Coronary artery CT calcium score assessed by direct calcium quantification using atomic absorption spectroscopy and compared to macroscopic and histological assessments

Gheorghe, Alexandra; Jacobsen, Christina; Thomsen, Ragnar; Línnet, Kristían; Lynnerup, Niels; Andersen, Claus B; Fuchs, Andreas; Kofoed, Klaus F.; Banner, Jytte

doi:10.1007/s00414-018-01998-8

Cited by 14 publications

(8 citation statements)

References 47 publications

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“…Echocardiography can not only make anatomical diagnosis of cardiovascular diseases but also make functional diagnosis. It can observe the intracardiac movement, ventricular wall thickness, and the connection of cardiac great vessels from any angle, but it is seriously affected by factors such as sound, visual field, resolution, and operator experience [8][9][10]. Although MRI has high temporal resolution and soft tissue resolution, it has poor effect on coronary artery imaging due to the thin diameter of coronary artery, tortuous shape, and more adipose tissue in adjacent parts [11,12].…”

Section: Introductionmentioning

confidence: 99%

Effect of Calcification Based on Computer-Aided System on CT-Fractional Flow Reserve in Diagnosis of Coronary Artery Lesion

Xiao

Gao

et al. 2022

Computational and Mathematical Methods in Medicine

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This study was to analyze the diagnostic value of coronary computed tomography angiography (CCTA) and fractional flow reserve (FFR) based on computer-aided diagnosis (CAD) system for coronary lesions and the possible impact of calcification. 80 patients who underwent CCTA and FFR examination in hospital were selected as the subjects. The FFR value of 0.8 was used as the dividing line and divided into the ischemic group ( FFR ≤ 0.8 ) and nonischemic group ( FFR > 0.8 ). The basic data and imaging characteristics of patients were analyzed. The maximum diameter stenosis rate (MDS %), maximum area stenosis rate (MAS %), and napkin ring sign (NRS) in the ischemic group were significantly lower than those in the nonischemic group ( P < 0.05 ). Remodeling index (RI) and eccentric index (EI) compared with the nonischemic group had no significant difference ( P > 0.05 ). The total plaque volume (TPV), total plaque burden (TPB), calcified plaque volume (CPV), lipid plaque volume (LPV), and lipid plaque burden (LPB) in the ischemic group were significantly different from those in the non-ischemic group ( P < 0.05 ). MAS % had the largest area under curve (AUC) for the diagnosis of coronary myocardial ischemia (0.74), followed by MDS % (0.69) and LPV (0.68). CT-FFR had high diagnostic sensitivity, specificity, accuracy, truncation value, and AUC area data for patients in the ischemic group and nonischemic group. The diagnostic sensitivity, specificity, accuracy, cutoff value, and AUC area data of CT-FFR were higher in the ischemic group (89.93%, 92.07%, 95.84%, 60.51%, 0.932) and nonischemic group (93.75%, 90.88%, 96.24%, 58.22%, 0.944), but there were no significant differences between the two groups ( P > 0.05 ). In summary, CT-FFR based on CAD system has high accuracy in evaluating myocardial ischemia caused by coronary artery stenosis, and within a certain range of calcification scores, calcification does not affect the diagnostic accuracy of CT-FFR.

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Section: Introductionmentioning

confidence: 99%

Effect of Calcification Based on Computer-Aided System on CT-Fractional Flow Reserve in Diagnosis of Coronary Artery Lesion

Xiao

Gao

et al. 2022

Computational and Mathematical Methods in Medicine

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“…There are many controversies about how to interpret coronary calcifications on PMCT and how to interpret their presence for cases of sudden death [3,[15][16][17]. Some recent postmortem studies demonstrated that Agatston scoring zero or low cannot rule out the presence of extensive stenosis [16] and that CACS can neither confirm nor exclude death due to ACAD [18]. In a recent Australian study, it was reported that about one-third of patients who died from severe ACAD had a zero CACS in postmortem imaging [19].…”

Section: Introductionmentioning

confidence: 99%

Postmortem coronary artery calcium score in cases of myocardial infarction

et al. 2021

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Sudden cardiac death (SCD) related to atherosclerotic coronary artery disease (ACAD) resulting in myocardial infarction is the most prevalent cause of death in western countries. In clinical practice, coronary artery calcium score (CACS) is considered an independent predictor of coronary events, closely related to atherosclerotic burden and is quantified radiologically by the Agatston score being calculated through computed tomography. Postmortem computed tomography (PMCT) allows the visualization and quantification of coronary calcifications before the autopsy. However, it was reported that some patients who died from severe ACAD had a zero CACS in PMCT. In this study, a retrospective evaluation of CACS in adult’s myocardial infarction cases related to ACAD, with available CACS and histological slides of coronary arteries, was performed in order to gain a deeper understanding of coronary calcifications and their role in myocardial infarction cases. The CACS was calculated by using the software Smartscore 4.0 after the radiological examination on a 64-row CT unit using a specific cardiac protocol. Thirty-six cases were identified out of 582 autopsies, recorded during a 2-year study period (29 men, 7 women; age 56.3 ± 11.7). CACS was 0–10 in 5 cases (5 men, 44.8 ± 13.7), 11–100 in 8 cases (6 men, 2 women, 53.1 ± 7.7), 101–400 in 13 cases (11 men, 2 women, 57.4 ± 9.6), and > 400 in 10 cases (9 men, 1 woman, 63.1 ± 11.9). Coronary thrombosis was found in 28 cases, histologically identified as plaque erosions in 6 cases and as plaque ruptures in 22 cases. Statistical analyses showed that CACS increases significantly with age (p-value < 0.05) and does not show significant correlation with gender, body weight, body mass index, and heart weight. CACS was significantly higher in plaque ruptures than in plaque erosions (p-value < 0.01). Zero or low CACS on unenhanced PMCT cannot exclude the presence of myocardial infarction related to ACAD. This paradoxical discrepancy between imaging and autopsy findings can be explained considering the histological aspect of fatal coronary plaques.

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“…Clinically, the extent of coronary calcification can be evaluated by means of coronary artery calcium scoring (CACS), commonly referred to as the Agatston method [ 37 ]. Postmortem CACS can be assessed by direct calcium quantification [ 38 ]. In a recent Australian study, it was reported that about one-third of patients who died from acute CAD had zero CACS in postmortem imaging [ 39 ].…”

Section: Postmortem Imaging Of Cardiovascular Structures Potentially ...mentioning

confidence: 99%

Application of postmortem imaging modalities in cases of sudden death due to cardiovascular diseases–current achievements and limitations from a pathology perspective

et al. 2022

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Postmortem imaging (PMI) is increasingly used in postmortem practice and is considered a potential alternative to a conventional autopsy, particularly in case of sudden cardiac deaths (SCD). In 2017, the Association for European Cardiovascular Pathology (AECVP) published guidelines on how to perform an autopsy in such cases, which is still considered the gold standard, but the diagnostic value of PMI herein was not analyzed in detail. At present, significant progress has been made in the PMI diagnosis of acute ischemic heart disease, the most important cause of SCD, while the introduction of postmortem CT angiography (PMCTA) has improved the visualization of several parameters of coronary artery pathology that can support a diagnosis of SCD. Postmortem magnetic resonance (PMMR) allows the detection of acute myocardial injury-related edema. However, PMI has limitations when compared to clinical imaging, which severely impacts the postmortem diagnosis of myocardial injuries (ischemic versus non-ischemic), the age-dating of coronary occlusion (acute versus old), other potentially SCD-related cardiac lesions (e.g., the distinctive morphologies of cardiomyopathies), aortic diseases underlying dissection or rupture, or pulmonary embolism. In these instances, PMI cannot replace a histopathological examination for a final diagnosis. Emerging minimally invasive techniques at PMI such as image-guided biopsies of the myocardium or the aorta, provide promising results that warrant further investigations. The rapid developments in the field of postmortem imaging imply that the diagnosis of sudden death due to cardiovascular diseases will soon require detailed knowledge of both postmortem radiology and of pathology.

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Coronary artery CT calcium score assessed by direct calcium quantification using atomic absorption spectroscopy and compared to macroscopic and histological assessments

Cited by 14 publications

References 47 publications

Effect of Calcification Based on Computer-Aided System on CT-Fractional Flow Reserve in Diagnosis of Coronary Artery Lesion

Effect of Calcification Based on Computer-Aided System on CT-Fractional Flow Reserve in Diagnosis of Coronary Artery Lesion

Postmortem coronary artery calcium score in cases of myocardial infarction

Application of postmortem imaging modalities in cases of sudden death due to cardiovascular diseases–current achievements and limitations from a pathology perspective

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