Patterns of coronary arterial lesion calcification by a novel, cross-sectional CT angiographic assessment

Rodrigo Cerci, Andrea L. Vavere, Julie M. Miller, Kihei Yoneyama, Carlos E. Rochitte, Marc Dewey, Hiroyuki Niinuma, Melvin E. Clouse, Roger Laham, David Bush, Edward P. Shapiro, Albert C. Lardo, Christopher Cox, Jeffrey Brinker, Joǎo A.C. Lima, Armin Arbab-Zadeh

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


To investigate the patterns and diagnostic implications of coronary arterial lesion calcification by CT angiography (CTA) using a novel, cross-sectional grading method, we studied 371 patients enrolled in the CorE-64 study who underwent CTA and invasive angiography for detecting coronary artery stenoses by quantitative coronary angiography (QCA). The number of quadrants involving calcium on a cross-sectional view for ≥30 and ≥50 % lesions in 4,511 arterial segments was assessed by CTA according to: noncalcified, mild (one-quadrant), moderate (two-quadrant), severe (three-quadrant) and very severe (four-quadrant calcium). Area under the receiver operating characteristic curve (AUC) were used to evaluate CTA diagnostic accuracy and agreement versus. QCA for plaque types. Only 4 % of ≥50 % stenoses by QCA were very severely calcified while 43 % were noncalcified. AUC for CTA to detect ≥50 % stenoses by QCA for non-calcified, mildly, moderately, severely, and very severely calcified plaques were 0.90, 0.88, 0.83, 0.76 and 0.89, respectively (P<0.05). In 198 lesions with severe calcification, the presence or absence of a visible residual lumen by CTA was associated with≥50 %stenosis by QCA in 20.3 and 76.9 %, respectively. Kappa was 0.93 for interobserver variability in evaluating plaque calcification. We conclude that calcification of individual coronary artery lesions can be reliably graded using CTA. Most ≥50 % coronary artery stenoses are not or only mildly calcified. If no residual lumen is seen on CTA, calcified lesions are predictive of ≥50 % stenoses and vice versa. CTA diagnostic accuracy for detecting ≥50 % stenoses is reduced in lesions with more than mild calcification due to lower specificity.

Original languageEnglish (US)
Pages (from-to)1619-1627
Number of pages9
JournalInternational Journal of Cardiovascular Imaging
Issue number7
StatePublished - Oct 2013


  • Cardiac CT
  • Coronary artery disease
  • Coronary atherosclerotic disease
  • Coronary calcium

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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