Approach to Analyzing and Reporting Coronary Computed Tomography

Abstract

Acomprehensive coronary computed tomographic (CT) examination may include the calcium score, evaluation of the coronary arteries including prior coronary interventions such as bypass grafts and stents, qualitative and quantitative evaluation of left ventricular function, cardiac chambers and morphology, and evaluation of the cardiac valves. Calcium Score Evaluation begins with review of the prospectively triggered non-contrast-enhanced axial source images acquired for cardiac scoring. The axial source images should be reviewed in conjunction with the semiquantitative calcium scores obtained using a dedicated calcium scoring software analysis program (Fig. 1). The calcium scores for the individual coronary arteries using the AJ-130 method are reported along with the total AJ-130 score, and also the newer volume score and/or mass score. 1-3 The latter two scoring methods have been shown to be less variable and may be more useful if patients undergo follow-up examinations. While a negative calcium score implies a low probability for obstructive coronary artery disease and future coronary events, a positive calcium score is an independent predictor of both. The relative risk for an acute cardiac event increases with a higher score. The risk for an acute cardiovascular event can be potentially estimated from the total cardiac score (Table 1). 4-6 Table 1 provides the scoring strata and relative risk in asymptomatic patients. The score should be reported by percentile rank for age and gender (Table 2).