BioScience and BioEngineering Research (BioSciBer), Biomaterials Cluster, Bernal Institute, School of Engineering, University of Limerick, Ireland; Health Research Institute (HRI), University of Limerick, Ireland.
Department of Vascular Surgery, University Hospital Limerick, Ireland.
J Cardiovasc Comput Tomogr. 2020 Jan-Feb;14(1):20-26. doi: 10.1016/j.jcct.2019.07.003. Epub 2019 Jul 9.
The Agatston Calcium Score is a predictor of major adverse cardiovascular events but it is unable to identify high-risk lesions. Recent research suggests that examining calcification phenotype could be more indicative of plaque stability.
To examine the Agatston score's ability to determine atherosclerotic calcification phenotype.
Micro-Computed Tomography was performed on 20 carotid and 20 peripheral lower limb lesions. ImageJ pixel histogram analysis quantified the non-calcified (≥30HU, <130HU) and calcified (≥130HU) tissue volumes. ImageJ '3D Objects Counter' plugin determined the calcified particle count, volumes and maximum attenuation density of each particle. Image stacks were subsequently downsampled to a resolution of 0.7 × 0.7 × 3 mm and an approximation for the Extra-Coronary Calcium Scores (ECCS) were calculated. Spearman's correlation examined the relationships between ECCS approximations and calcification parameters.
ECCS has a strong positive correlation with the Calcified Volume Fraction (CVF) (r = 0.865, p < 0.0005), weak positive correlations with Calcified Particle Fraction (CPF) (r = 0.422, p = 0.007) and Microcalcification Fraction (micro-CF) (r = 0.361, p = 0.022). There is no correlation evident between ECCS and Calcified Particle Index (CPI) (r = -0.162, p = 0.318). It is apparent that there is a high prevalence of microcalcifications in both carotid and peripheral lower limb lesions. Additionally, an inverse relationship exists between calcified particle volume and maximum-recorded attenuation density.
The density-weighted Agatston calcium scoring methodology needs to be reviewed. Calcium scoring which differentiates between critical calcification morphologies, rather than presenting a density-weighted score, is required to direct high-risk plaques towards tailored treatment.
Agatston 钙评分是主要不良心血管事件的预测指标，但它无法识别高危病变。最近的研究表明，检查钙化表型可能更能反映斑块的稳定性。
检查 Agatston 评分确定动脉粥样硬化钙化表型的能力。
对 20 例颈动脉和 20 例外周下肢病变进行了微计算机断层扫描。ImageJ 像素直方图分析量化了非钙化（≥30HU，<130HU）和钙化（≥130HU）组织体积。ImageJ'3D 对象计数器'插件确定了每个颗粒的钙化颗粒计数、体积和最大衰减密度。随后将图像堆栈下采样到分辨率为 0.7×0.7×3mm，并计算了体外冠状动脉钙评分（ECCS）的近似值。Spearman 相关性检验了 ECCS 近似值与钙化参数之间的关系。
ECCS 与钙化体积分数（CVF）呈强正相关（r=0.865，p<0.0005），与钙化颗粒分数（CPF）（r=0.422，p=0.007）和微钙化分数（micro-CF）（r=0.361，p=0.022）呈弱正相关。ECCS 与钙化颗粒指数（CPI）之间无明显相关性（r=-0.162，p=0.318）。在颈动脉和外周下肢病变中，微钙化的发生率都很高。此外，钙化颗粒体积与最大记录衰减密度之间存在反比关系。
需要重新评估密度加权的 Agatston 钙评分方法。需要区分关键钙化形态的钙评分，而不是呈现密度加权评分，以将高危斑块导向有针对性的治疗。
