Overestimation of coronary artery stenosis due to calcified plaque

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Imaging description Coronary artery calcification is routinely encountered at coronary CT angiography. In some cases, large amounts of calcium may obscure the lumen of the vessel, limiting the accuracy of evaluation. The true severity of coronary artery stenosis in the presence of large plaques is frequently overestimated by CT secondary to blooming artifact and beam hardening, leading to false positive diagnoses. Use of a wide window and level at the workstation, sharp reconstruction kernels, and iterative reconstruction techniques are recommended to limit these artifacts as much as possible (Figures 29.1 and 29.2). Importance Heavy coronary calcification limits the accuracy of coronary CT, sometimes leading to overcalling of severity of disease. This may lead to unnecessary testing such as cardiac catheterization or stress testing, and the risks and expenses associated with those procedures. Typical clinical scenario Coronary artery calcification is very common, particularly in older patients with risk factors for coronary artery disease. Several studies have shown an increase in false positive coronary CT angiography (CCTA) results in the setting of extensive coronary calcium. In a meta-analysis of 19 published studies, specificity of coronary CT compared to the gold standard of catheter angiography was reduced to 42% in patients with calcium scores ≥ 400, as compared to 90% for patients with scores 95%) in patients with extensive calcium.

Original languageEnglish (US)
Title of host publicationPearls and Pitfalls in Cardiovascular Imaging: Pseudolesions, Artifacts and Other Difficult Diagnoses
PublisherCambridge University Press
Pages93-95
Number of pages3
ISBN (Print)9781139152228, 9781107023727
DOIs
Publication statusPublished - Jan 1 2015

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ASJC Scopus subject areas

  • Medicine(all)

Cite this

Zimmerman, S. (2015). Overestimation of coronary artery stenosis due to calcified plaque. In Pearls and Pitfalls in Cardiovascular Imaging: Pseudolesions, Artifacts and Other Difficult Diagnoses (pp. 93-95). Cambridge University Press. https://doi.org/10.1017/CBO9781139152228.030