Coronary artery calcium scoring and its impact on the clinical practice in the era of multidetector CT

  • Jongmin Lee
Invited Review


With the suggestion of coronary artery calcium as an indicator of coronary artery disease 30 years ago, intense and controversial discussion regarding coronary artery calcium has been ongoing. Diverse techniques for evaluation of coronary artery calcium were suggested and validation of its feasibility has been followed up. Following establishment of reference standards, coronary artery calcium became widely utilized in clinical practice and scientific research. Originally coronary artery calcium scoring techniques were developed for prediction of cardiovascular risk. Additionally, coronary artery calcium scoring has been utilized as an indicator for other medical events. Recently, coronary artery calcium scoring used to be applied as a reference standard during scientific research. In this article, the topic of coronary artery calcium, from its introduction to its current usefulness, was discussed from the viewpoints of coronary artery calcium scoring techniques, imaging modalities, validation of the techniques, clinical feasibility of coronary artery calcium scoring beyond traditional cardiovascular risk prediction, and utilization of coronary artery calcium scoring as a reference standard. Popular coronary calcium scoring techniques comprises of Agatston, volume, and mass scores. Through validation of these techniques, pros and cons of each technique were analyzed and proper utility could be suggested. In parallel, the reference standards for Agatston and volume scores were established by age, sex, and race. Through the vigorous controversies, nowadays, the clinical feasibility of coronary artery calcium score as a surrogate marker of cardiovascular risk was acknowledged in the literature.


Coronary artery calcium Coronary artery disease Calcium score Cardiovascular risk 



Coronary artery calcium


Coronary artery disease


Electron beam CT


Coronary arterial calcium score


Multidetector CT




Hounsfield units


Signal-to-noise ratio


Coronary CT angiography


Volume score


Mass score


Calcium hydroxyapatite


Multi-ethnic study of atherosclerosis


Thoracic aortic calcification


Aortic valvular calcification


Mitral annular calcium


Neutrophil/lymphocyte ratio


Lipoprotein-associated phospholipase A2


Endothelial progenitor cells



“This research was supported by the MKE (The Ministry of Knowledge Economy), Korea, under the ITRC (Information Technology Research Center) support program supervised by the NIPA (National IT Industry Promotion Agency (NIPA-2011-(C1090-1121-0002)) and Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2010-000-7337).”

Conflict of interest



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© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  1. 1.Department of RadiologyKyungpook National University and HospitalDaeguSouth Korea

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