Patterns of Coronary Calcification and Their Impact on the Diagnostic Accuracy of Computed Tomography Coronary Angiography

Noll, Dariusz; Kruk, Mariusz; Demkow, Marcin; Pręgowski, Jerzy; Kaczmarska, Edyta; Kryczka, Karolina; Dzielińska, Zofia; Śleszycka, Justyna; Witkowski, Adam; Rużyłło, Witold; Kępka, Cezary

doi:10.1097/rct.0000000000000681

Cited by 10 publications

(3 citation statements)

References 19 publications

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“…Our results are consistent with previous reports confirming the inaccuracy of CCTA in dealing with larger or massive calcifications [ 5 , 6 , 7 , 8 , 31 ]. Despite widespread use of CCTA in the diagnosis of CAD, the presence of coronary calcification produces blooming artifacts interfering with the diagnostic accuracy of CCTA, primarily manifested as the low specificity and PPV.…”

Section: Discussionsupporting

confidence: 93%

3D-Printed Coronary Plaques to Simulate High Calcification in the Coronary Arteries for Investigation of Blooming Artifacts

Sun

Wong

et al. 2021

Biomolecules

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The diagnostic value of coronary computed tomography angiography (CCTA) is significantly affected by high calcification in the coronary arteries owing to blooming artifacts limiting its accuracy in assessing the calcified plaques. This study aimed to simulate highly calcified plaques in 3D-printed coronary models. A combination of silicone + 32.8% calcium carbonate was found to produce 800 HU, representing extensive calcification. Six patient-specific coronary artery models were printed using the photosensitive polyurethane resin and a total of 22 calcified plaques with diameters ranging from 1 to 4 mm were inserted into different segments of these 3D-printed coronary models. The coronary models were scanned on a 192-slice CT scanner with 70 kV, pitch of 1.4, and slice thickness of 1 mm. Plaque attenuation was measured between 1100 and 1400 HU. Both maximum-intensity projection (MIP) and volume rendering (VR) images (wide and narrow window widths) were generated for measuring the diameters of these calcified plaques. An overestimation of plaque diameters was noticed on both MIP and VR images, with measurements on the MIP images close to those of the actual plaque sizes (<10% deviation), and a large measurement discrepancy observed on the VR images (up to 50% overestimation). This study proves the feasibility of simulating extensive calcification in coronary arteries using a 3D printing technique to develop calcified plaques and generate 3D-printed coronary models.

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Section: Discussionsupporting

confidence: 93%

3D-Printed Coronary Plaques to Simulate High Calcification in the Coronary Arteries for Investigation of Blooming Artifacts

Sun

Wong

et al. 2021

Biomolecules

View full text Add to dashboard Cite

show abstract

“…We compared stenoses (≥ 25% diameter) identified by CCTA to invasive quantitative coronary angiography (QCA) measurement to determine the accuracy of clinical CCTA interpretation in patients with high CACs. Recognizing the known challenges to CT imaging of highly calcified vessels, [4][5][6][7] we hypothesized that CCTA with contemporary approaches would be effective at ruling out significant stenosis, but that overall accuracy would remain limited by low specificity.…”

Section: Introductionmentioning

confidence: 99%

Detection of small coronary calcifications in patients with Agatston coronary artery calcium score of zero

Tzolos¹,

Han²,

Klein³

et al. 2022

Journal of Cardiovascular Computed Tomography

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“…The average plaque density at the MLD level was 144 ± 138 HU with a maximum density of 541 HU. The calcium density on CTCA approaches the density of contrast fluid and could impede detection of lumen and vessel borders leading to the evidence that inaccurate CTCA vessel and plaque quantitative measurements are associated with greater calcified plaque volume, increased percentage of calcified plaque, and lumen diameter smaller than 2.8 mm (28)(29)(30). It should be noted that we did not perform calcium scoring according to Agatston score in order to reduce radiation exposure, and we excluded patients with type III and IV calcified lesions on CT.…”

Section: Discussionmentioning

confidence: 99%

Multislice computerized tomography coronary angiography can be a comparable tool to intravascular ultrasound in evaluating “true” coronary artery bifurcations

Radunović,

Vidaković,

Timčić

et al. 2023

Front. Cardiovasc. Med.

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AimCoronary bifurcation atherosclerosis depends on its angles, flow, and extensive branching. We investigate the ability of CT coronary angiography (CTCA) to determine atherosclerotic plaque characteristics of “true” bifurcation compared with intravascular ultrasound (IVUS) and the influence on side branch (SB) fate after percutaneous coronary intervention (PCI).Methods and resultsThe study included 70 patients with 72 “true” bifurcations. Most of the bifurcations were in the left anterior descending—diagonal (Dg) territory [50 out of 72 (69.4%)]. Longitudinal plaque evaluation at the polygon of confluence [carina and 5 mm proximal and distal in the main branch (MB)] showed that carina side MB and SB plaque had occurred with the lowest incidence with fibro-lipid structure (115 ± 63 HU and 89 ± 73 HU, p < 0.001 for all). Bland–Altman analysis showed a discrepancy in measuring mainly the lumen area between CTCA and IVUS in proximal MB [lumen 5.10, 95% CI (95% confidence interval, 4.53–5.68) mm2, p < 0.001; vessel −1.42, 95% CI (−2.63 to −0.21) mm2, p = 0.023], carina MB [lumen 3.74, 95% CI (3.37–4.10) mm2, p < 0.001; vessel −0.48, 95% CI (−1.45 to 0.48) mm2, p = 0.322], and distal MB [lumen 4.72, 95% CI (4.27–5.18) mm2, p < 0.001; vessel 0.62, 95% CI (−0.53 to 1.77) mm2, p = 0.283]. A significant correlation existed between average plaque density on CTCA with a percentage of calcified plaque on IVUS tissue characterization (proximal r = 0.307/p = 0.024, carina 0.469/0.008, distal 0.339/0.024, minimal lumen diameter 0.318/0.020). Circumferential plaque in the proximal MB segment remained an independent predictor of SB compromise [OR 3.962 (95% CI 1.170–13.418)].ConclusionDetection and characterization of atherosclerotic plaque by CTCA in non-left main “true” coronary bifurcations can provide useful information about bifurcation anatomy and plaque distribution that can predict outcomes after provisional stenting, thus guiding the interventional strategy to bifurcation PCI.

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Patterns of Coronary Calcification and Their Impact on the Diagnostic Accuracy of Computed Tomography Coronary Angiography

Cited by 10 publications

References 19 publications

3D-Printed Coronary Plaques to Simulate High Calcification in the Coronary Arteries for Investigation of Blooming Artifacts

3D-Printed Coronary Plaques to Simulate High Calcification in the Coronary Arteries for Investigation of Blooming Artifacts

Detection of small coronary calcifications in patients with Agatston coronary artery calcium score of zero

Multislice computerized tomography coronary angiography can be a comparable tool to intravascular ultrasound in evaluating “true” coronary artery bifurcations

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