Identification of coronary calcified nodules on noninvasive coronary CT: A two-case report with intravascular imaging correlation

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Coronary artery calcification with suspected calcified nodules (n=2). Intervention: High-resolution coronary computed tomography (CT) vs. Intravascular optical coherence tomography (OCT). Primary outcome: Identification of calcified nodules and procedural strategy selection.

Q: What does this research mean for the field?

High-resolution coronary computed tomography can noninvasively identify coronary calcified nodules, directly informing preprocedural strategy and planning for percutaneous coronary intervention. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Junji Mochizuki; Mitsuaki Matsumura; Masafumi Suzuki; Shinya Misawa; Hiroaki Matsumi; Kentaro Kawada; Yoshiki Hata

doi:10.1016/j.radcr.2026.05.033

June 6, 2026Radiology Case ReportsOpen Access

Identification of coronary calcified nodules on noninvasive coronary CT: A two-case report with intravascular imaging correlation

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Key result

High-resolution coronary CT enables noninvasive detection of calcified nodules to guide preprocedural strategy.

n=2

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Why the study?

Does high-resolution coronary CT accurately identify coronary calcified nodules to assist in preprocedural planning for percutaneous coronary intervention?

Key Points

To assess whether high-resolution noninvasive coronary computed tomography can identify coronary calcified nodules and guide preprocedural treatment planning prior to invasive confirmation.
Evaluated high-resolution coronary computed tomography acquisition and reconstruction protocols (0.625 mm slice thickness, HD Edge kernel, ASiR-V 40%) in N=2 patients with severe coronary stenosis.
Assessed noninvasive CT morphological features and attenuation measurements using region-of-interest analysis, comparing them against invasive coronary angiography and intravascular optical coherence tomography.
In case 1, CT identified a protruding nodular lesion in the mid-right coronary artery with CT attenuation of approximately 830 HU compared to approximately 1330 HU in adjacent calcification, managed with rotational atherectomy.
In case 2, CT demonstrated a protruding nodule in the proximal left circumflex artery with CT attenuation of approximately 630 HU compared to approximately 1370 HU in adjacent calcification (iFR 0.64), managed with orbital atherectomy.
Optical coherence tomography confirmed calcified nodules with fibrous cap disruption in case 1 and a calcified nodule in case 2, leading to adequate lumen expansion after calcium modification and stent deployment.

Study Design

Type

Case Report (n=2)

Structured PICO

Does high-resolution coronary CT accurately identify coronary calcified nodules to assist in preprocedural planning for percutaneous coronary intervention?

P

Population

2 older adults (mean age 75, 50% female) with symptomatic severe coronary artery calcification evaluated with high-resolution coronary CT and invasive intravascular imaging.

I

Intervention

Noninvasive high-resolution coronary computed tomography (CT) using specific reconstruction techniques (HD Edge kernel, thin-slice 0.625 mm, 40% ASiR-V).

C

Comparator

Intravascular optical coherence tomography (OCT) as a reference standard for confirmation.

O

Outcome

Identification of coronary calcified nodules, defined by protruding morphology and lower attenuation compared to adjacent calcification.surrogate

High-resolution coronary CT may serve as a valuable noninvasive screening tool to identify coronary calcified nodules and guide specialized calcium modification strategies prior to PCI.

Limitations

Small sample size
Requires invasive confirmation for definitive diagnosis
Motion artifacts from cardiac contraction and blooming artifacts can create pseudo-nodular appearance
Lipid-rich components or intraplaque hemorrhage may mimic internal heterogeneity of true nodules
Motion artifacts and blooming artifacts can create a pseudo-nodular appearance
Lipid-rich components or intraplaque hemorrhage can mimic low-attenuation heterogeneity of nodules
CT features are not yet definitive for diagnosis, serving only as a screening tool
Requires larger prospective studies to confirm findings

Implication

May support noninvasive nodule detection for PCI planning in select cases; hypothesis-generating and requires prospective validation before broader adoption.

Abstract

Calcified nodules are a form of coronary calcification associated with acute coronary syndrome and adverse outcomes after percutaneous coronary intervention. We report 2 cases in which noninvasive high-resolution coronary computed tomography (CT) suggested calcified nodules later corroborated by intravascular optical coherence tomography. In case 1, CT demonstrated a protruding calcified focus in the right coronary artery with lower attenuation than adjacent calcification. In case 2, CT showed a small nodular lesion in the proximal left circumflex artery with a similar attenuation pattern. In both cases, the CT findings prompted a calcium-modification strategy and directly informed procedural planning. High-resolution coronary CT may therefore enable noninvasive recognition of calcified nodules with direct implications for preprocedural strategy selection; however, further studies are needed.

Discussion

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Cite This Study

Mochizuki et al. (2026) conducted a case report in Coronary artery calcification with suspected calcified nodules (n=2). High-resolution coronary computed tomography (CT) vs. Intravascular optical coherence tomography (OCT) was evaluated on Identification of calcified nodules and procedural strategy selection. High-resolution coronary CT successfully enabled noninvasive recognition of calcified nodules with lower attenuation and protruding morphology, which directly informed preprocedural strategy selection.

synapsesocial.com/papers/6a3c2352d15afadd906f9fb2 https://doi.org/10.1016/j.radcr.2026.05.033

Topics

Coronary artery disease

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Identification of coronary calcified nodules on noninvasive coronary CT: A two-case report with intravascular imaging correlation

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Identification of coronary calcified nodules on noninvasive coronary CT: A two-case report with intravascular imaging correlation

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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