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Opening Plenary Session: 1998 1

Coronary Artery Calcification as an Indicator of Preclinical Coronary Artery Disease

William Stanford, MD

1 From the Department of Radiology, University of Iowa Hospitals and Clinics and University of Iowa College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242. From the Opening Plenary Session at the 1998 RSNA scientific assembly. Received April 22, 1999; revision requested June 11 and received July 2; accepted July 15. Address reprint requests to the author.



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Figure 1.   Photomicrograph (original magnification, x2; hematoxylin-eosin stain) of a coronary artery section shows a large amount of atherosclerotic plaque (p) deposited in the arterial wall. Because of remodeling, the plaque can distort and enlarge the coronary artery without compromising the lumen. Hence, the coronary angiogram may appear normal. (Reprinted, with permission, from reference 6.)

 


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Figure 2.   Photomicrograph (original magnification, x2; hematoxylin-eosin stain) of a coronary artery section shows total occlusion of the vessel by a large thrombus (t) formed by disruption of a thin fibrous plaque (p) over an accumulation of lipid in the arterial wall. Arrows = area of rupture of the fibrous cap (c).

 


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Figure 3.   Photomicrograph (original magnification, x2; hematoxylin-eosin stain) of a coronary artery section shows significant stenosis, with lipid and calcification (*) in the plaque (p). (Figs 2 and 3 reprinted, with permission, from reference 6.)

 


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Figure 4.   Electron beam CT scan of a 65-year-old man shows multiple areas of dense calcification along the left main, left anterior descending, and circumflex coronary arteries. Calcifications are also seen within the aortic wall.

 


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Figure 5.    Electron beam CT scan of a 32-year-old man shows a small area of calcification in the left anterior descending artery (arrow). At angiography, the calcification was associated with an area of critical stenosis; the patient subsequently underwent a successful balloon angioplasty.

 


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Figure 6a.   (a) Electron beam CT scan of a male patient shows multiple areas of calcification in the left main and left anterior descending coronary arteries (arrows). (b) On the electron beam CT scan, regions of interest have been placed around the lesions noted in the left main and left anterior descending arteries. Scoring is done by intrinsic scanner software. Lesion C (top rectangle) had a peak attenuation of +519 HU and an area of 11.59 mm2.

 


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Figure 6b.   (a) Electron beam CT scan of a male patient shows multiple areas of calcification in the left main and left anterior descending coronary arteries (arrows). (b) On the electron beam CT scan, regions of interest have been placed around the lesions noted in the left main and left anterior descending arteries. Scoring is done by intrinsic scanner software. Lesion C (top rectangle) had a peak attenuation of +519 HU and an area of 11.59 mm2.

 


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Figure 7a.   (a) Electron beam CT scan shows coronary artery calcific deposits in the left main and left anterior descending coronary arteries. (b) On a helical CT 500-msec image, the coronary calcific deposits appear somewhat blurred because of the longer scan times and absence of triggering of the helical CT scanner. (Many newer helical CT scanners now have triggering capability.)

 


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Figure 7b.   (a) Electron beam CT scan shows coronary artery calcific deposits in the left main and left anterior descending coronary arteries. (b) On a helical CT 500-msec image, the coronary calcific deposits appear somewhat blurred because of the longer scan times and absence of triggering of the helical CT scanner. (Many newer helical CT scanners now have triggering capability.)

 


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Figure 8a.   Helical CT (a) and electron beam CT (b) scans demonstrate calcific lesions (arrow) in the circumflex coronary artery. Images of the circumflex artery lesions are often less blurred than those of left anterior descending artery lesions because of less motion.

 


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Figure 8b.   Helical CT (a) and electron beam CT (b) scans demonstrate calcific lesions (arrow) in the circumflex coronary artery. Images of the circumflex artery lesions are often less blurred than those of left anterior descending artery lesions because of less motion.

 





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