliferative Diabetic Retinopathy in Type 2 Diabetes Is Related to Coronary Artery Calcium in the Veterans Affairs Diabetes Trial (VADT) Diabetes Care, May 1, 2008; 31(5): 952 - 957. [Abstract] [Full Text] [PDF]

				G. J. van Woudenbergh, R. Vliegenthart, F. J.A. van Rooij, A. Hofman, M. Oudkerk, J. C.M. Witteman, and J. M. Geleijnse Coffee Consumption and Coronary Calcification: The Rotterdam Coronary Calcification Study Arterioscler. Thromb. Vasc. Biol., May 1, 2008; 28(5): 1018 - 1023. [Abstract] [Full Text] [PDF]

				M. A. Allison, M. J. Budoff, N. D. Wong, R. S. Blumenthal, P. J. Schreiner, and M. H. Criqui Prevalence of and Risk Factors for Subclinical Cardiovascular Disease in Selected US Hispanic Ethnic Groups: The Multi-Ethnic Study of Atherosclerosis Am. J. Epidemiol., April 15, 2008; 167(8): 962 - 969. [Abstract] [Full Text] [PDF]

				A. J. Taylor, J. Bindeman, I. Feuerstein, T. Le, K. Bauer, C. Byrd, H. Wu, and P. G. O'Malley Community-Based Provision of Statin and Aspirin After the Detection of Coronary Artery Calcium Within a Community-Based Screening Cohort J. Am. Coll. Cardiol., April 8, 2008; 51(14): 1337 - 1341. [Abstract] [Full Text] [PDF]

				S. Voros Can Computed Tomography Angiography of the Coronary Arteries Characterize Atherosclerotic Plaque Composition?: Is the CAT (Scan) Out of the Bag? J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 183 - 185. [Full Text] [PDF]

				D. Sorajja, A. S. Gami, V. K. Somers, T. R. Behrenbeck, A. Garcia-Touchard, and F. Lopez-Jimenez Independent Association Between Obstructive Sleep Apnea and Subclinical Coronary Artery Disease Chest, April 1, 2008; 133(4): 927 - 933. [Abstract] [Full Text] [PDF]

				M.-T. Wu, P. Yang, Y.-L. Huang, J.-S. Chen, C.-C. Chuo, C. Yeh, and R.-S. Chang Coronary Arterial Calcification on Low-Dose Ungated MDCT for Lung Cancer Screening: Concordance Study with Dedicated Cardiac CT Am. J. Roentgenol., April 1, 2008; 190(4): 923 - 928. [Abstract] [Full Text] [PDF]

				R. Raman, B. Raman, S. Napel, and G. D. Rubin Semiautomated Quantification of the Mass and Distribution of Vascular Calcification with Multidetector CT: Method and Evaluation Radiology, April 1, 2008; 247(1): 241 - 250. [Abstract] [Full Text] [PDF]

				P. Greenland and R. O. Bonow How Low-Risk Is a Coronary Calcium Score of Zero?: The Importance of Conditional Probability Circulation, April 1, 2008; 117(13): 1627 - 1629. [Full Text] [PDF]

				M. P. Schenker, S. Dorbala, E. C. T. Hong, F. J. Rybicki, R. Hachamovitch, R. Y. Kwong, and M. F. Di Carli Interrelation of Coronary Calcification, Myocardial Ischemia, and Outcomes in Patients With Intermediate Likelihood of Coronary Artery Disease: A Combined Positron Emission Tomography/Computed Tomography Study Circulation, April 1, 2008; 117(13): 1693 - 1700. [Abstract] [Full Text] [PDF]