ELECTRON-BEAM COMPUTED-TOMOGRAPHY AND CORONARY-ARTERY DISEASE - SCANNING FOR CORONARY-ARTERY CALCIFICATION

Objective: To review the association of coronary artery calcification with coronary atherosclerosis and its potential clinical application a s detected on electron beam computed tomography (EBCT). Design: A lite rature review of coronary artery calcification, coronary artery diseas e, and EBCT is presented, and clinical applications of EBCT are discus sed. Results: Recent studies have confirmed that arterial calcificatio n is an active process intimately associated with atherosclerotic plaq ue evolution. Clinical investigations with use of EBCT have shown that a scan ''negative'' for coronary calcification is common in patients with normal or near-normal findings on coronary angiography, whereas p atients with severe obstructive disease most commonly have ''positive' ' scans-greater amounts of coronary artery calcium are associated with more severe luminal disease. Coronary artery calcium as evaluated on EBCT follows patterns that reflect the development of coronary atherom atous disease as a function of age and gender. Although histologic stu dies have confirmed that not all atherosclerotic segments have detecta ble calcification, the area of coronary artery calcification quantifie d on EBCT has a direct, positive relationship with the histopathologic coronary plaque area. Conclusion: The long-held notion of ''degenerat ive'' calcification of the coronary arteries with aging is incorrect. Although the incidence of coronary artery calcification increases with patient age, this relationship simply parallels the increased inciden ce of coronary atherosclerosis with advancing age. Data suggest that E BCT is a highly sensitive and specific test for coronary atheroscleros is and provide a basis for clinical applications when EBCT is viewed a s a noninvasive method to estimate human coronary atherosclerotic invo lvement and ''plaque burden.''