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Digital Radiography with Dual-Energy Subtraction: Improved Evaluation of Cardiac Calcification

Robert C. Gilkeson1, R. D. Novak and Peter Sachs

1 All authors: Department of Radiology, University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, OH 44106-5000.



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  		Fig. 1A. —67-year-old man who underwent dual-energy subtraction radiography for preoperative evaluation. Conventional posteroanterior chest digital radiograph is unremarkable.

 


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  		Fig. 1B. —67-year-old man who underwent dual-energy subtraction radiography for preoperative evaluation. Subtracted bone image shows evidence of linear calcification (arrow) in distribution of left coronary artery, which is consistent with coronary artery calcification.

 


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  		Fig. 2A. —58-year-old woman who underwent chest radiography at admission. Conventional posteroanterior digital radiograph shows finding (arrow) suspicious for left coronary artery calcium.

 


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  		Fig. 2B. —58-year-old woman who underwent chest radiography at admission. Subtracted low-energy bone image shows extensive coronary artery calcification (arrow) in left coronary artery distribution. Note extensive right coronary artery calcium (arrowhead) that is not visible on standard posteroanterior chest radiograph (A).

 


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  		Fig. 3A. —78-year-old woman with chest pain and dyspnea. Conventional posteroanterior digital radiograph shows cardiomegaly and pulmonary edema. Question of whether area of calcification (arrow) is present in region of mitral valve is raised.

 


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  		Fig. 3B. —78-year-old woman with chest pain and dyspnea. Subtracted low-energy bone image shows extensive mitral annulus (arrow) and coronary artery (arrowhead) calcium. Note improved visualization on subtracted bone image compared with A.

 


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  		Fig. 4A. —57-year-old man undergoing preoperative assessment for coronary artery bypass graft surgery. Standard digital radiograph shows negative findings.

 


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  		Fig. 4B. —57-year-old man undergoing preoperative assessment for coronary artery bypass graft surgery. Subtracted bone image shows calcification (arrow) in region of left main coronary artery.

 


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  		Fig. 4C. —57-year-old man undergoing preoperative assessment for coronary artery bypass graft surgery. Multiplanar reconstruction of CT scan shows calcium (arrow) in left coronary artery distribution corresponding to that shown in B.

 


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  		Fig. 5A. —40-year-old with history of thoracic radiation and cardiomyopathy. Coronal maximum-intensity-projection image shows extensive left atrial calcification (arrow).

 


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  		Fig. 5B. —40-year-old with history of thoracic radiation and cardiomyopathy. Subtracted low-energy bone image shows no definite cardiac calcification.

 


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  		Fig. 5C. —40-year-old with history of thoracic radiation and cardiomyopathy. Subtracted left anterior oblique low-energy bone image shows extensive curvilinear calcification (arrows) in left atrial distribution.

 


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  		Fig. 6A. —57-year-old man undergoing preoperative chest radiography. Standard posteroanterior digital radiograph of chest is unremarkable.

 


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  		Fig. 6B. —57-year-old man undergoing preoperative chest radiography. Subtracted bone image shows subtle linear density (arrow) in region of left coronary artery distribution, consistent with coronary artery calcification.

 


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  		Fig. 6C. —57-year-old man undergoing preoperative chest radiography. Representative axial non-ECG-gated MDCT scan with cursors placed around left coronary artery for coronary artery calcium evaluation shows calcified plaque in left coronary artery. Coronary artery calcium score was 78. LAD = left anterior descending artery.

 

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