Making the most of coronary calcium scans

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 - Aortic valve calcium on heart CT
Aortic valve calcium and coronary artery calcification.
Source: J. of Cardiovascular CT (doi:10.1016/j.jcct.2012.02.008)

Non-contrast CT scans of the heart can provide valuable information beyond coronary artery calcification (CAC) scoring, according to an article published in the September issue of the Journal of Cardiovascular Computed Tomography.

This additional information often has the added benefit of being accessible without additional scanning, radiation or patient burden, explained Paul Madaj, MD, and Matthew J. Budoff, MD, of the Los Angeles Biomedical Research Institution at Harbor-UCLA Medical Center.

“Thus, a single scan, able to identify a robust marker of atherosclerosis, can also provide insight into multiple other associated disease states,” they wrote. Among the additional measures are evaluation of thoracic aortic calcification, aortic valve calcification, mitral annular calcification, pericardial fat, liver fat, myocardial scar and bone density.

Madaj and Budoff offered a number of “clinical pearls” that could help maximize the utility of non-contrast CT scans of the heart, including:

  - Lesions counts should be reported in addition to total Agatston calcium scoring, with a larger number of lesions indicating greater clinical significance.

  - Measures of intrathoracic fat offer independent and incremental value as an additional evaluation in the assessment of CAC.

  - Mentioning presence and severity of aortic valve calcification and thoracic aortic calcium allows for further risk stratification beyond the Agatston score.

  - Osteoporosis and atherosclerosis can be assessed by evaluating bone mineral density on the thoracic spine present on the CAC scan.

“The only cost for these incremental measures, to the patient or scanning center, would be the time of interpretation. Given the incremental value reported, consideration to adding these measures to routine reporting of coronary calcium scanning is necessary to get at the full prognostic and diagnostic potential of this study,” wrote Madaj and Budoff.

The authors advised that diagnostic and prognostic yield of coronary calcium scans could be further improved by directing additional measurements based on patient characteristics. Older women, for example, would benefit more from adding bone density assessment, while patients with diabetes could benefit from pericardial fat measures, they noted.