The association between carotid calcium on dental panoramic radiographs and coronary calcium score on chest computerized tomography

Objectives:Coronary artery calcium measured by CT predicts future coronary events. Similarly, carotid artery calcium on dental panoramic radiographs has been associated with increased cardiovascular events. Pre-procedural assessment of candidates for valve replacement in our institution includes panoramic radiographs and chest tomography. We aimed to assess the association of carotid calcium on panoramic radiographs with coronary artery calcium on chest tomography.Methods:Paired pre-procedural panoramic radiographs and chest tomography scans were done in 177 consecutive patients between October 2016 and October 2017. Carotid calcium was quantified using NIH’s ImageJ. Coronary artery calcium was quantified by the Agatston score using Philips Intellispace portal, v. 8.0.1.20640.Results:Carotid calcium maximal intensity, area and perimeter were higher among patients with high coronary artery calcium. Non-zero carotid calcium was found in half of patients with high coronary artery calcium, doubling prevalence of low coronary artery calcium.Conclusion:Carotid calcium identified in panoramic radiographs was associated with high coronary artery calcium. Awareness of carotid calcium recognized by dental practitioners in low-cost, low radiation and commonly done panoramic radiographs may be useful to identify patients at risk of coronary disease with potential future cardiovascular events.     

Electron beam CT and cost-efficient diagnosis of coronary artery disease

Summary Background: Electron beam CT (EBCT) can acquire rapid, multiple thin-section tomograms of the beating heart in synchrony with the electrocardiogram and quantify coronary calcification without intravenous contrast. Coronary calcification is an active process exclusively associated with atherosclerotic plaque formation and regulated in a manner similar to the calcification of bone. Clinical studies have demonstrated that EBCT coronary calcification (1) follows a pattern similar to the epidemiology of coronary artery disease (CAD), (2) has a high sensitivity (90–95 %) for coronary plaque and significant angiographic coronary stenoses, and (3) has the potential to assess the prognosis of patients with coronary atherosclerotic disease. Coronary calcium area or “score” correlates best with overall plaque burden within the coronary system. However, coronary calcium is of limited value in distinguishing coronary stenosis on a segment-by-segment basis. EBCT and CAD: Due to spiraling health care costs, there is a need for cost-efficient strategies in the diagnosis and stratification of patients with known or suspected CAD. There are two major patient groups in which EBCT calcium scanning has a potential for cost-efficient application: (1) in asymptomatic, high-risk patients, identification of significant plaque burden may direct judicious use of long-term drug therapy or further investigation to those individuals most likely to benefit from an aggressive risk factor modification and medical program; (2) in patients with chest pain syndromes but no prior CAD, EBCT calcium scanning compares favorably with conventional diagnostic methods. In particular, using receiver operating characteristic analysis, the sensitivity and specificity of an EBCT calcium score of 80 in detecting obstructive CAD are both about 85 %. Using a theoretical model, EBCT calcium scanning was found to be the most cost-effective approach to diagnosis in populations with a low-to-moderate likelihood of obstructive CAD when compared with treadmill exercise, stress thallium, and stress echocardiography. Conclusions: EBCT calcium scanning is not a substitute for coronary angiography, but it has clear advantages over other more traditional diagnostic methods for CAD. In particular, it can be performed conveniently and inexpensively in most patients. Additionally, the site and extent of calcification are intimately related to the atherosclerotic plaque burden. The analyses presented suggest that it may also provide a cost-effective clinical alternative in specific subsets of the population. Eingegangen am 15. Januar 1996 Angenommen am 27. Februar 1996     

Coronary CT angiography: How should physicians use it wisely and when do physicians request it appropriately?

Coronary CT angiography has been increasingly used in the diagnosis of coronary artery disease due to rapid technological developments, which are reflected in the improved spatial and temporal resolution of the images. High diagnostic accuracy has been achieved with 64- and more slice CT scanners and in selected patients, coronary CT angiography is regarded as a reliable alternative to invasive coronary angiography. Although the tremendous contributions of coronary CT angiography to cardiac imaging are acknowledged, appropriate use of cardiac CT as the first line technique by physicians has not been well established. Optimal selection of cardiac CT is essential to ensure acquisition of valuable diagnostic information and avoid unnecessary invasive procedures. This is of paramount importance since cardiac CT not only involves patient risk assessment, prediction of major cardiac events, but also impacts physician decision-making on patient management. Applications of CT in cardiac imaging include coronary artery calcium scoring for predicting the patient risk of developing major cardiac events, followed by coronary CT angiography which is commonly used to determine the diagnostic and prognostic accuracy in the coronary artery disease. This review presents an overview of the applications of CT in cardiac imaging in terms of coronary calcium scoring and coronary CT angiography. Judicious use of both cardiac CT tools will be discussed with regard to their value in different patient risk groups with the aim of identifying the appropriate criteria for choosing a cardiac CT modality. An effective diagnostic pathway is finally recommended to physicians for appropriate selection of cardiac CT in clinical practice.     

64层螺旋CT冠状动脉钙化积分的再认识

目的：研究64层螺旋CT（64-MSCT）冠状动脉钙化积分（CACS）与冠状动脉狭窄间的关系,初步探讨诊断冠状动脉狭窄的钙化积分的合适切点（OCP）。方法：对150例同期行常规冠状动脉成像（CAG）和64层螺旋cT冠状动脉成像（cTA）的连续患者进行回顾性分析,定量评价钙化积分与冠状动脉狭窄的关系。结果：患者钙化积分与年龄、狭窄程度及病变支数均成正相关（r=0．41、0．37、0．41,P〈O．001）。对患者、分支、节段冠状动脉狭窄≥50％的诊断,R0c曲线下面积分别为0．78、0．76、0．67,对狭窄≥70％的诊断,ROC曲线下面积分别为0．76、0．75、0．66。依据R0c曲线获得诊断患者冠状动脉狭窄≥50％、≥70％的钙化积分切点为255分、374分（特异度均为95％,敏感度分别为42．2％和39．4％）。结论：钙化积分可反映冠状动脉病变的程度及范围,对患者或每支冠状动脉狭窄有较高的诊断准确性。对于冠状动脉大量钙化患者,钙化积分可作为传统冠状动脉造影前的筛查手段或辅助CTA诊断。     

平均心率、心率变异性和钙化负荷对双源CT冠状动脉成像诊断准确性的影响

目的 与常规冠状动脉造影(CAG)对照,评价双源CT冠状动脉血管成像(CTCA)诊断冠状动脉狭窄性病变的准确性以及平均心率、心率变异性和钙化负荷对CTCA诊断准确性的影响.资料与方法 2006年12月至2008年9月,113例患者同时进行了CTCA与CAG.以CAG为参照,评价CTCA诊断≥50%和>75%冠状动脉狭窄性病变的准确性.按心率、心率变异性和钙化积分将患者分组,评价不同亚组CTCA的诊断准确性,对敏感性和特异性数据进行χ~2检验.结果 以患者为分析单位,CTCA诊断≥50%和>75%冠状动脉狭窄性病变的敏感性和特异性分别为94%、93.3%;88.5%、96.2%;以血管为分析单位,CTCA诊断≥50%和>75%冠状动脉狭窄性病变的敏感性和特异性分别为90.0%、98.0%;84.8%、98.5%;而以节段为分析单位,CTCA诊断≥50%和>75%冠状动脉狭窄性病变的敏感性和特异性分别为89.9%、99.5%;83.0%、99.7%.平均心率对CTCA诊断冠状动脉狭窄无明显影响,而心率变异性和钙化积分对CTCA诊断冠状动脉狭窄有影响.结论 无论是以患者、血管还是节段为分析单位,CTCA在诊断冠状动脉狭窄方面均有较高的敏感性和特异性,平均心率对CTCA诊断冠状动脉狭窄的准确性无明显影响,而心率变异性和钙化积分对CTCA诊断冠状动脉狭窄的准确性有影响.     

Multidetector-row computed tomography of the coronary arteries: predictive value and quantitative assessment of non-calcified vessel-wall changes

The aim of this study was to quantitatively assess non-calcified coronary artery plaques and to determine their predictive value for the detection of coronary artery disease (CAD). A total of 179 patients underwent a calcium screening examination and a contrast-enhanced multidetector-row computed tomography angiography (MDCT) of the coronary arteries for various indications. The traditional calcium scores were evaluated and all examinations were reviewed for the presence of non-calcified plaques with an attenuation of 0–130 Hounsfield units (HU). The number, mean attenuation, and volume of these non-calcified plaques were recorded. All patients also underwent conventional catheter angiography. Coronary calcium was detected in 73% (131 of 179) of the patients. Overall incidence of purely non-calcified plaques was 30% (53 of 179). In 27% of the patients (48 of 179) no calcium was detected; however, 15% of these patients without calcifications showed non-calcified plaques (7 of 48). Significant correlations were found between the volume of calcified plaques, volume of non-calcified plaques, and total plaque volume. There were significant differences in plaque composition comparing different risk factor profiles and different stages of CAD. Volumetric assessment of non-calcified coronary artery plaques is feasible using contrast-enhanced MDCT. Screening for non-calcified plaques identifies patients with signs of CAD that are missed in a calcium screening examination.     

1879例成人非先天性心脏病患者双源CT检出的冠状动脉起源异常24例分析

目的：评价双源CT（DSCT）在成人非先天性心脏病患者冠状动脉起源异常检出中的价值。方法：回顾性分析2008年9月,2009年2月期间进行了DSCF冠状动脉检查的资料,总结成人非先天性心脏病患者冠状动脉起源异常的检出率。结果：1881例进行冠状动脉检查的患者中,共有1879例患者为非先天性心脏病患者,共检出了24例冠状动脉起源异常,检出率为1．3％。其中15例为右冠状动脉起源异常（12例起自左冠状窦,3例为高位起源）,8例为左冠状动脉起源异常（3例起自无冠状窦,回旋支起自左冠状窦、高位开口、回旋支起自右冠状动脉、左冠状动脉起自右冠状窦、单一冠状动脉各1例）,1例为左右冠状动脉均起源异常（均为高位开口）。结论：本组成人非先天性心脏病患者冠状动脉起源异常的检出率为1．3％。DSCT可很好地显示冠状动脉起源异常和走行,为临床决策提供重要信息。     

Coronary artery fistulae without adudible murmur in adults

Retrospective analysis of 4886 adults undergoing coronary arteriography for evaluation of angina between October 1988 and December 1991, revealed coronary artery fistulae in eight patients (all men, aged 36–69 years). No murmur was audible in any of these eight patients. Associated significant coronary artery disease was detected in five patients. The feeder arteries to the fistula were both the left main coronary artery and the left anterior desending artery (LAD) in two, the LAD in six, and the right coronary artery in two patients. The fistula terminated in the pulmonary artery in seven patients and in the right atrium in one patient. Successful operative treatment (coronary artery bypass grafting and ligation of the fistula) was undertaken in four patients with severe obstructive coronary artery disease with satisfactory results. Follow-up for up to 2 years of the three patients with coronary artery fistula and no associated coronary artery disease who did not undergo surgery revealed continuing good prognosis. We conclude that coronary artery fistula in adults is a distinct, though rare (incidence in present series 0.11%) entity, without audible murmur, commonly associated with coronary artery obstructive disease, and that the diagnosis is mostly incidental during routine coronary arteriography.     

Monckeberg calcification of coronary arteries: a string of pearls

Coronary artery calcium scores are derived from cardiac-gated noncontrast computed tomography scans that are used in cardiac risk stratification. However, an elevated calcium score does not always translate to coronary artery luminal obstruction. Our case demonstrates an extremely high coronary artery calcium score despite nonobstructive coronaries on angiogram.     

老年人多排螺旋CT冠状动脉钙化扫描临床应用初探

目的：评估不同扫描层厚对冠状动脉钙化积分和冠状动脉显示的影响。方法：98例70岁以上疑为冠心病的病人进行不同层厚的多排螺旋CT冠状动脉钙化积分扫描，36例扫描层厚为1mm，其中28例病人同次先后进行层厚为1mm和2mm的扫描，62例层厚为2mm；对每次扫描进行钙化分析。结果：在层厚为1mm的扫描，78％的病人不能一次闭气完成扫描，出现呼吸伪影。在同次先后进行层厚为1mm和2mm扫描的28例病人，扫描层厚为1mm的钙化积分明显高于扫描层厚为2mm的扫描的钙化积分。结论：对于4层多排螺旋CT而言，使用2mm的扫描层厚进行冠状动脉钙化扫描较为合适。     

Unusual origin and course of the first septal branch of the left coronary artery: Angiographic recognition

The anatomical variants of the origin and course of the first septal branch (S1) of the left coronary artery system have received little attention in the literature dealing with coronary angiography. We describe here the angiographic features of the ectopic origin of S1 from epicardial branches of the left coronary artery other than the left anterior descending artery as observed in 8 cases from a series of 700 consecutive patients (1.1%). The S1 originated from the left main coronary artery in 1 case, from a diagonal branch in 4, and from an intermediate branch in 3 cases. Previous reported cases are reviewed. Because the S1 may supply up to 15% of the blood to the myocardium, the recognition of this variable origin may have clinical implications and has to be considered as a part of the complete evaluation of coronary arteriograms of patients referred for coronary artery revascularization.     

脊神经刺激对冠脉内皮功能及血流储备的影响

目的观察脊神经刺激对冠脉内皮功能及血流储备的影响。方法小型猪10只,用冠脉造影的方法,测量左冠脉主干的内径。同时插入5F塑型后的右冠造影管到冠状静脉窦。在胸椎3～4间隙椎旁2cm,分别进针3．5cm,电麻仪刺激30分钟。刺激后立即做冠脉造影,并同时分别抽取冠状动静脉血各1ml送检,测量其NO、ET含量。结果刺激脊神经可以改善内皮功能,促进内皮细胞释放NOx同时减少ET的释放,增加冠状动脉直径。结论脊神经刺激疗法能改善冠脉内皮功能及血流储备。     

Value of conventional chest radiography for the detection of coronary calcifications: comparison with MSCT

Purpose

To evaluate if computed tomography (CT) coronary calcium scoring is needed after detection of coronary calcifications on conventional chest radiographs.

Materials and methods

One hundred and five patients (67 men; 57.2 ± 12.8 years) with suspected coronary artery disease underwent conventional chest radiography and non-enhanced, retrospectively ECG-gated multislice spiral CT (MSCT) of the heart (4 mm × 2.5 mm, 120 kV, 133 mAs_eff.). Chest radiographs were assessed independently by two radiologists. Detection of coronary calcifications was compared between both methods. Sensitivity, specificity, negative and positive predictive values, median, 25% and 75% percentiles for the detection of coronary calcifications were calculated. Receiver operating characteristics (ROC) analyses were computed.

Results

In 90 patients, MSCT revealed coronary calcifications. The mean coronary calcium score was 526.2 (0–4784.5). On chest radiographs, coronary calcifications were correctly detected in 46 (61) patients by observer 1 (observer 2). The corresponding sensitivity was 51.1% in observer 1 and 67.8% in observer 2. Median of detected coronary calcifications was 361.9 (426.4) for observer 1 (observer 2). Corresponding 25% und 75% percentiles were 109.6 (109.6) and 798.5 (898.5). The area under the ROC curve was 0.636 for observer 1 and 0.715 for observer 2. There was no correlation between image quality and the detection of coronary calcifications on plain film radiographs.

Conclusion

As coronary calcifications of various extents are inconsistently detected on plain chest radiographs, CT calcium scoring may not be omitted even if coronary artery calcifications were detected on conventional chest radiographs.     

The Journal of Cardiovascular Computed Tomography year in review - 2018

Since the introduction of ≥64 detector row coronary computed tomography angiography (CCTA) as a noninvasive imaging modality, various clinical trials have established its diagnostic performance and prognostic significance when compared to other anatomic and functional tests for coronary artery disease (CAD). CCTA has been increasingly utilized for a wide range of clinical scenarios, driven by both advances in technology as well as data showing improvement in outcomes. Accumulating evidence has continually refined and supported the central role of CCTA within clinical care, and this year has witnessed continued evolution of the application of CCTA within healthcare and translational research. The purpose of the present review is to summarize the year of the Journal of Cardiovascular Computed Tomography (JCCT), highlighting the evidence base supporting the appropriate application of cardiac computed tomography across numerous clinical domains.     

成人冠状动脉起源异常的分类及其发生率

 目的 探讨成人冠状动脉起源异常(AOCA)类型及其发生率.方法 对2000年10月～2006年10月在我院行冠状动脉造影(1 520例)检出的26例存在AOCA患者资料,以及国内2006年10月以前发表的有关成人AOCA研究的8篇文献资料进行综合分析.结果 9组资料冠状动脉造影总例数48 158例,检出AOCA439例,检出率0.91%.右冠状动脉起源异常发生率0.55%(267例),明显高于左冠状动脉0.36%(174例),差异有统计学意义(P＜0.01).右冠状动脉起源于左冠窦为最常见类型,占41.5%(182例);其次为前降支和回旋支独立开口,占26.0%(114例).结论 我国成人AOCA多见于右冠状动脉,其中具有潜在临床危险的右冠状动脉起源于左冠窦为最常见类型,提示加强国人AOCA研究具有重要临床意义.     

Practical tips and tricks in cardiovascular computed tomography: Non-contrast “heartscans”—beyond the calcium score

The Agatston total coronary artery calcium (CAC) score, derived from a non-contrast CT scan of the heart (also known as the “heartscan”) in asymptomatic and symptomatic patients, has been shown to provide incremental and independent assessment to conventional risk factors based upon literally hundreds of studies published from around the world. However, recent data have emerged to indicate that there is additional information which can be derived from a “heartscan” beyond the calcium score. These include recent data on the applicability across ethnic sub-groups, prognostication in the elderly, defining “heart age” versus chronological age for individual risk stratification, evaluating CAC distribution in addition to total CAC score, and looking beyond the coronary arteries regarding left ventricular size, arotic root/thoracic aorta diameter, and epicardial fat.     

64排容积CT对成人冠状动脉起源异常的诊断价值

 目的 探讨64排容积CT对成人冠状动脉起源异常的诊断价值.方法 回顾分析3 030例成人冠状动脉CTA检查资料. 结果 3 030例冠脉CTA中,检查出冠状动脉起源异常70例,检出率为2.3%,其中冠状动脉起源于对侧冠状窦及窦外27例(38.5%);冠状动脉高位开口23例(32.8%);前降支、回旋支均开口于左冠状窦17例(24.3%);单一冠脉2例(均为单一左冠,其中1例合并左主干高开口,2.8%),回旋支开口于对角支及窦房结支开口于右冠状窦各1例(1.4%).结论 64排容积CT诊断冠状动脉起源异常是一种无创、安全、准确、经济的检查方法 .     

Coronary artery calcification and ethnicity

Differences in risk factors do not fully explain the differences in the prevalence of atherosclerotic cardiovascular disease (ASCVD) in various ethnicities. Coronary artery calcification (CAC) is an established marker of subclinical coronary artery disease. Several published studies within and outside the United States (US) have shown that racial and ethnic differences exist regarding prevalence and severity of CAC. Although ethnic-specific CAC nomograms are used for more accurate prediction of ASCVD events, some reports suggest a linear relationship between coronary artery calcium (CAC) scoring and ASCVD regardless of age, sex and ethnicity. We performed a comprehensive review of available studies on ethnic differences in coronary calcification in MEDLINE, Cochrane library and BioMed Central databases. We review in detail the differences in CAC in predominant racial groups residing within the US, including whites, blacks, Hispanics, East and South Asians. Furthermore, we discuss available data from outside the US, mainly originating in Europe, Japan, and Korea.     

64排螺旋CT冠脉成像在冠心病诊断中的应用

目的 评价64排螺旋CT冠状动脉(冠脉)成像(CTA)在冠心病诊断中的应用价值.方法 以选择性冠脉造影(SCA)结果为金标准,采用64排螺旋CT对68例疑诊冠心病患者的冠脉主干及主要分支272节段进行重建和分析,评价其诊断冠心病的灵敏度和特异度.结果 CTA能够清晰显示冠脉主干及其分支狭窄、钙化、开口起源异常及桥血管病变,CTA发现钙化病变52节段,SCA仅发现钙化病变35节段.CTA诊断冠脉病变的灵敏度96.33%,特异度98.16%,阳性预测值97.22%,阴性预测值97.56%.其中对左主干、左前降支病变及＞75%的病变灵敏度最高,分别达到100%和94.4%.结论 CTA对冠脉狭窄病变、桥血管、开口畸形、支架管腔均显影良好,对冠心病诊断有较高的准确性,对钙化病变诊断率优于冠脉造影,可以作为冠心病高危人群无创性筛选检查及冠脉支架术后随访手段.     

钙化积分扫描缩短冠脉CTA扫描范围及降低辐射量的作用

目的:探讨使用钙化积分扫描缩短增强扫描范围以降低后门控冠状动脉CTA检查辐射量的临床应用价值。方法:40例患者行冠脉钙化积分及冠脉CTA检查,其增强扫描的实际扫描范围根据钙化积分扫描图像来决定,即冠状动脉树上缘1cm至心尖部心包影即将消失的层面。并按常规方法在定位像上测量增强扫描的预计扫描范围,即气管隆突下1cm至心脏下缘2cm。比较两种扫描范围及相应的辐射剂量的差异。结果:实际扫描范围比预计扫描范围平均缩短(2.09±0.76)cm(t=17.31,P<0.01),冠状动脉CTA各序列总剂量较常规方法平均减少(1.51±0.87)mSv,差异有极显著性意义(t=10.92,P<0.01),相当于各序列平均剂量总和的9.20%。结论:使用钙化积分扫描图像能有效缩短增强扫描的范围,从而明显降低冠状动脉CT血管成像的辐射量。