Computed Tomography to Detect Coronary Artery Calcification
DESCRIPTION
Computed tomography (CT), including electron beam (EBCT), helical, multislice spiral, or multidetector row, can detect calcium deposits in the coronary arteries. CT software provides calcium scores.
Calcium scores have been investigated as a technique for detecting coronary artery calcification, both:
As a diagnostic tool to determine the necessity of coronary angiography in symptomatic individuals, and
As a screening technique for coronary artery disease in asymptomatic individuals who have one or more traditional risk factors for CAD.
Electron beam computed tomography (i.e., ultrafast CT, cine computed tomography, rapid acquisition x-ray computed tomography and high-speed computed x-ray tomography) uses a rotating electron gun rather than a standard x-ray tube. Multislice spiral computed tomography (MSCT) and multidetector row computed tomography (MDCT), a technical evolution of helical CT, take multiple, thin slices simultaneously, using CT machines equipped with an array of multiple x-ray detectors imaging multiple sections of the individual during a rapid volumetric image acquisition.
As of 2007, EBCT and multi-detector computed tomography (MDCT) are the primary fast CT methods for measurement of coronary artery calcification. A fast CT study for coronary artery calcium measurement generally takes 10 to 15 minutes and requires only a few seconds of scanning time.
POLICY
Electron beam computed tomography for the detection of coronary artery calcification is considered investigational.
Multislice spiral computed tomography (i.e. multidetector row computed tomography) for the detection of coronary artery calcification is considered investigational.
See also: Computed Tomography Angiography for Coronary Artery Evaluation
ADDITIONAL INFORMATION
Published studies do not establish a clear role for detection of coronary artery calcification by computed tomography in coronary disease risk stratification in symptomatic or asymptomatic patients. Published studies have not shown that clinical outcomes can be favorably altered by the use of computed-tomography-based determination of coronary artery calcification in screening for coronary artery disease.
SOURCES
Agency for Healthcare Research and Quality. Systematic Evidence Review, No. 22. (2003, December). Screening for asymptomatic coronary artery disease: A systematic review for the U. S. preventive services task force. Retrieved from http://www.ahrq.gov/downloads/pub/prevent/pdfser/chdser.pdf. (82 articles and/or guidelines reviewed)
BlueCross BlueShield Association. Medical Policy Reference Manual. (2:2008). Contrast-enhanced computed tomographic angiography (CTA) for coronary artery evaluation (6.01.43). Retrieved July 10, 2008 from BlueWeb. (15 articles and/or guidelines reviewed)
BlueCross BlueShield Association. Medical Policy Reference Manual. (7:2008). Computed tomography to detect coronary artery calcification (6.01.03). Retrieved July 14, 2008 from BlueWeb. (10 articles and/or guidelines reviewed)
BlueCross BlueShield of Tennessee (Riverbend Government Benefits Administrator). Medicare Part A Carrier - Tennessee Local Coverage Determination. (2006, September). LCD for cardiac computed tomography (L23480). Retrieved November 8, 2006 from http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=23480&lcd_version=8&show=all.
Budoff, M. J., Shaw, L. J., Liu, S. T., Weinstein, S. R., Mosler, T. P., Tseng, P. H., et al. (2007). Long-term prognosis associated with coronary calcification. Journal of the American College of Cardiology, 49 (18), 1860-1870.
Budoff, M. J., Achenbach, S., Blumenthal, R. S., Carr, J. J., Goldin, J. G., Greenland, P., et al. (2006). Assessment of coronary artery disease by cardiac computed tomography: A scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation, 114, 1761-1791. (245 articles and/or guidelines reviewed)
CIGNA Government Services. Medicare Part B Carrier - Tennessee Local Coverage Determination. (2005, December). LCD for computed tomographic angiography of the chest, heart and coronary arteries (L21382). Retrieved July 10, 2008 from http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=21382&lcd_version=7&show=all.
Greenland, P., Bonow, R. O., Brundage, B. H., Budoff, M. J., Eisenbeerg, M. J., Grundy, S. M., et al. (2007). ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: A report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. Journal of the American College of Cardiology, 49 (3), 378-402. (115 articles and/or guidelines reviewed)
Health Technology Assessment Information Service. Hotline Response. (2004, April). Computed tomography (CT) angiography for diagnosing coronary artery disease (CAD). Retrieved January 11, 2005 from ECRI HTAIS.
Health Technology Assessment Information Service. Windows on Medical Technology. (2004, April). Computed tomography for predicting coronary artery disease risk. Retrieved January 11, 2005 from ECRI HTAIS.
Hendel, R.C., Kramer, C. H., Patel, M. R., & Poon, M. (2006). ACCF/ACR/SCCT/SCMR/ ASNC/NASCI/SCAI/SIR appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. Journal of the American College of Cardiology, (48) 7, 1-23.
Naghavi, M., Falk, E., Hecht, H. S., Jamieson, M. J., Kaul, S., Berman, D., et al. (2006). From vulnerable plaque to vulnerable patient - part III: Executive summary of the screening for heart attack prevention and education (SHAPE) task force report. American Journal of Cardiology, 55 (2A), 2H-15H. Abstract retrieved November 8, 2006 from PubMed database.
Screening for coronary heart disease: Recommendation statement. (2004). Annals of Internal Medicine, 140 (7), 569-572. Retrieved January 12, 2005 from National Guideline Clearinghouse.
The Technology Evaluation Center. (1994, August). Electron beam computed tomography (Vol. 9, No. 16). Chicago: BlueCross BlueShield Association. (89 articles and/or guidelines reviewed)
The Technology Evaluation Center. (2005, May). Contrast-enhanced cardiac computed tomographic angiography for coronary artery evaluation (Vol. 20, No. 4). Chicago: BlueCross BlueShield Association.
ORIGINAL EFFECTIVE DATE: 8/1998
MOST RECENT REVIEW DATE: 8/14/2008
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