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Electrocardiographically gated multi-detector row CT for assessment of valvular morphology and calcification in aortic stenosis.

PURPOSE: To evaluate the applicability and image quality of nonenhanced and contrast material-enhanced multi-detector row computed tomography (CT) combined with retrospective electrocardiographic (ECG) gating for visualization of the aortic valve, determination of aortic valve morphology and diameter of the aortic valve annulus, and assessment of the degree of valvular calcification in patients with aortic valve stenosis, as compared with results of surgery and echocardiography. MATERIALS AND METHODS: Prior to surgical valve replacement, 25 patients with aortic valve stenosis and sinus rhythm underwent nonenhanced (n = 15) and contrast-enhanced (n = 25) retrospectively ECG-gated multi-detector row CT. Two readers working in consensus evaluated image quality and assessed valvular morphology and the degree of valvular calcification. In addition, the diameter of the aortic valve annulus was measured. Results were compared with surgical and echocardiographic findings by using the paired sign test, kappa statistics, and the method of Bland and Altman. RESULTS: The aortic valve could be visualized nearly free of motion artifacts on all multi-detector row CT images. Image quality and diagnostic confidence for classification of aortic valve morphology were significantly superior on contrast-enhanced rather than nonenhanced images (P =.004 and P =.006, respectively). Nonenhanced and contrast-enhanced CT showed good agreement with surgical findings with regard to quantification of the degree of aortic valve calcification (kappa = 0.77 and kappa = 0.74, respectively). Measurement of the diameter of the aortic valve annulus was more reliable on contrast-enhanced images. CONCLUSION: Contrast-enhanced retrospectively ECG-gated multi-detector row CT allows determination of aortic valve morphology, measurement of the diameter of the aortic valve annulus, and assessment of the degree of aortic valve calcification in patients with aortic stenosis.

Aged↗

Coronary calcification compared in patients with acute versus in those with chronic coronary events by using dual-sector spiral CT.

PURPOSE: To compare underlying calcific atherosclerotic lesions in acute versus chronic coronary events in patients with hypertension by using dual-sector spiral computed tomography (CT). MATERIALS AND METHODS: Eight hundred eighty-four calcific lesions were analyzed in a cohort of 50 patients (39 men, 11 women; age range, 55-79 years; mean age, 66 years +/- 6 [SD]) with hypertension who sustained a coronary event during 3-year follow-up. All underwent dual-sector spiral CT within 12 months before the event. Twenty-nine patients had an acute event (acute group): acute myocardial infarction, 20; unstable angina pectoris, six; acute ischemia, two; sudden death, one. Twenty-one patients had chronic manifestations of obstructive coronary disease (chronic group): severe stable angina, five; angiographically identified disease, 12; disease requiring angioplasty, two; and disease requiring bypass surgery, two. To examine differences between the two study groups, the chi(2) or Fisher exact test was applied to categorical parameters and the two-sample t test or Wilcoxon rank sum test to quantitative parameters. RESULTS: High prevalence of coronary calcium (total coronary calcium score [TCS] >0) was observed in both groups: 93% (27 of 29) in the acute and 95% (20 of 21) in the chronic group. There were 518 lesions in the chronic and 366 in the acute group, with a median number of 35 and nine lesions per patient, respectively (P <.001). The median TCS was 906 for the chronic and 63 for the acute group (P <.01). CONCLUSION: A mild degree of calcification characterizes patients with acute coronary events, while diffuse high-attenuation calcific plaques are associated with chronic coronary events.

Acute Disease↗

Calcification of the basal ganglia as visualized by computed tomography.

Physiological calcification of the globus pallidus was visualized by computed tomography in 32 patients. The frequency of visualization increased with increasing age. Patients under the age of 40 with calcification of the globus pallidus should be evaluated for disorders associated with pathological calcification of the basal ganglia. Patients of any age with calcification in the lenticular nucleus and elsewhere in the basal ganglia, dentate nucleus, or multiple areas of the cortex should also be evaluated for these disorders.

Adolescent↗

Calcification associated with duodenal duplications in children.

Calcification of intestinal duplications is rare, and it is most uncommon in duodenal duplications. In this report, two cases illustrate distinct forms of calcification associated with duodenal duplication cysts. Each type may be confused with calcifications in other benign or malignant lesions. Calcified duodenal duplication cysts should be considered when investigating spherical upper abdominal calcifications.

Calcinosis↗

Tracheobronchial calcification: an observation in three children after mitral valve replacement and warfarin sodium therapy.

Tracheal calcification in children may be congenital or acquired. The authors describe three children in whom tracheal or tracheobronchial calcification was noted on radiographs after prosthetic mitral valve replacement and after long periods of warfarin sodium therapy. Laryngeal and tracheal calcification has been known to occur in warfarin embryopathy. This suggests that possibility of warfarin sodium as an etiologic factor in the development of the tracheal or tracheobronchial calcification in these children. However, further investigation is necessary.

Bronchial Diseases↗

Mixed form, diffusely scattered calcifications in breast cancer with apocrine features.

Diffusely scattered calcifications visible with mammography are almost always benign. Certain patterns, however, should arouse concern. For example, extensive comedocarcinoma is associated with large areas of mammographically visible calcium deposition. The authors identified 10 women in whom calcifications were visible throughout large volumes of breast tissue at mammography. The calcifications did not resemble those typical of extensive comedocarcinoma, yet they were associated with extensive breast cancer. Their mammographic pattern was characterized by a strikingly wild, chaotic appearance with profuse deposition of calcium. As in many cancers, the particles were heterogeneous, but unlike in most carcinomas, many deposits had a typically benign morphology. Histologic examination showed that even these typically benign calcifications were associated with malignant cells. The authors believe that the apocrine features displayed by many of the cancer cells in these 10 patients may explain the unusual profusion of calcium deposits.

Adult↗

Coronary artery calcification detected with ultrafast CT as an indication of coronary artery disease.

To assess the relationship of coronary artery calcification to angiographically detectable disease, the authors evaluated 100 patients less than 60 years of age who underwent clinically indicated coronary angiography and ultrafast computed tomography (CT). The ultrafast CT technique consisted of 3-mm-thick contiguous sections and a 100-msec acquisition time. All patients with clinically significant disease at angiography (defined as at least one stenosis with a diameter narrowing of at least 50%) had some coronary artery calcification present at ultrafast CT (100% sensitivity in this population). The absence of calcification at ultrafast CT had a 100% negative predictive value for clinically significant coronary artery disease. Specificity and positive predictive value were 47% and 62%, respectively. Sensitivity and specificity of ultrafast CT in the detection of patients with angiographically detectable disease were 94% and 72%, respectively. Ultrafast CT of the heart is an anatomically based, noninvasive test with high sensitivity for the detection of coronary artery calcification. Ultrafast CT may be beneficial in the screening of selected populations for the presence of atherosclerotic coronary disease.

Adult↗

Occult breast calcifications sampled with large-core biopsy: confirmation with radiography of the specimen.

In a series of nine stereotaxic large-core biopsies of calcifications, radiography of the specimen was used to ensure that appropriate tissue was removed. In eight cases, calcifications were evident at radiography as well as at histologic evaluation. Four cases were malignant and four were benign, and in one case in which calcification was not evident at either radiographic or histologic evaluation, a benign process was confirmed at surgical excision. Radiography of the specimen is a key component in diagnosis of breast calcifications sampled with large-core technique.

Biopsy↗

Dermal calcifications in fixed orientation: the tattoo sign.

Calcifications located in the dermis of the breast may appear indistinguishable from intramammary calcifications. The authors present a sign, called the tattoo sign, that can help radiologists identify dermal calcifications. When mammograms are compared, calcifications that maintain a fixed relationship to each other suggest a dermal location. This can be verified with standard techniques. Understanding the tattoo sign may help prevent unnecessary needle localization and biopsy procedures.

Breast Neoplasms↗

Rotator cuff calcifications: treatment with US-guided technique.

PURPOSE: The authors developed and tested a technique to treat calcific tendinitis in the rotator cuff with multiple needle punctures, aspiration, and lavage under ultrasonographic (US) guidance. MATERIALS AND METHODS: Atraumatic pain in the shoulders of a 46-year-old woman and a 42-year-old man was resistant to conservative therapy. With local anesthesia and continuous three-dimensional US visualization, the tips of two 18-gauge needles were placed within the calcification in the rotator cuff. Saline solution was injected and aspirated with the needles until the aspirate was free of calcific particles. RESULTS: Both patients experienced complete relief of pain and recovery of full range of motion, one on the 3rd day after treatment and one within 15 minutes. CONCLUSION: Use of this US-guided technique is successful to treat calcific tendinitis in the rotator cuff without the radiation exposure of fluoroscopic guidance.

Adult↗

Calcification of coronary arteries: detection and quantification with double-helix CT.

PURPOSE: To evaluate the accuracy of double-helix computed tomography (CT) in coronary artery calcification detection and quantification. MATERIALS AND METHODS: One hundred sixty patients with coronary disease (135 men, 25 women; age range, 45-62 years), of whom 138 had obstructive (stenosis of > 50% of diameter; n = 129) or mild (< 50% stenosis; n = 9) coronary artery disease (CAD) and 22 had normal coronary arteries (per angiographic findings), and 56 age-matched healthy control subjects underwent double-helix CT. RESULTS: Double-helix CT findings indicated that calcification was significantly more prevalent in patients with CAD (> 83%) than in patients with normal coronary arteries (27%) or in healthy control subjects (34%; P < .01). Sensitivity in detecting obstructive CAD was high (91%); however, specificity was low (52%) because of calcification in nonobstructive lesions. Comparison of double-helix CT and angiographic findings indicated that double-helix CT was 84% accurate with positive and negative predictive values of 89% and 59%, respectively. CONCLUSION: Double-helix CT is a useful noninvasive method for detection and quantification of coronary artery calcification.

Adult↗

Intracranial calcification on gradient-echo phase image: depiction of diamagnetic susceptibility.

PURPOSE: To differentiate calcification from hemorrhage on the basis of susceptibility at magnetic resonance imaging. MATERIALS AND METHODS: Gradient-recalled echo (GRE) phase imaging was performed at 1.5 T in 101 calcified areas (15 in the basal ganglia, 86 out of the basal ganglia) and 39 uncalcified locations (13 choroid plexus and pineal glands, 26 old hemorrhages). Experiments with a small lead particle and a numerical simulation were also performed. RESULTS: The majority of calcifications outside the basal ganglia (n = 63) revealed a phase shift that represents diamagnetic susceptibility and was similar to the phase shift in the lead particle and to the calculated phase shift for a diamagnetic sphere. All hemorrhages and almost all calcified basal ganglia revealed a phase shift that represents paramagnetic susceptibility. All uncalcified choroid plexus and pineal glands revealed no obvious phase shift. Any location without calcification did not reveal the diamagnetic phase shift. CONCLUSION: GRE phase imaging differentiated paramagnetic from diamagnetic susceptibility, which was specific for calcification.

Aged↗

1alpha-Hydroxylase gene ablation and Pi supplementation inhibit renal calcification in mice homozygous for the disrupted Npt2a gene.

Disruption of the major renal Na-phosphate (Pi) cotransporter gene Npt2a in mice leads to a substantial decrease in renal brush-border membrane Na-Pi cotransport, hypophosphatemia, and appropriate adaptive increases in renal 25-hydroxyvitamin D3-1alpha-hydroxylase (1alphaOHase) activity and the serum concentration of 1,25-dihydroxyvitamin D3 [1,25(OH)2D]. The latter is associated with increased intestinal Ca absorption, hypercalcemia, hypercalciuria, and renal calcification in Npt2-/- mice. To determine the contribution of elevated serum 1,25(OH)2D levels to the development of hypercalciuria and nephrocalcinosis in Npt2-/- mice, we examined the effects of 1alphaOHase gene ablation and long-term Pi supplementation on urinary Ca excretion and renal calcification by microcomputed tomography. We show that the urinary Ca/creatinine ratio is significantly decreased in Npt2-/-/1alphaOHase-/- mice compared with Npt2-/- mice. In addition, renal calcification, determined by estimating the calcified volume to total renal volume (CV/TV), is reduced by 80% in Npt2-/-/1alphaOHase-/- mice compared with that in Npt2-/- mice. In Npt2-/- mice derived from dams fed a 1% Pi diet and maintained on the same diet, we observed a significant decrease in urinary Ca/creatinine that was also associated with 80% reduction in CV/TV when compared with counterparts fed a 0.6% diet. Taken together, the present data demonstrate that both 1alphaOHase gene ablation and Pi supplementation inhibit renal calcification in Npt2-/- mice and that 1,25(OH)2D is essential for the development of hypercalciuria and nephrocalcinosis in the mutant strain.

25-Hydroxyvitamin D3 1-alpha-Hydroxylase↗

Coronary artery disease but not coronary calcification is associated with elevated levels of cardiolipin, beta-2-glycoprotein-I, and oxidized LDL antibodies.

BACKGROUND: Autoimmune factors have been shown to play a role in atherosclerosis. The aim of this study is to correlate 5 autoantibodies (anticardiolipin, anti-CL, beta2-glycoprotein-I, beta2GPI, phosphatidylcholine, oxidized low-density lipoprotein, oxLDL, endothelial cell) with the presence of coronary heart disease, angiographic findings, and with coronary artery calcification. METHODS: The levels of the 5 autoantibodies and a control antifibroblast line of 126 coronary heart disease patients and 20 healthy controls were measured. Fifty-one patients underwent coronary angiography, and 98 patients had coronary artery calcium determination using spiral computerized tomography (dual mode). RESULTS: Levels of 3 autoantibodies (anti-CL, beta2GPI, oxLDL) were significantly elevated in coronary heart disease patients compared with controls (p < 0.001, p = 0.001, p < 0.001, respectively). Within the subgroup of patients with significant coronary artery stenosis, anti-CL antibodies were also elevated (p = 0.008). No correlation was found between anti-CL, and anti-beta2GPI autoantibody levels and coronary calcium scores as measured by spiral computerized tomography. However, anti-oxLDL antibodies were raised in patients with no calcification detected by spiral computerized tomography, compared with the patients with any coronary calcification (p = 0.046). CONCLUSION: Anti-CL, beta2GPI and oxLDL antibodies are elevated in coronary heart disease patients regardless of coronary calcification.

Aged↗

Idiopathic calcification of the seminal vesicles: a rare cause for prostate cancer overstaging.

Calcification of the seminal vesicles is a rare phenomenon. We present 2 cases in whom calcification of the seminal vesicles led to preoperative overstaging of prostate cancer. Although idiopathic calcifications are extremely rare, calcifications appear more frequently in diabetic patients. Therefore, knowledge of these formations is essential to prevent overstaging, namely infiltration of the seminal vesicles.

Calcinosis↗

Tissue-specific utilization of menaquinone-4 results in the prevention of arterial calcification in warfarin-treated rats.

The effects of vitamin K (phylloquinone: K1 and menaquinone-4: MK-4) on vascular calcification and their utilization in the arterial vessel wall were compared in the warfarin-treated rat model for arterial calcification. Warfarin-treated rats were fed diets containing K1, MK-4, or both. Both K1 and MK-4 are cofactors for the endoplasmic reticulum enzyme gamma-glutamyl carboxylase but have a structurally different aliphatic side chain. Despite their similar in vitro cofactor activity we show that MK-4 and not K1 inhibits warfarin-induced arterial calcification. The total hepatic K1 accumulation was threefold higher than that of MK-4, whereas aortic MK-4 was three times that of K1. The utilization of K1 and MK-4 in various tissues was estimated by calculating the ratios between accumulated quinone and epoxide species. K1 and MK-4 were both equally utilized in the liver, but the aorta showed a more efficient utilization of MK-4. Therefore, the observed differences between K1 and MK-4 with respect to inhibition of arterial calcification may be explained by both differences in their tissue bioavailability and cofactor utilization in the reductase/carboxylase reaction. An alternative explanation may come from an as yet hypothetical function of the geranylgeranyl side chain of MK-4, which is a structural analogue of geranylgeranyl pyrophosphate and could interfere with a critical step in the mevalonate pathway.

Animals↗

Calcifications in untreated Burkitt's lymphoma of the upper jaw.

BACKGROUND: Dystrophic calcifications are uncommon in lymphomas. They may occur after chemotherapy or radiotherapy, whereas calcifications in untreated non- Hodgkin's lymphomas are rarely reported in the literature. CASE REPORT: We report the case of a 9-year-old boy who developed tumefaction of the right upper jaw. CT examination revealed a neoplastic lesion in the right upper jaw sinus with destruction of the maxilla and subcutaneous fat infiltration. Furthermore the tumor showed accentuated central calcifications. Histological examination revealed endemic type of Burkitt's lymphoma of the paranasal sinus. CONCLUSION: Our experience showed that calcification can rarely occur also in untreated Burkitt's lymphoma.

Burkitt Lymphoma↗

The functional role of C-reactive protein in aortic wall calcification.

As an ongoing effort to elucidate the mechanisms involved in bioprosthetic heart valve (BHV) calcification, the role of C-reactive protein (CRP) in the tissue calcification process was investigated. The profile of calcium-associated proteins (CAP) on glutaraldehyde-preserved (0.6%) porcine aortic wall, which were subcutaneously implanted in rats for up to 8 weeks, showed a temporal appearance pattern. The total extracted amount of proteins from the control tissues implanted for 8 weeks was significantly greater than that from ethanol-treated tissues (1.78+/-0.2 vs. 1.27+/-0.18 microg/mg), indicating that the binding affinity of CAP for BHV pretreated with an anticalcification agent was significantly decreased (p<0.05). The dye Stains-All method showed that the dark-blue colored bands, representing high calcium binding and phosphorylated proteins, were stained from the extract of the control BHV at the molecular weight varying from 4 to 250 kDa, but rarely seen in the extract of BHV pretreated with ethanol. One of those proteins was exclusively immunoreactive with CRP antibody, while there was no immunoreaction in less calcified tissues. When aortic wall was exposed to an excess amount of CRP in an in vitro simulating model, the calcification rate of aortic wall increased as the concentration of CRP increased. The results of this work clearly revealed that CRP has indirect vascular effects, leading to an increased rate of aortic wall calcification.

Animals↗