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  • Title: The degree of stenosis on cardiac catheterization compared to calcified coronary segments on multi-detector row cardiac computed tomography MDCT.
    Author: Madaj P, Gopal A, Hamirani Y, Zeb I, Elamir S, Budoff M.
    Journal: Acad Radiol; 2010 Aug; 17(8):1001-5. PubMed ID: 20605733.
    Abstract:
    RATIONALE AND OBJECTIVES: Cardiac computed tomography is increasingly being used to assess the degree of stenosis in coronary arteries. It has been shown in multiple studies to have high negative predictive value for obstructive disease compared to invasive cardiac catheterization (ICA). However, calcified segments are interpreted differently in each study. The aim of this study was to examine the association of calcified plaques on multi-detector row cardiac computed tomography (MDCT) with the degree of stenosis on ICA. MATERIALS AND METHODS: A total of 129 consecutive patients who underwent coronary evaluation on MDCT and also underwent ICA within 1 month of MDCT were included in the study. Each segment in the coronary artery was classified as mixed, calcified, or noncalcified. All segments with calcified plaque were evaluated, further classifying them as mild, moderate, or severe, and obstructive disease on ICA was used as the reference standard, in a blinded fashion. RESULTS: The average age of the patients was 60.8 9.5 years. A total of 379 calcified segments were included in the study. Among these segments, 363 (95.8%) were found to be nonobstructive (<70% stenosis) on ICA. Calcifications were categorized as mild, moderate, and severe in 283 (74.7%), 58 (15.3%), and 38 (10.0%) segments, respectively. When calcium was incomplete in the cross-section of the lumen (mild or moderate calcification), 98.5% of these segments (336 of 341) were associated with nonobstructive disease, decreasing to 71% with severe calcification. CONCLUSION: Calcified plaques seen on MDCT were commonly associated with nonobstructive disease on invasive angiography. Increasing focal calcification increased the likelihood of obstructive disease, but only 29% of severe segments were associated with significant obstructive disease.
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