J Korean Soc Radiol.  2010 Feb;62(2):105-112. 10.3348/jksr.2010.62.2.105.

Calcified Plaque of Coronary Artery: Factors Influencing Overestimation of Coronary Artery Stenosis on Coronary CT Angiography

• Kim MH
• Ko JS
• Kim YH
• Choi S
• Seon HJ
• Jeong GW
• Park JG
• Kang HK

• KMID: 2208946
• DOI: http://doi.org/10.3348/jksr.2010.62.2.105

Abstract

PURPOSE: To assess the influence of calcified plaque characteristics on the overestimation of coronary arterial stenosis on a coronary CT angiography (CCTA).
MATERIALS AND METHODS
The study included 271 coronary arteries with calcified plaques identified by CCTA, and based on 928 coronary arteries from 232 patients who underwent both CCTA and invasive coronary angiography (ICA). Individual coronary arteries were classified into two groups by agreement based on the degree of stenosis from each CCTA and ICA: 1) group A includes patients with concordant CCTA and ICA results and, 2) group B includes patients with an overestimation of CCTA compared to ICA. Parameters including total calcium score, calcium score of an individual coronary artery, calcium burden number of an individual coronary artery, and the density of each calcified plaque (calcium score/number of calcium burden) for each individual coronary artery were compared between the two groups.
RESULTS
Of the 271 coronary arteries, 164 (60.5%) were overestimated on CCTA. The left anterior descending artery (LAD) had a significantly low rate of overestimation (47.1%) compared to the other coronary arteries (p=0.001). No significant differences for total calcium score, calcium score of individual coronary artery, and the density of each calcified plaque from individual coronary arteries between two groups was observed. However, a decreasing tendency for the rate of overestimation on CCTA was observed with an increase in calcium burden of individual coronary arteries (p<0.05).
CONCLUSION
The evaluation of coronary arteries suggests that the degree of coronary arterial stenosis had a tendency to be overestimated by calcified plaques on CCTA. However, the rate of overestimation for the degree of coronary arterial stenosis by calcified plaques was not significantly influenced by total calcium score, calcium score of individual coronary artery, and density of each calcified plaque.

MeSH Terms

Angiography
Arteries
Calcification, Physiologic
Calcium
Constriction, Pathologic
Coronary Angiography
Coronary Artery Disease
Coronary Stenosis
Coronary Vessels
Humans
Tomography, X-Ray Computed
Calcium

Figure

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  Fig. 1 A 76-year-old woman with chest pain. A. Screenshot of calcium scoring displays number of calcium burden as number of lesion. B. Precontrast CT image shows multiple calcified plaques in proximal & mid-left circumflex artery. C. Curved multiplanar reformation of coronary CT angiography (CCTA) image shows significant stenosis (arrows) at proximal & mid-left circumflex artery. D. Invasive coronary angiography shows corresponding results (arrows) with CCTA.

• 

  Fig. 2 A 65-year-old man with chest pain. A. Screenshot of calcium scoring displays number of calcium burden as number of lesion. B. Precontrast CT scan shows dense calcified plaques in proximal left anterior descending artery. C. Curved multiplanar reformation of coronary CT angiography image shows significant stenosis (arrow) at left anterior descending artery. D. Invasive coronary angiography shows insignificant (<50%) luminal narrowing (arrow) at proximal left anterior descending artery.

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