Optimized detection, visualization, and quantification of the coronary artery plaque – which pathway?
Optimized detection, visualization, and quantification of the coronary artery plaque – which pathway?
For her dissertation, Magdalena Dobrolinska explored the detection, visualization, and quantification of coronary artery calcifications (coronary calcification) using various imaging techniques. First, Dobrolinska assessed the effectiveness of an improved scoring method for coronary calcifications in preclinical studies. She used both coronary calcium scoring CT (CSCT) and coronary CT angiography (CCTA) for this purpose. Second, she investigated whether coronary calcifications could be detected with low-dose CT (LDCT) combined with myocardial perfusion PET. She also examined potential improvements in predicting major cardiac events based on coronary calcium scores derived from LDCT scans. Third, Dobrolinska analyzed coronary calcifications in patients at the highest risk of cardiovascular disease. Finally, she proposed future research combining both invasive and non-invasive methods to distinguish ischemia (insufficient blood flow to tissues) caused by narrowing of the aorta and coronary arteries.
Dobrolinska's key finding was the introduction of a calibration tool that enables consistent calcium score measurements across different CT scanners (vnAS – vendor-neutral Agatston score). Calcium scores for the same patient obtained from six different scanners can vary by up to 50%. This highlights the urgent need for changes in calcium scoring methodology to allow stricter thresholds in routine clinical practice. Using the proposed vnAS, Dobrolinska reassigned a significant portion of patients to different risk categories, ranging from low to high calcium groups. A substantially higher percentage of these reclassified individuals experienced coronary artery disease and calcification compared to participants who were not reassigned. This suggests that vnAS offers improved risk classification compared to the traditional Agatston score.
Approximately 90% of medical centers worldwide rely on CT scanners with much lower temporal resolution, leading to greater variability in calcium scores. Moreover, these older scanners are often found in middle- to low-income countries, which are disproportionately affected by cardiovascular disease. Therefore, the calibration factor Dobrolinska proposes is a cost-effective and easily applicable refinement to achieve consistent Agatston scores where they are most needed. She believes that vnAS can be seamlessly integrated into routine clinical practice for reporting calcium scores.