Visual assessment of coronary artery calcification

Last revised by Yaïr Glick on 18 Sep 2023

Overall visual assessment of coronary artery calcification is a simple scoring system for risk assessment of coronary heart disease mortality by an overall "gestalt" of none, mild, moderate or heavy coronary artery calcification (CAC). It is comparable to the Agatston score but has the advantage of being able to be performed on non-dedicated cardiac scans without dedicated post-processing 1; it has yet (c. 2019) to be validated in the wider radiological community with one study performed by subspecialist thoracic radiologists on low-dose CT thorax exams for lung cancer screening 1

Summed segmented vessel-specific score, aka ordinal scoring (OS), is an alternative, minimally complex, visual assessment scoring system 1-3. OS is calculated by evaluating the presence of CAC in the left main, left anterior descending, left circumflex, and right coronary arteries, and categorizing the CAC content as either

  • absent - score of 0

  • less than one-third of entire length of artery - 1

  • 1/3-2/3 of entire length of artery- 2

  • >2/3 of entire length of artery - 3

This method is recommended by the British Society of Cardiovascular Imaging/British Society of Cardiovascular CT (BSCI/BSCCT) and British Society of Thoracic Imaging (BSTI) for the detection and reporting of incidental coronary artery calcification 3. This method was validated using in the aforementioned 2019 paper against Agatston scoring in non-gated low dose chest CTs. An additional study has validated this method comparing Agatston scored dedicated gated CTCAs against recent prior non-gated chest NCCT performed for non-cardiac indications 2.

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