Skip to main content
SpringerLink
Log in

Anatomical References to Evaluate Thoracic Aorta Calcium by Computed Tomography

  • Evidence-Based Medicine, Clinical Trials and Their Interpretations (L. Roever, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Thoracic aortic calcium (TAC) has received some interest in recent studies as an important subclinical marker of atherosclerosis. Besides that, using computed tomography (CT) scans performed with cardiac or chest protocols, ECG-gated, or non-gated, TAC can be easily evaluated with no addition in radiation dose. This review discusses the particularities of the aortic wall calcium formation, as well as the differences between the aortic segments and summarizes the current status of TAC evaluation, mainly concerning the anatomical references used in the studies.

Recent Findings

The studies have evaluated TAC considering different anatomical references. It was identified two different study groups. In the first one, researchers have analyzed the aorta as the sum of calcium in the ascending aorta (ATAC), aortic arch (AAC), and descending thoracic aorta (DTAC). The second group has used cardiac CT scans to assess TAC; therefore, they did not include AAC; however, the aortic root calcium (ARC) was added in the analysis. So, caution is advisable when interpreting and comparing studies that used different TAC anatomical references.

Summary

The broad methodological variability, in addition to the variations in the population characteristics of the studies on TAC, may be in part contributing to the differences between results of different studies. Currently TAC does not have a role in clinical decisions, so it is necessary to create a standard protocol for the aortic calcium research as well as exists for the coronary artery calcium evaluation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

AAC:

abdominal aortic calcium

ATA:

ascending thoracic aorta

ATAC:

ascending thoracic aorta calcium

CAC:

coronary artery calcium

CAD:

coronary artery disease

CHD:

coronary heart disease

CV:

cardiovascular

CVD:

cardiovascular disease

CT:

computed tomography

DTA:

descending thoracic aorta

DTAC:

descending thoracic aorta calcium

MESA:

Multi-ethnic Study of Atherosclerosis

TAC:

thoracic aortic calcium

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Rodríguez-Palomares JF, Evangelista MA. Aortic calcium score and vascular atherosclerosis in asymptomatic individuals: beyond the coronary arteries. Rev Española Cardiol (English Ed). 2016;69:813–6 Elsevier BV Available from: https://linkinghub.elsevier.com/retrieve/pii/S1885585716301347.

    Article  Google Scholar 

  2. Wang Y, Osborne MT, Tung B, Li M, Li Y. Imaging cardiovascular calcification. J Am Heart Assoc. 2018;7:1–15.

    Google Scholar 

  3. Hecht HS. Coronary artery calcium scanning: past, present, and future. JACC Cardiovasc Imaging. 2015;8:579–96. https://doi.org/10.1016/j.jcmg.2015.02.006 Elsevier.

    Article  PubMed  Google Scholar 

  4. Brodov Y, Gransar H, Rozanski A, Hayes SW, Friedman JD, Thomson LEJ, et al. Extensive thoracic aortic calcification is an independent predictor of development of coronary artery calcium among individuals with coronary artery calcium score of zero. Atherosclerosis. 2015;238:4–8 Elsevier Ireland Ltd.

    Article  CAS  Google Scholar 

  5. Cho I-J, Chang H-J, Park H-B, Heo R, Shin S, Shim CY, et al. Aortic calcification is associated with arterial stiffening, left ventricular hypertrophy, and diastolic dysfunction in elderly male patients with hypertension. J Hypertens. 2015;33:1633–41 Available from: https://insights.ovid.com/crossref?an = 00004872-201508000-00021.

    Article  CAS  Google Scholar 

  6. Mitchell GF. Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage. J Appl Physiol. 2008;105:1652–60.

    Article  Google Scholar 

  7. Nasir K, Roguin A, Sarwar A, Rumberger J a, Blumenthal RS. Gender differences in coronary arteries and thoracic aorta calcification. Arterioscler Thromb Vasc Biol. 2007;27:1220–2.

    Article  CAS  Google Scholar 

  8. Takasu J, Katz R, Nasir K, Carr JJ, Wong N, Detrano R, et al. Relationships of thoracic aortic wall calcification to cardiovascular risk factors: The Multi–Ethnic Study of Atherosclerosis (MESA). Am Heart J. 2008;155:765–71 Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002870307009477.

    Article  Google Scholar 

  9. Allison MA, Budoff MJ, Nasir K, Wong ND, Detrano R, Kronmal R, et al. Ethnic-Specific Risks for Atherosclerotic Calcification of the Thoracic and Abdominal Aorta (from the Multi-Ethnic Study of Atherosclerosis). Am J Cardiol. 2009;104:812–7. https://doi.org/10.1016/j.amjcard.2009.05.004 Elsevier Inc.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kälsch H, Lehmann N, Möhlenkamp S, Hammer C, Mahabadi AA, Moebus S, et al. Prevalence of thoracic aortic calcification and its relationship to cardiovascular risk factors and coronary calcification in an unselected population-based cohort: the Heinz Nixdorf Recall Study. Int J Card Imaging. 2013;29:207–16.

    Article  Google Scholar 

  11. Pedrosa JF, Ribeiro ALP, Santana PC, Araújo LF, Barreto SM. Relation of thoracic aortic and coronary artery calcium to cardiovascular risk factors (From The Brazilian Longitudinal Study of Adult Health [ELSA-Brasil]). Am J Cardiol. 2019; Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002914919309956.

  12. Kälsch H, Lehmann N, Moebus S, Hoffmann B, Stang A, Jöckel K, et al. Aortic calcification onset and progression: association with the development of coronary atherosclerosis. J Am Heart Assoc. 2017;6:1–12 John Wiley and Sons Inc. Available from: https://www.ahajournals.org/doi/10.1161/JAHA.116.005093.

    Article  Google Scholar 

  13. Dudink EAMP, Peeters FECM, Altintas S, Heckman LIB, Haest RJ, Kragten H, et al. Agatston score of the descending aorta is independently associated with coronary events in a low-risk population. Open Hear. 2018;5:1–8.

    Article  Google Scholar 

  14. Rodríguez-Granillo GA, Reynoso E, Capuñay C, Antoniades C, Shaw LJ, Carrascosa P. Prognostic value of vascular calcifications and regional fat depots derived from conventional chest computed tomography. J Thorac Imaging. 2019;34:33–40.

    Article  Google Scholar 

  15. Budoff MJ, Nasir K, Kinney GL, Hokanson JE, Barr RG, Steiner R, et al. Coronary artery and thoracic calcium on noncontrast thoracic CT scans: comparison of ungated and gated examinations in patients from the COPD Gene cohort. J Cardiovasc Comput Tomogr. 2011;5:113–8.

    Article  Google Scholar 

  16. Leroux-Berger M, Queguiner I, MacIel TT, Ho A, Relaix F, Kempf H. Pathologic calcification of adult vascular smooth muscle cells differs on their crest or mesodermal embryonic origin. J Bone Miner Res. 2011;26:1543–53.

    Article  CAS  Google Scholar 

  17. Wong ND, Gransar H, Shaw L, Polk D, Moon JH, Miranda-Peats R, et al. Thoracic aortic calcium versus coronary artery calcium for the prediction of coronary heart disease and cardiovascular disease events. JACC Cardiovasc Imaging. 2009;2:319–26. https://doi.org/10.1016/j.jcmg.2008.12.010 Elsevier Inc.

    Article  PubMed  Google Scholar 

  18. Churchill TW, Rasania SP, Rafeek H, Mulvey CK, Terembula K, Ferrari V, et al. Ascending and descending thoracic aorta calcification in type 2 diabetes mellitus. J Cardiovasc Comput Tomogr. 2015;9:373–81 Elsevier Inc.

    Article  Google Scholar 

  19. Thomas IC, McClelland RL, Michos ED, Allison MA, Forbang NI, Longstreth WT, et al. Density of calcium in the ascending thoracic aorta and risk of incident cardiovascular disease events. Atherosclerosis. 2017;265:190–6. https://doi.org/10.1016/j.atherosclerosis.2017.09.009 Elsevier Ireland Ltd.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. • Thomas IC, Thompson CA, Yang M, Allison MA, Forbang NI, Michos ED, et al. Thoracic aorta calcification and noncardiovascular disease-related mortality the multi-ethnic study of atherosclerosis. Arterioscler Thromb Vasc Biol. 2018;38:1926–32 Recent and the only analysis of DTAC and noncardiovascular mortality.

    Article  CAS  Google Scholar 

  21. • Thomas IC, McClelland RL, Allison MA, Ix JH, Michos ED, Forbang NI, et al. Progression of calcium density in the ascending thoracic aorta is inversely associated with incident cardiovascular disease events. Eur Heart J Cardiovasc Imaging. 2018;19:1343–50 Oxford University Press Recent and the only analysis of ATAC and cardiovascular events.

    Article  Google Scholar 

  22. Lanzer P, Boehm M, Sorribas V, Thiriet M, Janzen J, Zeller T, et al. Medial vascular calcification revisited: review and perspectives. Eur Heart J. 2014;35:1515–25.

    Article  Google Scholar 

  23. • Desai MY, Cremer PC, Schoenhagen P. Thoracic Aortic Calcification: Diagnostic, Prognostic, and Management Considerations. JACC Cardiovasc Imaging. 11:2018, 1012–26 Elsevier Inc. Recent review concerning thoracic aortic calcium.

  24. • Abramowitz Y, Jilaihawi H, Chakravarty T, Mack MJ, Makkar RR. Porcelain aorta: a comprehensive review. Circulation. 2015;131:827–36 Recent and comprehensive review of porcelain aorta.

    Article  Google Scholar 

  25. • Craiem D, Chironi G, Casciaro ME, Graf S, Simon A. Calcifications of the thoracic aorta on extended non-contrast-enhanced cardiac CT. Hendrikse J, editor. PLoS One. Public Library of Science; 2014;9:e109584. Available from: https://dx.plos.org/10.1371/journal.pone.0109584 The first study to propose an extended CAC scan to include aortic arch and measure the difference between TAC prevalences considering and not the aortic arch.

  26. Craiem D, Chironi DG, Casciaro ME, Sirieix ME, Mousseaux E, Simon A. Association of thoracic aorta calcium and non-cardiac vascular events in cardiac disease-free individuals. Atherosclerosis. 2016;245:22–7 Elsevier Ireland Ltd.

    Article  CAS  Google Scholar 

  27. Ong K-L, McClelland RL, Rye K-A, Cheung BMY, Post WS, Vaidya D, et al. The relationship between insulin resistance and vascular calcification in coronary arteries, and the thoracic and abdominal aorta: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis. 2014;236:257–62. https://doi.org/10.1016/j.atherosclerosis.2014.07.015 Elsevier Ltd.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Yeboah J, Carr JJ, Terry JG, Ding J, Zeb I, Liu S, et al. Computed tomography-derived cardiovascular risk markers, incident cardiovascular events, and all-cause mortality in nondiabetics: The Multi-Ethnic Study of Atherosclerosis. Eur J Prev Cardiol. 2014;21:1233–41.

    Article  Google Scholar 

  29. Youssef G, Guo M, McClelland RL, Shavelle DM, Nasir K, Rivera J, et al. Risk factors for the development and progression of thoracic aorta calcification: The Multi-Ethnic Study of Atherosclerosis. Acad Radiol Elsevier USA. 2015;22:1536–45.

    Article  Google Scholar 

  30. Kim J, Budoff MJ, Nasir K, Wong ND, Yeboah J, Al-Mallah MH, et al. Thoracic aortic calcium, cardiovascular disease events, and all-cause mortality in asymptomatic individuals with zero coronary calcium: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis. 2017;257:1–8 Elsevier Ireland Ltd Available from: https://linkinghub.elsevier.com/retrieve/pii/S0021915016315337.

    Article  CAS  Google Scholar 

  31. Mahabadi AA, Lehmann N, Möhlenkamp S, Pundt N, Dykun I, Roggenbuck U, et al. Noncoronary measures enhance the predictive value of cardiac CT above traditional risk factors and CAC score in the general population. JACC Cardiovasc Imaging. 2016;9:1177–85 Elsevier Inc. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1936878X16304089.

    Article  Google Scholar 

  32. Hoffmann U, Massaro JM, D’Agostino RB, Kathiresan S, Fox CS, O’Donnell CJ. Cardiovascular event prediction and risk reclassification by coronary, aortic, and valvular calcification in the Framingham Heart Study. J Am Heart Assoc. 2016;5:1–11. https://doi.org/10.1161/JAHA.115.003144.

    Article  Google Scholar 

  33. •• Bos D, Leening MJG, Kavousi M, Hofman A, Franco OH, Van Der Lugt A, et al. Comparison of Atherosclerotic Calcification in Major Vessel Beds on the Risk of All-Cause and Cause-Specific Mortality: The Rotterdam Study. Circ Cardiovasc Imaging. 2015;8:1–9 The only analysis of the presence of calcium in the aortic arch and its predictive value for mortality.

  34. Cho IJ, Chang HJ, Cho I, Heo R, Lee SE, Shim CY, et al. Association of thoracic aorta calcium score with exercise blood pressure response and clinical outcomes in elderly individuals: differential impact of aorta calcification compared with coronary artery calcification. J Am Heart Assoc John Wiley and Sons Inc 2016;5

  35. Katz R, Budoff MJ, O’Brien KD, Wong ND, Nasir K. The metabolic syndrome and diabetes mellitus as predictors of thoracic aortic calcification as detected by non-contrast computed tomography in the Multi-Ethnic Study of Atherosclerosis. Diabet Med. 2016;33:912–9.

    Article  CAS  Google Scholar 

  36. •• Tesche C, De Cecco CN, Stubenrauch A, Jacobs BE, Varga-Szemes A, Litwin SE, et al. Correlation and predictive value of aortic root calcification markers with coronary artery calcification and obstructive coronary artery disease. Radiol Med. 2017;122:113–20 Springer Milan The only analysis of the presence of calcium in the aortic root and its predictive value for CAC and obstructive CAD.

    Article  Google Scholar 

  37. Hoffmann U, Massaro JM, D’Agostino RB, Kathiresan S, Fox CS, O’Donnell CJ. Cardiovascular Event Prediction and Risk Reclassification by Coronary, Aortic, and Valvular Calcification in the Framingham Heart Study. J Am Heart Assoc [Internet]. 2016;5:1–11. Available from: https://www.ahajournals.org/doi/10.1161/JAHA.115.003144.

  38. Elias-Smale SE, Odink AE, Wieberdink RG, Hofman A, Hunink MGM, Krestin GP, et al. Carotid, aortic arch and coronary calcification are related to history of stroke: the Rotterdam study. Atherosclerosis. 2010;212:656–60 Available from: https://linkinghub.elsevier.com/retrieve/pii/S0021915010004934.

    Article  CAS  Google Scholar 

  39. Saboo SS, Abbara S, Rybicki FJ, Chatzizisis YS. Quantification of aortic calcification – How and why should we do it? Atherosclerosis. 2015;240:469–71 Elsevier Ireland Ltd.

    Article  CAS  Google Scholar 

  40. •• Mori S, Takaya T, Kinugasa M, Ito T, Takamine S, Fujiwara S, et al. Three-dimensional quantification and visualization of aortic calcification by multidetector-row computed tomography: a simple approach using a volume-rendering method. Atherosclerosis. Elsevier; 2015 [cited 2019 Jul 2];239:622–8. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0021915014016633 Focus on advanced techniques to measure TAC by CT.

    Article  CAS  Google Scholar 

  41. Liyanage L, Lee NJ, Cook T, Herrmann HC, Jagasia D, Litt H, et al. The impact of gender on cardiovascular system calcification in very elderly patients with severe aortic stenosis. Int J Card Imaging. 2016;32:173–9 Springer Netherlands.

    Article  Google Scholar 

  42. Heuvelmans MA, Vonder M, Rook M, Groen HJM, De Bock GH, Xie X, et al. Screening for early lung cancer, chronic obstructive pulmonary disease, and cardiovascular disease (the big-3) using low-dose chest computed tomography: Current evidence and technical considerations. J Thorac Imaging. 2019:160–9 Lippincott Williams and Wilkins.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Avenida Alfredo Balena 190, Bairro Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil

    Jesiana Ferreira Pedrosa, Sandhi Maria Barreto & Antonio Luiz Pinho Ribeiro

  2. Faculdade de Medicina e Hospital das Clínicas, Universidade de São Paulo (USP), São Paulo, SP, Brazil

    Márcio Sommer Bittencourt

Authors
  1. Jesiana Ferreira Pedrosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sandhi Maria Barreto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Márcio Sommer Bittencourt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonio Luiz Pinho Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jesiana Ferreira Pedrosa.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Video 1

Anatomical references for TAC segmentation presented slice-by-slice in axial computed tomography images (WMV 23666 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pedrosa, J.F., Barreto, S.M., Bittencourt, M.S. et al. Anatomical References to Evaluate Thoracic Aorta Calcium by Computed Tomography. Curr Atheroscler Rep 21, 51 (2019). https://doi.org/10.1007/s11883-019-0811-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11883-019-0811-9

Keywords

Search

Navigation