Arq. Bras. Cardiol. 2020; 115(3): 501-502
Our Precious Calcium Score
This Short Editorial is referred by the Research article "Quantification of Calcified Coronary Plaques by Chest Computed Tomography: Correlation with the Calcium Score Technique".
Some things are strong, robust. In imaging in general, those are based on solid principles of physics that can resist the inequities of daily use. In computed tomography (CT), the main tissue densities are solid, measured in Hounsfield Units (HU), and some are really strong, calcium-strong, so to speak. Contrast resolution is an issue in CT imaging in general, mainly in the wide range of structures inside the water density spectrum. But the densities on both ends of the whole HU spectrum, i.e., air and fat on one side and bone and metal on the other, are depicted clearly. Also, they could be measured with a great deal of accuracy, and, as these images were mathematical in origin, there is a lot more than the eye can see that could be measured on a CT image, and there are several measurements that could be done on rather simple scans. But let’s revise this latter.
Measuring the amount of calcification in coronary arteries is rather old. It is termed coronary calcium score (CCS). It has been developed, tested and implemented, has had its clinical value shown, but still lacks consensus of use and insurance coverage in medical procedures around the world.– At first, it had to be done in electron beam tomography and then, with the new generation of CT scans. In this issue of Arquivos Brasileiros de Cardiologia, Souza et al. elegantly show how this CCS measurement has excellent correlation as done in the “usual” manner as well as from a standard chest CT. This was shown in the past, to a wide variety of scans and with good accuracy, some comparing with semiquantitative and visual methods, with a consensus of the Society of Cardiovascular Computed Tomography, including a recent great work from this same group of researchers. But now, crunching the numbers, the correlation is excellent, as has been shown by others before, and the suggestion is that we could accurately measure CCS, this important tool in coronary artery disease risk stratification, from a rather more common exam.
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