Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
JACC Cardiovasc Imaging. 2018 Jul;11(7):1012-1026. doi: 10.1016/j.jcmg.2018.03.023.
Thoracic aortic calcification (TAC) is associated with adverse cardiovascular outcomes, and for the cardiovascular imager, is predominantly encountered in 4 settings: 1) incidentally, for example, during a coronary artery calcium scan; 2) as part of dedicated screening; 3) in the evaluation of an embolic event; or 4) in procedural planning. This review focuses on TAC in these contexts. Within atherosclerosis, TAC is common, variable in extent, and begins in the intima with a patchy distribution. In metabolic disorders, aortitis, and radiation-associated cardiovascular disease, calcification preferentially involves the media and is often more concentric. As an incidental finding, atherosclerotic TAC provides limited incremental discriminative value, and current data do not support screening. After an embolic event, the demonstration of thoracic atheroma provides diagnostic clarity, but has limited treatment implications. Before any procedure, the plan often changes if the most severe form of TAC, a porcelain aorta, is discovered.
胸主动脉钙化（TAC）与不良心血管结局相关，对于心血管成像医生而言，TAC 主要见于以下 4 种情况：1）偶然发现，例如，在冠状动脉钙扫描期间；2）作为专门筛查的一部分；3）在栓塞事件的评估中；或 4）在程序规划中。本综述重点关注这些情况下的 TAC。在动脉粥样硬化中，TAC 很常见，程度不一，始于内膜并呈斑片状分布。在代谢紊乱、巨细胞性动脉炎和与辐射相关的心血管疾病中，钙化更倾向于累及中膜，且往往更呈同心性。作为偶然发现，动脉粥样硬化性 TAC 的鉴别诊断价值有限，目前的数据不支持筛查。栓塞事件后，如果发现胸主动脉粥样硬化斑块，可明确诊断，但治疗意义有限。在任何介入手术前，如果发现最严重的 TAC（瓷主动脉），则计划往往会改变。
