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      Coronary Artery Calcifications: A Critical Assessment of Imaging Techniques

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          The presence of coronary artery calcifications is a distinct marker of atherosclerosis and the severity of calcifications is claimed to reflect a patient’s individual plaque burden. Calcium deposits can be detected non-invasively by cardiac computed tomography (CT). This enables detection of coronary artery disease in a subclinical stage, description of the extent of the disease and risk estimation of future cardiovascular events. However, calcium quantification may also be used to monitor atherosclerotic disease, for example in the context of an intensified medical treatment. For years, electron-beam CT has been considered the gold-standard for calcium scoring. However, multi-slice spiral CT has recently captured the market and seems to achieve better measuring results with regard to the accuracy and reproducibility of calcium scores because of its superior image quality. For an optimal comparability of different CT techniques the calcium load should now be reported as absolute calcium mass rather than the traditional scoring methods.

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          Most cited references 17

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          Morphology of coronary atherosclerotic lesions in patients with end-stage renal failure.

          An excessive rate of cardiac death is a well-known feature of renal failure. Coronary heart disease is frequent and the possibility has been raised that the natural history of the coronary plaque is different in uraemic patients. We assessed the morphology of coronary arteries in patients with end-stage renal failure and compared them with coronary arteries of matched non-uraemic control patients. Fifty-four cases were identified at autopsy who met the inclusion criteria: cases, end-stage renal disease (n=27); controls, non-renal patients with coronary artery disease (n=27). At autopsy all three coronary arteries were prepared at corresponding sites for investigations: (i) qualitative analysis (after Stary), (ii) quantitative measurements of intima and media thickness (by planimetry), (iii) immunohistochemical analysis of the coronary plaques and (iv) X-ray diffraction of selected calcified plaques. Qualitative analysis of the coronary arteries showed significantly more calcified plaques of coronary arteries in patients with end-stage renal failure. Plaques of non-uraemic patients were mostly fibroatheromatous. Media thickness of coronary arteries was significantly higher in uraemic patients (187+/-53 microm vs 135+/-29 microm in controls) and intima thickness tended to be higher (158+/-38 microm vs 142+/-31 microm) but this difference was not statistically significant. Plaque area (4.09+/-1. 50 mm(2) vs 4.39+/-0.88 mm(2)) was comparable in both groups. Lumen area, however, was significantly lower in end-stage renal patients. Immunohistochemical analysis of the cellular infiltrate in coronary arteries showed no major differences in these advanced plaques of uraemic and non-uraemic subjects. Coronary plaques in patients with end-stage renal failure are characterized by increased media thickness and marked calcification. In contrast to the previous opinion the most marked difference compared to non-uraemic controls does not concern the size, but the composition of the plaque. Deposition of calcium within the plaques may contribute to the high complication rate in uraemic patients.
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            Radiation exposure during cardiac CT: effective doses at multi-detector row CT and electron-beam CT.

            To measure the effective radiation doses delivered at electron-beam computed tomography (CT) and multi-detector row spiral CT of coronary arteries and to compare these doses with those delivered at catheter coronary angiography. An anthropomorphic phantom equipped with 66 thermoluminescent dosimeters was imaged at cardiac CT. Four protocols for unenhanced coronary artery calcium scoring were simulated: one with electron-beam CT and three with multi-detector row CT. Four similar protocols for coronary CT angiography were simulated. All multi-detector row spiral CT protocols were performed with retrospective electrocardiographic triggering. Biplane catheter coronary angiography also was simulated. Radiation doses to organs were measured, and effective doses were calculated according to guidelines published in International Commission on Radiological Protection Publication 60. Coronary artery calcium scoring with electron-beam CT yielded effective radiation doses of 1.0 and 1.3 mSv for male and female patients, respectively. The radiation doses at calcium scoring with multi-detector row CT were 1.5-5.2 mSv for male patients and 1.8-6.2 mSv for female patients. Electron-beam CT coronary angiography yielded effective doses of 1.5 and 2.0 mSv for male and female patients, respectively. The highest effective doses were delivered at multi-detector row CT angiography: 6.7-10.9 mSv for male patients and 8.1-13.0 mSv for female patients. Catheter coronary angiography yielded effective doses of 2.1 and 2.5 mSv for male and female patients, respectively. Higher radiation doses are delivered at multi-detector row cardiac CT compared with the doses delivered at electron-beam CT and catheter coronary angiography. Copyright RSNA, 2002
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              CT of coronary artery disease.

              The socioeconomic importance of heart disease provides considerable motivation for development of radiologic tools for noninvasive imaging of the coronary arteries. Current computed tomographic (CT) techniques combine high speed and spatial resolution with sophisticated electrocardiographic synchronization and robustness of use. Application of these modalities for evaluation of coronary artery disease is a topic of active current research. Coronary artery calcium measurements with different CT techniques have been used for determining the risk of coronary events, but the exact role of this marker for cardiac risk stratification remains unclear pending results of population-based studies. Contrast material-enhanced CT coronary angiography has become an established clinical indication for some scenarios (eg, coronary artery anomalies, bypass patency, surgical planning). With current technology, the accuracy of CT coronary angiography for detection of coronary artery stenoses appears promising enough to warrant pursuit of this application, but sensitivity is still not high enough for routine diagnostic needs. The high negative predictive value of a normal CT coronary angiogram, however, may be useful for reliable exclusion of coronary artery stenosis. The cross-sectional nature of CT may allow noninvasive assessment of the coronary artery wall. Use of contrast-enhanced CT coronary angiography for detection, characterization, and quantification of atherosclerotic changes and total disease burden in coronary arteries as a potential tool for cardiac risk stratification is currently being investigated. Copyright RSNA, 2004

                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                December 2006
                14 December 2006
                : 25
                : 1
                : 115-119
                Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
                96409 Blood Purif 2007;25:115–119
                © 2007 S. Karger AG, Basel

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