title: Patterns of coronary arterial lesion calcification by a novel, cross-sectional CT angiographic assessment.
abstract: To investigate the patterns and diagnostic implications of coronary arterial lesion calcification by CT angiography (CTA) using a novel, cross-sectional grading method, we studied 371 patients enrolled in the CorE-64 study who underwent CTA and invasive angiography for detecting coronary artery stenoses by quantitative coronary angiography (QCA). The number of quadrants involving calcium on a cross-sectional view for ≥ 30 and ≥ 50 % lesions in 4,511 arterial segments was assessed by CTA according to: noncalcified, mild (one-quadrant), moderate (two-quadrant), severe (three-quadrant) and very severe (four-quadrant calcium). Area under the receiver operating characteristic curve (AUC) were used to evaluate CTA diagnostic accuracy and agreement versus. QCA for plaque types. Only 4 % of ≥ 50 % stenoses by QCA were very severely calcified while 43 % were noncalcified. AUC for CTA to detect ≥ 50 % stenoses by QCA for non-calcified, mildly, moderately, severely, and very severely calcified plaques were 0.90, 0.88, 0.83, 0.76 and 0.89, respectively (P < 0.05). In 198 lesions with severe calcification, the presence or absence of a visible residual lumen by CTA was associated with ≥ 50 % stenosis by QCA in 20.3 and 76.9 %, respectively. Kappa was 0.93 for interobserver variability in evaluating plaque calcification. We conclude that calcification of individual coronary artery lesions can be reliably graded using CTA. Most ≥ 50 % coronary artery stenoses are not or only mildly calcified. If no residual lumen is seen on CTA, calcified lesions are predictive of ≥ 50 % stenoses and vice versa. CTA diagnostic accuracy for detecting ≥ 50 % stenoses is reduced in lesions with more than mild calcification due to lower specificity.
authors.affiliation: Division of Cardiology, Johns Hopkins University, 600 North Wolfe Street, Blalock 524, Baltimore, MD, 21287-0409, USA.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Cerci
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Vavere
authors.forename: Julie M
authors.initials: JM
authors.lastname: Miller
authors.forename: Kihei
authors.initials: K
authors.lastname: Yoneyama
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rochitte
authors.forename: Marc
authors.initials: M
authors.lastname: Dewey
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Niinuma
authors.forename: Melvin E
authors.initials: ME
authors.lastname: Clouse
authors.forename: Roger
authors.initials: R
authors.lastname: Laham
authors.forename: David E
authors.initials: DE
authors.lastname: Bush
authors.forename: Edward P
authors.initials: EP
authors.lastname: Shapiro
authors.forename: Albert C
authors.initials: AC
authors.lastname: Lardo
authors.forename: Christopher
authors.initials: C
authors.lastname: Cox
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Brinker
authors.forename: Joăo A C
authors.initials: JA
authors.lastname: Lima
authors.forename: Armin
authors.initials: A
authors.lastname: Arbab-Zadeh
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D061205:Vascular Calcification / Q000000981:diagnostic imaging*