(Radiographics. 1999;19:1419.)
© RSNA, 1999
Invited Commentary
Theresa C. McLoud, MD
Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
Coronary artery calcification is an important marker for atherosclerotic disease. In the preceding article
, which was based on his presentation at the Opening Session of the 1998 scientific assembly of the Radiological Society of North America, Dr Stanford provides an excellent review of the state of the art in the imaging of coronary calcification. The review focuses on electron beam CT, but the application of other imaging modalities is considered. An historical review of the role of standard radiography and chest fluoroscopy is provided as well as a description of limitations of more current imaging modalities, such as intravascular US, MR imaging, and transthoracic and transesophageal echocardiography.
Electron beam CT is highly sensitive compared with all other imaging modalities in the detection of coronary artery calcification. The true clinical significance of coronary artery calcification remains somewhat controversial. Electron beam CT appears to have the greatest clinical usefulness as a screening modality, particularly in the detection of coronary calcification in young individuals who may benefit from the administration of lipid-lowering drugs. The high negative predictive value of electron beam CT indicates that it is an accurate instrument for determining the absence of significant atherosclerosis in the coronary arteries. Conversely, high coronary calcification scores determined with electron beam CT may indicate a high risk factor for significant obstructive coronary artery disease. However, there is no convincing evidence that calcification scores are predictive of significant stenosis at any particular site of calcification.
With the development of faster scanners, particularly with the advent of helical CT scanning and multidetector high-speed scanners, accurate estimations of the amount of coronary calcification may be possible with the use of electrocardiographic gating. This is an important advance because electron beam scanners are not widely distributed throughout this country.
This article provides an excellent review of the literature on the pathophysiology of coronary calcification, a summary of the currently available imaging modalities for determining coronary calcification, an analysis of the relationship between coronary calcification and clinical outcome, and finally, a description of new imaging modalities that may be available for accurate assessment of coronary disease.
Related Article
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Opening Plenary Session: 1998 : Coronary Artery Calcification as an Indicator of Preclinical Coronary Artery Disease
- William Stanford
RadioGraphics 1999 19: 1409-1419.
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