Why is detection of coronary artery calcification important?

Updated: Jul 24, 2019
  • Author: J Bayne Selby, Jr, MD; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

There are 3 primary reasons why detection of calcification in the coronary arteries is of primary importance. The first and foremost reason is that calcium is a marker for a diseased artery.

The second reason has to do with the revolution in CT scanning. Electron-beam CT (EBCT) was the first technique to provide a real breakthrough in the quantitation of calcium in the coronary arteries. Although this examination is valuable, the cost of the machines limited its use, and, by association, its impact. Some time afterward came helical, or spiral, CT. This technique was further improved with the addition of twin- and even quad-detector arrays. These machines allowed truly fast, completely noninvasive examination of the average person. During this period, the scanners were still not quite sophisticated enough to allow direct visualization of the coronary arteries while filled with contrast material. This continued to focus attention on the capabilities and significance of calcium scoring.

Advances in CT technology continued with the development of 16- and 64-slice scanners. With these scanners, more attention was directed to coronary artery CT angiography, but the use of calcium scoring in preventive cardiology had solidified. Newest scanner have  320 detector rows that allow imaging of a larger area of the body at one time, and the gantry (the doughnut-shaped part) can complete a full rotation in 275 milliseconds. In addition, the newest scanners substantially reduce radiation exposure. [4]

The third reason is mortality from heart disease. Cardiovascular disease is the leading global cause of death, accounting for more than 17.9 million deaths in 2015. That number is expected to increase to close to 24 million by 2030. In the United States, over 366,000 people die each year of coronary artery disease. [1]

(See the CT scan images of coronary artery calcification below.)

Coronary artery calcification - CT. Cross-sectiona Coronary artery calcification - CT. Cross-sectional image obtained through the heart at the level of the left anterior descending (LAD) artery. The protocol on the CT machine colors all structures with an attenuation of greater than 130 HU pink. No calcium (pink) is present in the LAD or diagonal branch.
Coronary artery calcification - CT. Image obtained Coronary artery calcification - CT. Image obtained in a patient with a large amount of calcium in the left anterior descending (LAD) artery. Note that other hyperattenuating structures (eg, bone, calcified lymph nodes) are pink. During the scoring process, the radiologist must circle only those areas that correspond to one of the coronary arteries.
Coronary artery calcification - CT. Image obtained Coronary artery calcification - CT. Image obtained without the threshold set to color the calcium pink. Note the large amount of calcium in the left anterior descending (LAD) and left circumflex arteries.
Coronary artery calcification - CT. Section caudal Coronary artery calcification - CT. Section caudal to that in the previous image shows calcium in the left anterior descending (LAD) artery as it courses down the front of the heart. The vessel is now depicted in cross section.

 

Helical non–contrast-enhanced CT reveals calcifica Helical non–contrast-enhanced CT reveals calcification involving the left main coronary artery.

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