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Coronary Calcium Scoring


What is coronary artery disease?

Every 33 seconds someone in the U.S. dies from coronary artery disease (CAD) making it the most common form of heart disease. CAD and its complications, like arrhythmia, angina, and heart attack (also called myocardial infarction), are the leading causes of death in the United States. CAD most often results from a condition known as atherosclerosis, which happens when a waxy substance forms inside the arteries that supply blood to your heart. This substance, called plaque, is made of cholesterol, fatty compounds, calcium, and a blood-clotting material called fibrin.

Frequently Asked Questions
CT Cat Scan MRI Imaging Centers for Cardiology & Oncology in New Jersey & New York City What is coronary artery disease?
CT Cat Scan MRI Imaging Centers for Cardiology & Oncology in New Jersey & New York City What is coronary calcium scoring?
CT Cat Scan MRI Imaging Centers for Cardiology & Oncology in New Jersey & New York City What are some common uses of the procedure?
CT Cat Scan MRI Imaging Centers for Cardiology & Oncology in New Jersey & New York City How should I prepare for the procedure?
CT Cat Scan MRI Imaging Centers for Cardiology & Oncology in New Jersey & New York City What does the equipment look like?
CT Cat Scan MRI Imaging Centers for Cardiology & Oncology in New Jersey & New York City How is the procedure performed?
CT Cat Scan MRI Imaging Centers for Cardiology & Oncology in New Jersey & New York City What will I experience during and after the procedure?
CT Cat Scan MRI Imaging Centers for Cardiology & Oncology in New Jersey & New York City Who interprets the results and how do I get them?
CT Cat Scan MRI Imaging Centers for Cardiology & Oncology in New Jersey & New York City Calcium Score Chart
CT Cat Scan MRI Imaging Centers for Cardiology & Oncology in New Jersey & New York City General Guidelines for Interpretation of Calcium Scores
CT Cat Scan MRI Imaging Centers for Cardiology & Oncology in New Jersey & New York City What are the benefits of Coronary Calcium Scoring?


What is coronary calcium scoring?

Cardiac CT, or coronary calcium scoring, is a fast, painless, and non-invasive way of obtaining information about the location and extent of calcified plaque in the coronary arteries—the vessels that supply oxygen-containing blood to the heart wall. Plaque is a build-up of fat and other substances, including calcium, which can, over time, narrow the arteries or even close off blood flow to the heart. The result may be painful angina in the chest or a heart attack.

Because calcium is a marker of coronary artery disease, the amount of calcium detected on a cardiac CT scan is a helpful diagnostic tool. The findings on cardiac CT are expressed as a calcium score and can help present an overall picture of your heart health.


What are some common uses of the procedure?

The goal of cardiac CT for calcium scoring is to detect coronary artery disease (CAD) at an early stage when there are no symptoms and to determine its severity. It is a screening study that may be recommended by a physician for patients with risk factors for CAD but no clinical symptoms. The procedure is most often suggested for men aged 45 years or older and for women who are aged 55 and above or who are postmenopausal. Some patients choose to have the test on their own even if their doctors have not recommended it, in order to detect early-stage CAD.

The major risk factors for CAD, other than age, are:

  • abnormally high blood cholesterol levels
  • a family history of heart disease
  • diabetes
  • high blood pressure
  • cigarette smoking
  • being overweight or obese
  • being physically inactive


How should I prepare for the procedure?

No special preparation is necessary in advance of a cardiac computed tomography (CT) examination. You may continue to take your usual medications, but should avoid caffeine and smoking for four hours before the exam. If your heart rate is 90 beats a minute or higher, you may be given a drug to slow the rate in order to obtain accurate CT images.

You should wear comfortable, loose-fitting clothing to your exam. You may be given a gown to wear during the procedure.

Metal objects including jewelry, eyeglasses, dentures and hairpins may affect the CT images and should be left at home or removed prior to your exam. You may also be asked to remove hearing aids and removable dental work.

Women should always inform their physician or technologist if there is any possibility that they are pregnant as this test may be harmful to the fetus.


What does the equipment look like?

The CT scanner is typically a large machine with a hole, or tunnel, in the center. A moveable examination table slides into and out of this tunnel. In the center of the machine, the x-ray tube and electronic x-ray detectors are located opposite each other on a ring, called a gantry, which rotates around you. The computer that processes the imaging information and monitor are located in a separate room.


How is the procedure performed?

The technologist begins by positioning you on the CT examination table lying flat on your back. Straps and pillows may be used to help you maintain the correct position and to hold still during the exam.

Electrodes (small metal discs) will be attached to your chest and to an electrocardiograph (ECG) machine that records the electrical activity of the heart. This makes it possible to record CT scans when the heart is not actively contracting.

Next, the table will move quickly through the scanner to determine the correct starting position for the scans. Then, the table will move slowly through the machine as the actual CT scanning is performed.

Patients are periodically asked to hold their breath for periods of 20 to 30 seconds while images are recorded.

When the examination is completed, you will be asked to wait until the technologist determines that the images are of high enough quality for the Radiologist to read.

The actual CT scanning is usually completed in less than 10 minutes.


What will I experience during and after the procedure?

CT exams are painless, fast and easy. When you enter the CT scanner, special lights may be used to ensure that you are properly positioned. With modern CT scanners, you will hear only slight buzzing, clicking and whirring sounds as the CT scanner revolves around you during the imaging process.

You will be alone in the exam room during the CT scan, however, the technologist will be able to see, hear and speak with you at all times.

After a CT exam, you can return to your normal activities immediately.


Who interprets the results and how do I get them?

A Radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will share the results with you.
A negative cardiac CT scan that shows no calcification within the coronary arteries suggests that atherosclerotic plaque is minimal and that the chance of coronary artery disease developing over the next two to five years is very low.

A positive test means that coronary artery disease is present, regardless of whether or not the patient is experiencing any symptoms. The amount of calcification—expressed as a score—may help to predict the likelihood of a myocardial infarction (heart attack) in the coming years.


Calcium Score

Presence of Plaque

0 No evidence of plaque
1-10 Minimal evidence of plaque
11-100 Mild evidence of plaque
101-400 Moderate evidence of plaque
Over 400 Extensive evidence of plaque


General Guidelines for Interpretation of Calcium Scores

MDCT Calcium Score Plaque burden & probability of significant CAD Implications for CV risk Recommendations
0-10 Cannot exclude the possibility of atherosclerosis. Although negative or extremely low, there is a five percent or lower probability of significant obstructive disease Very Low to Low No specific further work-up would be recommended in an asyptomatic group. Non-calcified atherosclerosis cannot be excluded, discussion of primary prevention of CV disease should be emphasized.
11-100 Consistent with mild atherosclerotic burden and despite the fact that the likelihood of significant obstructive disease is low (less than 20 percent) atherosclerosis is clearly present. Moderate Daily use of coated aspirin (81-325 mg) and NCEP1 guidelines for cholesterol reduction similar to patients with greater than or equal to two traditional CV risk factors should be considered. Antioxidant therapies could also be considered in this group.
101-400 Consistent with at least moderate atherosclerosis and a high likelihood of moderate non-obstructive CAD. Moderately High An aggressive approach to lipid lowering (similar to patients with documented CAD by angiography or previous cardiac events), strict control of diabetes and hypertension, smoking cessation, dietary counseling, daily coated aspirin use (81-325 mg), antioxidant therapies and regular aerobic exercise should be instituted. Exercise stress testing should be considered.
Over 400 Advanced atherosclerotic plaque present. There is high likelihood of at least one obstructive coronary stenosis and high CVD risk. High These patients should undergo the above outlined aggressive risk strategies and should be strongly considered for a stress imaging study such as stress nuclear or echo testing.
* NCEP-National Cholesterol Education Program
* If calcium score is greater than or equal to 75th percentile for age/gender, advance to recommendations for next calcium score range.


What are the benefits of Coronary Calcium Scoring?

  • Cardiac computed tomography (CT) for calcium scoring is a convenient and noninvasive way of evaluating the coronary arteries.
  • Cardiac CT takes little time and causes no pain.
  • The exam does not require injection of contrast material and therefore avoids its possible side effects.
  • The examination can suggest the presence of CAD even when the coronary arteries are less than 50 percent narrowed. Standard cardiac tests will not reliably detect this level of blockage, and more than half of all heart attacks occur with less than 50 percent narrowing.
  • No radiation remains in a patient's body after a CT examination.
  • X-rays used in CT scans usually have no side effects.
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