News | Computed Tomography (CT) | October 12, 2018

Abdominal Aortic Calcification May Signal Future Heart Attack

CT-based measurement of calcification may improve risk assessment for individuals in indeterminate range with traditional risk scores

Images from computed tomography (CT) colonography show segmented abdominal aortic calcification measured with semiautomated CT tool on coronal image. Within region of interest over aorta selected by user, tool automatically segments and quantifies aortic calcification (shown in blue). 

Image Credit: O’Connor S D, Graffy P M, Zea R, et al. Does nonenhanced CT-based quantification of abdominal aortic calcification outperform the Framingham Risk Score in predicting cardiovascular event sin asymptomatic adults? Radiology doi: 10.1148/radiol.2018180562. Published online Oct. 2, 2018. © RSNA.

October 12, 2018 — Computed tomography (CT)-based measures of calcification in the abdominal aorta are strong predictors of heart attacks and other adverse cardiovascular events — stronger even than the widely used Framingham risk score. These assertions are according to a new study published in the journal Radiology.1

Cardiovascular diseases are the leading cause of death worldwide. Of these deaths, heart disease and stroke are the deadliest. Effective measures of cardiovascular disease risk are crucial in predicting which patients are most in need of early interventions like diet and lifestyle changes, or medications to lower cholesterol.

“We found a strong association between abdominal aortic calcification and future cardiovascular events,” said lead author Stacy D. O’Connor, M.D., MPH, assistant professor of radiology at the Medical College of Wisconsin in Milwaukee. “With heart disease being a leading cause of death, anything we can do to make our patients more aware of their risk is going to help.”

The Framingham risk score is a well-known and widely used prediction model for cardiovascular disease based on traditional risk factors like age, cholesterol and blood pressure. However, many patients evaluated by the Framingham risk score fall into an indeterminate risk category and could benefit from additional noninvasive tools for refining risk assessment like measures of atherosclerosis, which is narrowing of the arteries due to plaque buildup. CT is commonly used to measure calcium, a component of plaque, in the coronary arteries.

CT can also measure calcium in the abdominal aorta, the large vessel that carries oxygenated blood to the lower extremities. The abdominal aorta can be seen on abdominal imaging exams like CT colonography, also known as virtual colonoscopy, and in the diagnostic workup for acute cholecystitis, an inflammation of the gallbladder often caused by gallstones.

For the new study, conducted at the University of Wisconsin School of Medicine and Public Health in Madison, researchers assessed the relationship between abdominal aortic calcification on CT and cardiovascular events in 829 asymptomatic patients with a mean age of approximately 58 years. The patients had undergone non-enhanced screening CT colonography between April 2004 and March 2005. The researchers were able to follow the patients for an average of 11 years to see if they had developed adverse cardiovascular events like heart attack, stroke, death or congestive heart failure.

Of the 829 patients, 156 (18.8 percent) had a major cardiovascular event. The events occurred almost seven years after CT, on average, and included heart attack in 39 and death in 79. CT-based abdominal aortic calcification was a strong predictor of future cardiovascular events, outperforming the Framingham risk score. Abdominal aortic calcification was more than five times higher, on average, among those who had a cardiovascular event than those who did not.

The results point to the potential of abdominal aortic calcification assessment as an opportunistic screening tool — something that could be added to other exams without the need for additional patient time or radiation dose. Patients could be assigned to preventive treatment regimens based on their cardiovascular risk categories.

“There are thousands of CT scans performed every day across the United States, so this gives us an opportunity to reach a lot of people,” O’Connor said. “For instance, if someone is getting a scan for cholecystitis and we see abdominal aortic calcification on the CT, we can address things like blood pressure and cholesterol with the patient.”

The researchers plan to build on their results by studying larger groups of patients. They also intend to move toward a fully-automated protocol for more widespread implementation of the assessment.

“It’s our hope that these opportunistic measures can be added to reports for patients undergoing routine abdominal CT, regardless of the imaging indication,” O’Connor said.

For more information: www.pubs.rsna.org/journal/radiology

Reference

1. O’Connor S.D., Graffy P.M., Zea R., Pickhardt P.J. Does Nonenhanced CT-based Quantification of Abdominal Aortic Calcification Outperform the Framingham Risk Score in Predicting Cardiovascular Events in Asymptomatic Adults? Radiology, Oct. 2, 2018. https://doi.org/10.1148/radiol.2018180562

 

Related Content

A lung CT of a COVID-19 patient, showing ground-glass opacities in the lung from COVID pneumonia. Image courtesy of John Kim.

A lung CT of a COVID-19 patient, showing ground-glass opacities in the lung from COVID pneumonia. Image courtesy of John Kim.

News | Coronavirus (COVID-19) | July 09, 2020
July 9, 2020 — With increased lung CT exam paradigms being used in the current...

Image courtesy of GE Healthcare

Feature | Mobile C-Arms | July 08, 2020 | By Melinda Taschetta-Millane
Moblie C-arms have seen several advances over the past de
 Many patients with severe coronavirus disease 2019 (COVID-19) remain unresponsive after surviving critical illness. Investigators led by a team at Massachusetts General Hospital (MGH) now describe a patient with severe COVID-19 who, despite prolonged unresponsiveness and structural brain abnormalities, demonstrated functionally intact brain connections and weeks later he recovered the ability to follow commands

Getty Images

News | Coronavirus (COVID-19) | July 08, 2020
July 8, 2020 — Many patients with severe coronavirus disease 2019 (...
This data represents wave 2 of a QuickPoLL survey conducted in partnership with an imagePRO panel created by The MarkeTech Group (TMTG), regarding the effects of COVID-19 on their business

Getty Images

Feature | Coronavirus (COVID-19) | July 01, 2020 | By Melinda Taschetta-Millane
A 3-D ultrasound system provides an effective, noninvasive way to estimate blood flow that retains its accuracy across different equipment, operators and facilities, according to a study published in the journal Radiology.

Volume flow as a function of color flow gain (at a single testing site). For each row the color flow c-plane and the computed volume flow are shown as a function of color flow gain. The c-plane is shown for four representative gain levels, whereas the computed volume flow is shown for 12–17 steps across the available gain settings. Flow was computed with (solid circles on the graphs) and without (hollow circles on the graphs) partial volume correction. Partial volume correction accounts for pixels that are only partially inside the lumen. Therefore, high gain (ie, blooming) does not result in overestimation of flow. Systems 1 and 2 converge to true flow after the lumen is filled with color pixel. System 3 is nearly constant regarding gain and underestimates the flow by approximately 17%. Shown are mean flow estimated from 20 volumes, and the error bars show standard deviation. Image courtesy of the journal Radiology

News | Ultrasound Imaging | July 01, 2020
July 1, 2020 — A 3-D ultrasound
R2* maps of healthy control participants and participants with Alzheimer disease. R2* maps are windowed between 10 and 50 sec21. Differences in iron concentration in basal ganglia are too small to allow visual separation between patients with Alzheimer disease and control participants, and iron levels strongly depend on anatomic structure and subject age. Image courtesy of Radiological Society of North America

R2* maps of healthy control participants and participants with Alzheimer disease. R2* maps are windowed between 10 and 50 sec21. Differences in iron concentration in basal ganglia are too small to allow visual separation between patients with Alzheimer disease and control participants, and iron levels strongly depend on anatomic structure and subject age. Image courtesy of Radiological Society of North America

News | Magnetic Resonance Imaging (MRI) | July 01, 2020
July 1, 2020 — Researchers using magnetic...
Imaging Artificial Intelligence (AI) provider Qure.ai announced its first US FDA 510(k) clearance for its head CT scan product qER. The US Food and Drug Administration's decision covers four critical abnormalities identified by Qure.ai's emergency room product.
News | Artificial Intelligence | June 30, 2020
June 30, 2020 — Imaging Artificial Intelligence (AI) provider Qure.ai announced its first US FDA 510(k) clearance for
In new QuickPoLL survey on imaging during the pandemic, responses were tallied from around 170 radiology administrators and business managers, who are part of an imagePRO panel created by The MarkeTech Group (TMTG), regarding the effects of COVID-19 on their business. TMTG is a research firm specializing in the medical device, healthcare and pharmaceutical industries.
Feature | Coronavirus (COVID-19) | June 30, 2020 | By Melinda Taschetta-Millane
Cardiac MR can offer data above and beyond anatomical imaging, which is the main reason why this system was installed at Baylor Scott White Heart Hospital in Dallas. The system is a dedicated heart MRI scanner.

Cardiac MR can offer data above and beyond anatomical imaging, which is the main reason why this system was installed at Baylor Scott White Heart Hospital in Dallas. The system is a dedicated heart MRI scanner.

News | Pediatric Imaging | June 29, 2020
June 29, 2020 — A type of smart magnetic r...