Bildgebende Untersuchungen des kardiovaskulären Systems VI: Calcium-Scoring-CT

A calcium-scoring CT scan detects calcium deposits within plaque in the coronary arteries, identifying early coronary calcification. It confirms suspected coronary artery disease, particularly in individuals at intermediate risk such as those with hypercholesterolemia and hypertension. The scan quantifies calcified plaque, which indicates atherosclerosis—a condition characterized by fatty deposits in arterial walls that can lead to CAD.

During the procedure, the patient lies supine on the CT table with ECG electrodes attached to monitor heart rate. The patient holds their breath briefly to ensure clear images. The table slides into the CT scanner, which rotates around the body to capture multiple images in seconds. The procedure is quick, non-invasive, and painless.

Calcium scores are interpreted as follows: a score of 0 indicates no plaque and low CAD risk; scores 1-10 show minimal plaque with low risk; 11-100 denote mild plaque with low to moderate risk; 101-400 reveal moderate plaque with moderate risk; and scores over 400 indicate extensive plaque with high CAD risk. Each range guides decisions on preventive measures and further testing.

Calcium-scoring CT scans are recommended for asymptomatic individuals at intermediate CAD risk, including men aged 40-75 and women aged 50-75, especially those with family history of heart disease. Candidates typically have high cholesterol, hypertension, diabetes, smoking history, or obesity. The test is not recommended for those under 40, pregnant women, or those requiring radiation avoidance.

Benefits include early CAD detection before symptoms appear, risk stratification to guide treatment, and non-invasive assessment unlike catheterization procedures. Limitations include minimal radiation exposure concerns and inability to detect non-calcified plaques, which can also contribute to CAD. The scan only quantifies calcified plaque, potentially missing soft plaque deposits.

Calcium-scoring CT specifically quantifies calcified plaque in coronary arteries, whereas imaging studies for cardiovascular system like echocardiography assess cardiac structure and function. While echocardiography visualizes heart chambers and valves, calcium-scoring CT focuses on atherosclerotic plaque burden. Each imaging modality serves distinct diagnostic purposes in cardiovascular assessment.

Results guide preventive strategies tailored to risk level. Low scores prompt review of prevention guidelines; moderate scores necessitate risk factor modifications and clinical follow-up; high scores require aggressive risk factor modification, intensive follow-up, and potentially further diagnostic testing. The calcium score helps determine whether lifestyle changes, medications, or additional cardiac evaluation is needed.