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Coronary Calcium Scoring

Q.     What is Coronary Calcification Scoring?

Coronary calcification scoring or cardiac scoring is a CT technique to determine the amount of calcium build up in the coronary arteries. Coronary artery calcification is a specific marker for coronary atherosclerosis. The amount of calcification correlates with severity of coronary atherosclerosis and the probability of obstructive disease.

Q.     How is it performed?

The scan is performed on an ultrafast CT (either helical or electron beam CT with similar accuracy) in one breathhold. At AIC a 16-slice ultrafast multi-slice, multi-detector helical CT is used, and the whole procedure takes just a few minutes.

Q.     What happens after the scan?

The data are processed via a special cardiac scoring software package. A radiologist then evaluates the images and puts region of interests (ROI's) on the calcified coronary arteries. At the end, individual scores for four arteries (left main, LAD, circumflex, and right coronary) and a total score are calculated. The total score falls under one of the following categories:

0-1: NO CALCIFICATION (extremely low likelihood for obstructive coronary disease);

1-10: MINIMAL CALCIFICATION;

11-100: SMALL AMOUNT CALCIFICATION;

101-400: MODERATE CALCIFICATION;

>400: LARGE AMOUNT CALCIFICATION (high likelihood for extensive coronary atherosclerosis).

Q.     What's the accuracy of the test?

It has a nearly 100% sensitivity for calcifications and nearly 100% negative predictive value for future coronary events. The positive predictive value ranges from 50 to 80. A zero or very low score implies virtually no coronary obstructive disease with the exception occurring in young patients who smoke (soft plaques). A high score indicates a significant plaque burden and risk for future cardiovascular event. It should be understood that calcification is not site specific for stenosis but rather indicates the extent of atherosclerosis in the coronary arteries overall. The score may be used as benchmark to measure subsequent disease development or assess preventive programs.

Q.     Who should get this test?

Individuals who have any of the following: history of smoking, diabetes, hypertension, hypercholesterolemia, family history of coronary artery disease, obesity, sedentary lifestyle, high level of stress, atypical chest pain, asymptomatic males over 45 and females over 55 years of age.

No calcification Calcification in LAD coronary artery



Coronary artery disease (CAD) is the leading cause of death in the United States. Each year 30-50% of the 1.5 million American men and women who have a heart attack (myocardial infarct) die as a result. Most of these occur in people who've had no previous symptoms or warning. Men are at greater risk for heart attack at certain times of their lives, but overall men and women die at equal rates from CAD.

Coronary artery calcification scoring is a non-invasive CT scan of the heart performed on our 16-slice Helical CT. The scan detects and quantifies calcified atherosclerotic plaque in the coronary arteries. A score is computed based on the amount of calcification detected. Your score is an accurate predictor of the degree of narrowing of the coronary arteries and the likelihood of a future coronary event (heart attack). The radiologist, an imaging specialist, will interpret the scans and send a report to you and your physician.

The American Heart Association has identified the following risk factors:

  • Men over age 45
  • Women over age 55
  • Elevated LDL cholesterol
  • Low HDL cholesterol
  • Family history of coronary artery disease
  • Smoking
  • Obesity
  • Sedentary life style
  • High blood pressure
  • Diabetes

If you are a male over 45 or a female over 55 and have one or more of these risk factors,

 

CORONARY CALCIFICATION SCORING
WILL BE USEFUL TO YOU!

500,000 Americans die from coronary artery disease (heart attack) yearly. Most have no warning prior to their death! Early detection of calcified atherosclerotic plaque can prompt preventive action to minimize risk of heart attack or direct you to seek medical evaluation for further testing. Coronary atherosclerosis can be slowed, stopped, and possibly reversed before artery blockage results in heart muscle damage or death.

Remember, in cardiac disease, PREVENTION could mean everything!

Coronary Artery Calcification Scoring has clinical value:

  • To determine if patients with chronic atypical chest pain have coronary atherosclerosis.
  • To screen asymptomatic patients in order to stratify their risk of coronary disease and future cardiac events.
  • To exclude the presence of coronary artery disease in women over 60 years of age.
  • To determine if patients with equivocal stress or thallium test have coronary artery plaque before proceeding to coronary angiography.
  • To identify postmenopausal women with low risk for coronary disease who are therefore less likely to benefit from cardioprotective effects of hormone replacement therapy.
  • To determine if a dilated cardiomyopathy is secondary to coronary artery disease or not.
  • To simplify the pre-operative cardiac clearance of women over age 60.
  • To follow the progression of coronary artery plaque non-invasively.

Read selected journal references for Coronary Artery Calcification Scoring.
 

Q & A regarding AIC's Ultrafast, multidetector Helical CT

Q.     Can you tell me about the new helical CT at AIC?

A.     Certainly. It is a 16-slice CT. The new helical CT has replaced our old dual-slice CT. It is a multi-slice (multi-detector) CT capable of simultaneously scanning 16 slices evry 0.4 second (or 40 slices per second), thus increasing the speed of CT scanning by at least a factor of 40 or more. It is the fastest CT in the Antelope Valley area.

Q.     What does ultrafast CT allow you to do?

A.     Here's a summary (* denotes AIC exclusive):

  1. Fast high-resolution (1-2 mm) routine imaging of the neck, chest, abdomen, and pelvis.
  2. *Fast high-res (0.5 mm) imaging of the IAC's/Temporal bones.
  3. *Fast ultra-high-resolution (0.5 mm) imaging of the bones for 4D isotropic reconstruction.
  4. 3D and 4D CT Angiography (CTA): aorta, pulmonary arteries, runoffs, brain.
  5. Coronary artery calcification scoring (excellent non-invasive screening test).
  6. Virtual endoscopy (colonoscopy, bronchoscopy, and endovascular angioscopy with CT!)

Q.     What does coronary calcification scoring tell you?

A.     Coronary scoring is a safe, noninvasive and fast screening CT technique that scans the heart in a few seconds and gives a score based on the amount of calcium build up in the coronary arteries. The score is a good predictor of future coronary events. For instance, it has a 100% negative predictive value!

Q.     Can you tell me more about the new workstation at AIC?

A.     Certainly. The new workstation is a state-of-the-art silicon graphics workstation linked to all our modalities including Open MRI, high-field MRI, Helical CT, and Nuclear med (SPECT/PET). It is a powerful and sophisticated computer capable of amazing multiplanar and 4D reconstruction, fusion of images from different modalities, 4D virtual endoscopy, dental scan, 3D/4D CT Angiography (CTA), just to name a few. It is simply technology at its best.

Q.     What is virtual endoscopy?

A.     This noninvasive technique is one of the hottest areas in CT today that allows 4D visualization of hollow organs (colon, bronchus, etc.) similar to video endoscopy. This is only available at AIC.

Q.     I have not heard of image Fusion. Can you explain?

A.     Of course. Image fusion is a sophisticated software utilized by our workstation that allows fusion of images from different modalities (e.g., CT, MRI, SPECT, PET) or fusion of images from the same modality at different times (to evaluate for growth). For example, a physiologic/metabolic SPECT or PET image can be combined with an anatomic CT or MRI image to provide an anatomico-physiologic image.
 

| ScanHealth | Open MRI | High-field MRI | MR Angiography | Helical CT | CT Angiography | Calcium Scoring |
| 4D CT Reconstruction | Dental Scan | 4D Ultrasound | Nuclear Medicine | PET Scan | DEXA Bone Density | X-ray |


Facts about services at AIC

1.     The only community-based, private-practice, physician-operated imaging facility in the Antelope Valley, just like any other private practice medical office.   Not belonging to any hospital or outside imaging network.   This means more personal and caring service.

2.     AIC was the first MRI-accredited site in the Antelope Valley ... approved by the American College of Radiology's MRI Accreditation Committee.

3.     Dr. Ray Hashemi is the only radiologist in the area with fellowship training in ALL aspects of MRI, including neuro and musculoskeletal MRI.

 

Why is AIC the PIONEER in advanced medical imaging in the Antelope Valley?

1.     AIC was the first to introduce a high-quality OPEN MRI (open-air or open-sided MRI) to the Antelope Valley (January 1998).

2.     AIC was the first to introduce Short-bore OPEN High-Field (1.5 Tesla) MRI to the Antelope Valley (January 1999).

3.    AIC was the first to introduce multi-slice CT (MSCT) to the Antelope Valley (August 1999); upgraded to a 16-slice CT in 2003.

4.     AIC was the first to introduce revolutionary 3D Ultrasound to the Antelope Valley (April 1999); upgraded to a GE 4D Ultrasound in 2004.

5.     AIC was the first to introduce a PET scanner to the Antelope Valley (July 1999).

6.     AIC was the first to achieve MRI Accreditation in the Antelope Valley (July 2000).

Call us at one of our three locations: Lancaster (661) 949-8111, Palmdale (661) 456-2020 or Valencia (661) 255-0060

copyright © 2004 ray h. hashemi, m.d., ph.d.