Imaging Cardiovascular Calcification

Abstract

Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Atherosclerosis is a complex and multifactorial process, characterized by early asymptomatic formation of plaque in the arterial walls, silent plaque progression that poses flow limitation, and risk of sudden rupture and subsequent thrombotic occlusion.1 The early assessment and predictive value of atherosclerotic plaque development and rupture are critically important to prevent clinical consequences. Inflammation and calcification play important roles in the pathophysiological progression of atherosclerosis. In the early stage, inflammation is the predominant process involved that promotes plaque progression and calcification.2 The repeated cycles of inflammatory damage and repair ultimately lead to calcification of the vessel walls,3 whose extent provides an important estimate of atherosclerotic progression and clinical prognosis. Macrocalcification is considered the stable stage of vascular disease, whereas the dynamic process of microcalcification may increase the risk of plaque rupture and adverse clinical events.4 Therefore, imaging early calcification is important to identify individuals with enhanced risk of cardiovascular events. Furthermore, many studies have demonstrated coronary artery calcification as a marker for the extent of atherosclerosis and overall plaque burden, and as an important independent predictor of cardiovascular events, mortality, and morbidity.5, 6, 7, 8 Over the past few decades, advanced imaging methods have improved our assessment of atherosclerotic calcification and have provided insights into cardiovascular risk and have contributed to the understanding of the underlying pathophysiologic mechanisms of atherosclerosis. This review aims to summarize current imaging techniques for vascular calcification (Table) and their applications in clinical research. Table 1 Current Imaging Techniques for Vascular Calcification