When do we really need coronary calcium scoring prior to contrast-enhanced coronary computed tomography angiography? Analysis by age, gender and coronary risk factors.
OBJECTIVE
To investigate the value of coronary calcium scoring (CCS) as a filter scan prior to coronary computed tomography angiography (CCTA).


RESULTS
Between February 2008 and April 2011, 732 consecutive patients underwent clinically indicated CCTA. During this 'control phase', CCS was performed in all patients. In patients with CCS≥800, CCTA was not performed. During a subsequent 'CCTA phase' (May 2011-May 2012) another 200 consecutive patients underwent CCTA, and CCS was performed only in patients with increased probability for severe calcification according to age, gender and atherogenic risk factors. In patients where CCS was not performed, calcium scoring was performed in contrast-enhanced CCTA images. Significant associations were noted between CCS and age (r = 0.30, p<0.001) and coronary risk factors (χ2 = 37.9; HR = 2.2; 95%CI = 1.7-2.9, p<0.001). Based on these associations, a ≤3% pre-test probability for CCS≥800 was observed for males <61 yrs. and females <79 yrs. According to these criteria, CCS was not performed in 106 of 200 (53%) patients during the 'CCTA phase', including 47 (42%) males and 59 (67%) females. This resulted in absolute radiation saving of ∼1 mSv in 75% of patients younger than 60 yrs. Of 106 patients where CCS was not performed, estimated calcium scoring was indeed <800 in 101 (95%) cases. Non-diagnostic image quality due to calcification was similar between the 'control phase' and the 'CCTA' group (0.25% versus 0.40%, p = NS).


CONCLUSIONS
The value of CCS as a filter for identification of a high calcium score is limited in younger patients with intermediate risk profile. Omitting CCS in such patients can contribute to further dose reduction with cardiac CT studies.
University of Heidelberg, Department of Cardiology, Heidelberg, Germany.
Gitsios
G
Gitsioudis
University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany.
Waldemar
W
Hosch
University of Heidelberg, Department of Cardiology, Heidelberg, Germany.
Johannes
J
Iwan
University of Heidelberg, Institute of Psychology, Heidelberg, Germany.
Andreas
A
Voss
University of Heidelberg, Department of Cardiology, Heidelberg, Germany.
Edem
E
Atsiatorme
University of Heidelberg, Department of Cardiology, Heidelberg, Germany.
Nina P
NP
Hofmann
University of Heidelberg, Department of Cardiology, Heidelberg, Germany.
Sebastian J
SJ
Buss
University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany.
Stefan
S
Siebert
University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany.
Hans-Ulrich
HU
Kauczor
University of Heidelberg, Department of Cardiology, Heidelberg, Germany.
Evangelos
E
Giannitsis
University of Heidelberg, Department of Cardiology, Heidelberg, Germany.
Hugo A
HA
Katus
University of Heidelberg, Department of Cardiology, Heidelberg, Germany.
Grigorios
G
Korosoglou
D000367:Age Factors; D000368:Aged; D002114:Calcinosis / Q000175:diagnosis* / Q000453:epidemiology; D002118:Calcium / Q000032:analysis*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D014057:Tomography, X-Ray Computed / Q000379:methods
D002118:Calcium