What are the benefits of electron-beam CT (EBCT) over conventional CT for the detection of coronary artery calcification?

Answer

One of the factors that limit the speed of a conventional CT scanner is necessary rotation of the tube around the patient. EBCT completely avoids this problem because the machine does not have any moving parts. A beam of electrons is generated and then focused with a series of electromagnets. The beam is directed onto 1 of 4 tungsten targets under the patient. The resultant fan-shaped x-ray beam passes through the patient and is collected by a 210° arc of detectors above the patient. More than 3,000 detectors are used in this process.

EBCT allows the acquisition of 1.5- to 3-mm sections, with an exposure time of 100 milliseconds. The images are gated to the end of diastole, and the entire examination is performed during 1 breath-hold by the patient. Usually, 40-60 sections are obtained with this method.

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American Heart Association/American Stroke Association. Heart Disease and Stroke Statistics 2018 At-a-Glance. heart.org. Available at https://www.heart.org/-/media/data-import/downloadables/heart-disease-and-stroke-statistics-2018---at-a-glance-ucm_498848.pdf. 2018; Accessed: July 23, 2019.
Hecht HS, Cronin P, Blaha MJ, Budoff MJ, Kazerooni EA, Narula J, et al. 2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. J Thorac Imaging. 2017 Sep. 32 (5):W54-W66. [Medline].
Andersson C, Johnson AD, Benjamin EJ, Levy D, Vasan RS. 70-year legacy of the Framingham Heart Study. Nat Rev Cardiol. 2019 May 7. [Medline].
Sharma RK, Arbab-Zadeh A, Kishi S, Chen MY, Magalhães TA, George RT, et al. Incremental diagnostic accuracy of computed tomography myocardial perfusion imaging over coronary angiography stratified by pre-test probability of coronary artery disease and severity of coronary artery calcification: The CORE320 study. Int J Cardiol. 2015 Dec 15. 201:570-7. [Medline].
Panh L, Lairez O, Ruidavets JB, Galinier M, Carrié D, Ferrières J. Coronary artery calcification: From crystal to plaque rupture. Arch Cardiovasc Dis. 2017 Oct. 110 (10):550-561. [Medline]. [Full Text].
Abazid RM, Kattea MO, Sayed S, Saqqah H, Qintar M, Smettei OA. Visceral adipose tissue influences on coronary artery calcification at young and middle-age groups using computed tomography angiography. Avicenna J Med. 2015 Jul-Sep. 5 (3):83-8. [Medline].
Wang X, Le EPV, Rajani NK, Hudson-Peacock NJ, Pavey H, Tarkin JM, et al. A zero coronary artery calcium score in patients with stable chest pain is associated with a good prognosis, despite risk of non-calcified plaques. Open Heart. 2019. 6 (1):e000945. [Medline].
Liew G, Chow C, van Pelt N, Younger J, Jelinek M, Chan J, et al. Cardiac Society of Australia and New Zealand Position Statement: Coronary Artery Calcium Scoring. Heart Lung Circ. 2017 Dec. 26 (12):1239-1251. [Medline].
Grandhi G, Dardari Z, Whelton S, et al. Interplay of coronary artery calcium testing and burden of traditional risk factors for cause-specific mortality: CAC Consortium. Washington, DC: Society of Cardiovascular Computed Tomography (SCCT) 2017 Annual Scientific Meeting; July 8, 2017. Abstract 97.
Joshi PH, Blaha MJ, Blumenthal RS, Blankstein R, Nasir K. What is the role of calcium scoring in the age of coronary computed tomographic angiography?. J Nucl Cardiol. 2012 Dec. 19(6):1226-35. [Medline].
Marwan M, Mettin C, Pflederer T, Seltmann M, Schuhbäck A, Muschiol G, et al. Very low-dose coronary artery calcium scanning with high-pitch spiral acquisition mode: comparison between 120-kV and 100-kV tube voltage protocols. J Cardiovasc Comput Tomogr. 2013 Jan-Feb. 7(1):32-8. [Medline].
Rumberger JA, Brundage BH, Rader DJ. Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc. 1999 Mar. 74(3):243-52. [Medline].
Rumberger JA. Coronary artery calcification: "...empty your cup.". Am Heart J. 1999 May. 137(5):774-6. [Medline].
Nishida C, Okajima K, Kudo T, Yamamoto T, Hattori R, Nishimura Y. The relationship between coronary artery calcification detected by non-gated multi-detector CT in patients with suspected ischemic heart disease and myocardial ischemia detected by thallium exercise stress testing. Ann Nucl Med. 2005 Dec. 19(8):647-53. [Medline].
Raggi P, Khan A, Arepali C, Stillman AE. Coronary artery calcium scoring in the age of CT angiography: what is its role?. Curr Atheroscler Rep. 2008 Oct. 10(5):438-43. [Medline].
Ho JS, Fitzgerald SJ, Stolfus LL, Wade WA, Reinhardt DB, Barlow CE, et al. Relation of a coronary artery calcium score higher than 400 to coronary stenoses detected using multidetector computed tomography and to traditional cardiovascular risk factors. Am J Cardiol. 2008 May 15. 101(10):1444-7. [Medline].
Prabhakar M, Ko DT. Can coronary calcification measured by CT predict future coronary events?. CMAJ. 2005 Oct 25. 173(9):1034. [Medline].
Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990 Mar 15. 15(4):827-32. [Medline].
Taylor AJ, O''Malley PG. Self-referral of patients for electron-beam computed tomography to screen for coronary artery disease. N Engl J Med. 1998 Dec 31. 339(27):2018-20. [Medline].
Budoff MJ, Gul KM. Expert review on coronary calcium. Vasc Health Risk Manag. 2008. 4(2):315-24. [Medline].
Ratti C, Chiurlia E, Grimaldi T, Malagoli A, Ligabue G, Modena MG. Coronary calcification in cardiovascular risk stratification. Minerva Cardioangiol. 2006 Oct. 54(5):591-601. [Medline].
Htwe Y, Cham MD, Henschke CI, Hecht H, Shemesh J, Liang M, et al. Coronary artery calcification on low-dose computed tomography: comparison of Agatston and Ordinal Scores. Clin Imaging. 2015 Sep-Oct. 39 (5):799-802. [Medline].
Willemink MJ, van der Werf NR, Nieman K, Greuter MJW, Koweek LM, Fleischmann D. Coronary artery calcium: A technical argument for a new scoring method. J Cardiovasc Comput Tomogr. 2018 Oct 19. [Medline].
Blaha MJ, Mortensen MB, Kianoush S, Tota-Maharaj R, Cainzos-Achirica M. Coronary Artery Calcium Scoring: Is It Time for a Change in Methodology?. JACC Cardiovasc Imaging. 2017 Aug. 10 (8):923-937. [Medline]. [Full Text].
National Institutes of Health. Next-generation CT scanner provides better images with minimal radiation. NIH. US Department of Health and Human Services. Available at https://www.nih.gov/news-events/news-releases/next-generation-ct-scanner-provides-better-images-minimal-radiation. January 31, 2018; Accessed: July 23, 2019.

Media Gallery

Coronary artery calcification - CT. Cross-sectional image obtained through the heart at the level of the left anterior descending (LAD) artery. The protocol on the CT machine colors all structures with an attenuation of greater than 130 HU pink. No calcium (pink) is present in the LAD or diagonal branch.
Coronary artery calcification - CT. Image obtained in a patient with a large amount of calcium in the left anterior descending (LAD) artery. Note that other hyperattenuating structures (eg, bone, calcified lymph nodes) are pink. During the scoring process, the radiologist must circle only those areas that correspond to one of the coronary arteries.
Coronary artery calcification - CT. Image obtained without the threshold set to color the calcium pink. Note the large amount of calcium in the left anterior descending (LAD) and left circumflex arteries.
Coronary artery calcification - CT. Section caudal to that in the previous image shows calcium in the left anterior descending (LAD) artery as it courses down the front of the heart. The vessel is now depicted in cross section.
Helical non–contrast-enhanced CT reveals calcification involving the left main coronary artery.

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Author

J Bayne Selby, Jr, MD Professor of Radiology, Co-Director, Division of Interventional Radiology, Department of Radiology, Medical University of South Carolina

J Bayne Selby, Jr, MD is a member of the following medical societies: Radiological Society of North America, South Carolina Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Pamela Bowe Morris, MD, FACC, FACP, FACPM Assistant Professor of Medicine, Consulting Staff, Director of Preventive Cardiology, Co-Director of Women's Heart Care, Medical University of South Carolina; Consulting Staff, Department of Internal Medicine and Cardiology, Roper Hospital; Medical Director, FitHeart Cardiovascular Disease Prevention Program

Pamela Bowe Morris, MD, FACC, FACP, FACPM is a member of the following medical societies: American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American College of Preventive Medicine, American Heart Association, Phi Beta Kappa, National Lipid Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand

Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency Program, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine

Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, Society of Nuclear Medicine and Molecular Imaging

Disclosure: Nothing to disclose.

Additional Contributors

Justin D Pearlman, MD, ME, PhD, FACC, MA Chief, Division of Cardiology, Director of Cardiology Consultative Service, Director of Cardiology Clinic Service, Director of Cardiology Non-Invasive Laboratory, Chair of Institutional Review Board, University of California, Los Angeles, David Geffen School of Medicine

Justin D Pearlman, MD, ME, PhD, FACC, MA is a member of the following medical societies: American College of Cardiology, International Society for Magnetic Resonance in Medicine, American College of Physicians, American Federation for Medical Research, Radiological Society of North America

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of eMedicine gratefully acknowledge the contributions of Michael Assey, MD, to the development and writing of this article.

What are the benefits of electron-beam CT (EBCT) over conventional CT for the detection of coronary artery calcification?

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