How is stenosis graded when calcified plaques are present on coronary computed tomography angiography (CCTA)?

Updated: Dec 21, 2017
  • Author: Eugene C Lin, MD; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

Stenosis is typically overestimated in areas where heavily calcified plaques are present. In one study, when calcification was greater than 50% of the luminal diameter, there was a signficant decrease in specificity, positive predictive value, and accuracy of CTA for evaluating coronary stenosis. [80] In the presence of extensive calcification, reconstruction of a additional dataset using a sharper convolution kernel (as used for stents) and use of bone window setting can reduce blooming artifacts from calcification. [81] Zhang et al offer the following suggestions to better assess the degree of stenosis when calcified plaques are present [82] :

  • A significant luminal stenosis is unlikely if the plaque thickness measures 50% or less of the diameter of a nearby normal segment and if it is eccentrically positioned on a cross-sectional multiplanar reconstruction (MPR) view or there is visible lumen adjacent to the plaque on a long-axis MPR view, .

  • A significant stenosis is likely if calcified plaque fills the entire central portion of the lumen on a cross-sectional MPR image.

  • A significant stenosis can be suggested if calcified plaque is 50% or greater than the diameter of a nearby normal segment on cross-sectional MPR images but does not completely fill the lumen; however, the interpreter might add that coronary computed tomography (CT) angiography (CCTA) may overestimate the degree of stenosis in this situation.


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