Abstract Background Although coronary computed tomography angiography (CCTA) is a valuable noninvasive modality for diagnosing coronary artery disease, coronary calcification can reduce its diagnostic accuracy due to artifacts. However, there are few studies investigating the association between the morphologic characteristics of coronary calcification on CCTA and the prevalence of obstructive coronary artery disease. Purpose This study aimed to clarify how the distribution and patterns of calcification on CCTA are associated with the probability of obstructive lesions identified by invasive coronary angiography (ICA). Methods We retrospectively analyzed 150 lesions from 50 consecutive patients (age: 75 ±7.7 years, male: 73%) who underwent both CCTA and subsequent ICA within three months. The presence of severe stenosis visually assessed as 70% with calcification on CCTA was compared with the presence of obstructive disease on quantitative coronary angiography (diameter stenosis 50%). Results Lesions presenting a single calcium deposit with a central angle of 180° in the cross-sectional view (n=69) on CCTA had a higher prevalence of obstructive disease when accompanied by a low-density area (LDA), defined as less than 130 Hounsfield units, around the lesion, compared to those without (69% vs. 10%, p0.01, Figure A). In contrast, lesions with calcification characterized by a central angle of ≥180° or multiple calcium deposits (n=81) showed no association between LDA presence and the prevalence of obstructive disease (LDA present: 27% vs. LDA absent: 46%, p=0.25). In these lesions, the prevalence of obstructive disease increased with the progression of calcification (split moon: 0%, crescent moon: 20%, full moon: 52%; p0.01, Figure B). Conclusion Morphologic patterns of lesion calcification on CCTA may be associated with the prevalence of obstructive lesions and could help enable risk stratification of coronary artery disease.
Fujino et al. (2025) studied this question.