Calcified Coronary Artery Plaque Measurement with Cardiac CT in Population-based Studies: Standardized Protocol of Multi-Ethnic Study of Atherosclerosis (MESA) and Coronary Artery Risk Development in Young Adults (CARDIA) Study

Calcified coronary artery plaque, measured at cardiac computed tomography (CT), is a predictor of cardiovascular disease and may play an increasing role in cardiovascular disease risk assessment. The Multi-Ethnic Study of Atherosclerosis (MESA) and the Coronary Artery Risk Development in Young Adults (CARDIA) study of the National Heart, Lung, and Blood Institute are population-based studies in which calcified coronary artery plaque was measured with electron-beam and multi–detector row CT and a standardized protocol in 6814 (MESA) and 3044 (CARDIA study) participants. The studies were approved by the appropriate institutional review board from the study site or agency, and written informed consent was obtained from each participant. Participation in the CT examination was high, image quality was good, and agreement for the presence of calcified plaque was high (κ = 0.92, MESA; κ = 0.77, CARDIA study). Extremely high agreement was observed between and within CT image analysts for the presence (κ > 0.90, all) and amount (intraclass correlation coefficients, >0.99) of calcified plaque. Measurement of calcified coronary artery plaque with cardiac CT is well accepted by participants and can be implemented with consistently high-quality results with a standardized protocol and trained personnel. If predictive value of calcified coronary artery plaque for cardiovascular events proves sufficient to justify screening a segment of the population, then a standardized cardiac CT protocol is feasible and will provide reproducible results for health care providers and the public.

© RSNA, 2005


  • 1 Committee on Advanced Cardiac Imaging and Technology, Council on Clinical Cardiology, and Committee on Newer Imaging Modalities, Council on Cardiovascular Radiology, American Heart Association. Potential value of ultrafast computed tomography to screen for coronary artery disease. Circulation 1993; 87:2071. Crossref, MedlineGoogle Scholar
  • 2 Wexler L, Brundage B, Crouse J, et al. Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications: a statement for health professionals from the American Heart Association—Writing Group. Circulation 1996; 94:1175-1192. Crossref, MedlineGoogle Scholar
  • 3 Bild DE, Bluemke DA, Burke GL, et al. Multi-ethnic study of atherosclerosis: objectives and design. Am J Epidemiol 2002; 156:871-881. Crossref, MedlineGoogle Scholar
  • 4 Cutter GR, Burke GL, Dyer AR, et al. Cardiovascular risk factors in young adults: the CARDIA baseline monograph. Control Clin Trials 1991; 12(suppl 1):1S-77S. Crossref, MedlineGoogle Scholar
  • 5 Detrano R, Carr JJ. Computed tomography of the heart. In: Topol EJ, eds. Textbook of cardiovascular medicine. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2002; 1281-1296. Google Scholar
  • 6 Carr JJ. Coronary calcium: the case for helical computed tomography. J Thorac Imaging 2001; 16:16-24. Crossref, MedlineGoogle Scholar
  • 7 Hofman MB, Wickline SA, Lorenz CH. Quantification of in-plane motion of the coronary arteries during the cardiac cycle: implications for acquisition window duration for MR flow quantification. J Magn Reson Imaging 1998; 8:568-576. Crossref, MedlineGoogle Scholar
  • 8 Achenbach S, Ropers D, Holle J, Muschiol G, Daniel WG, Moshage W. In-plane coronary arterial motion velocity: measurement with electron-beam CT. Radiology 2000; 216:457-463. LinkGoogle Scholar
  • 9 U.S. Food and Drug Administration. Whole body scanning using computed tomography (CT). Available at: Accessed March 4 2004. Google Scholar
  • 10 Protection ICoR: 1990 recommendations of the International Commission on Radiological Protection Oxford, England: Pergamon, 1991. Google Scholar
  • 11 McCollough CH, Schueler BA. Calculation of effective dose. Med Phys 2000; 27:828-837. Crossref, MedlineGoogle Scholar
  • 12 Morin RL, Gerber TC, McCollough CH. Radiation dose in computed tomography of the heart. Circulation 2003; 107:917-922. Crossref, MedlineGoogle Scholar
  • 13 McNitt-Gray MF. Radiation issues in computed tomography screening. Semin Roentgenol 2003; 38:87-99. Crossref, MedlineGoogle Scholar
  • 14 McNitt-Gray MF. AAPM/RSNA physics tutorial for residents: topics in CT—radiation dose in CT. RadioGraphics 2002; 22:1541-1553. LinkGoogle Scholar
  • 15 Yaghoubi S, Tang W, Wang S, et al. Offline assessment of atherosclerotic coronary calcium from electron beam tomograms. Am J Card Imaging 1995; 9:231-236. MedlineGoogle Scholar
  • 16 Bielak LF, Kaufmann RB, Moll PP, McCollough CH, Schwartz RS, Sheedy PF, 2nd. Small lesions in the heart identified at electron beam CT: calcification or noise? Radiology 1994; 192:631-636. LinkGoogle Scholar
  • 17 Becker CR, Jakobs TF, Aydemir S, et al. Helical and single-slice conventional CT versus electron beam CT for the quantification of coronary artery calcification. AJR Am J Roentgenol 2000; 174:543-547. Crossref, MedlineGoogle Scholar
  • 18 Carr JJ, Crouse JR, 3rd, Goff DC, Jr, D’Agostino RB, Jr, Peterson NP, Burke GL. Evaluation of subsecond gated helical CT for quantification of coronary artery calcium and comparison with electron beam CT. AJR Am J Roentgenol 2000; 174:915-921. Crossref, MedlineGoogle Scholar

Article History

Published in print: Jan 2005