Koroner kalsiyum skoru ve Agatston yöntemi

Özet

Koroner arter kalsiyum (CAC) skoru, kontrastsız kardiyak BT'de koroner duvar kalsifikasyonunu saptayıp toplam kalsiyum yükünü sayısallaştıran yöntemdir. Agatston hesabı lezyon alanını, en yüksek atenüasyona göre verilen yoğunluk ağırlığıyla çarpar ve LM, LAD, LCx ile RCA skorlarını toplar. Agatston skoru koroner aterosklerotik plak yüküyle ilişkilidir; ancak kalsifiye olmayan plağı dışlamaz ve lümen darlığının derecesini doğrudan göstermez. Uygun olmayan rekonstrüksiyon, hareket, komşu aort/kapak kalsifikasyonu ya da yanlış teknikle hesaplanan skor hastalık yükünü eksik veya fazla gösterebilir.

Faz ve pencere

Kontrastsız tanısal

ECG eşzamanlı, kontrastsız ince kesit görüntülerde koroner seyir üzerinde en az 130 HU atenüasyonlu kalsifik odaklar segmentlenir; Agatston hesabı alanı tepe atenüasyon yoğunluk faktörüyle ağırlıklandırır. İyotlu kontrast gerekmez; kontrastlı lümen kalibrasyonu bu skorun parçası değildir.

Önerilen pencereler: Mediasten (G 350 / M 50).

BT bulguları

• LM, LAD, LCx ve RCA seyri boyunca koroner duvarla örtüşen fokal yüksek atenüasyonlu kalsifik odaklar.
• Her kalsifik odağın yerinin koroner arter üzerinde olduğu komşu aort kökü, mitral anulus ve aort kapağından ayrı ayrı doğrulanır.
• Aynı damardaki lezyonların alan ve yoğunluk ağırlıklı skorları damar bazında toplanır; dört ana damar skorunun toplamı toplam CAC skorunu verir.
• En yüksek lezyon atenüasyonu Agatston yoğunluk faktörünü belirler; alan ve dansite bileşenleri skora ayrı katkı yapar.
• Skor 0, ölçüm eşiğini karşılayan koroner kalsifikasyon görülmediğini belirtir; kalsifiye olmayan koroner plağı dışlamaz.
• Kalsifik odakların damar boyunca yaygınlığı ve birden fazla koroner bölgedeki dağılımı, toplam sayı yanında raporda görünür kılınır.
• Kalp hareketi, görüntü gürültüsü, kesit kalınlığı ve rekonstrüksiyon aralığı skor ölçümünü ve tekrarlanabilirliğini etkileyebilir.

Ölçütler ve sınıflamalar

Agatston kalsifik odak eşiği

≥130 HU ve ≥1 mm²

Agatston yoğunluk faktörü

130–199 HU: 1; 200–299 HU: 2; 300–399 HU: 3; ≥400 HU: 4

Agatston yoğunluk ağırlıkları

Her eşik üstü koroner kalsifik lezyon alanı, lezyonun en yüksek atenüasyonuna göre ağırlıklandırılır: 130–199 HU için 1, 200–299 HU için 2, 300–399 HU için 3, en az 400 HU için 4. Damar skorları ve ardından toplam skor elde edilir.

Normalde

Normal kalsiyum skorlamasında koroner arterlerin izlenen seyri üzerinde eşik üstü kalsifik odak saptanmaz ve toplam Agatston skoru 0 olur; aort kapağı veya aort duvarındaki kalsiyum bu koroner toplama eklenmez. LM, LAD, LCx ve RCA yollarını ayrı ayrı takip edip her parlak odağın gerçekten koroner arter duvarında olup olmadığını, kalp hareketi ve komşu yapı örtüşmelerini karşılaştır.

Ayırıcı tanı

Aort kökü veya kapak kalsifikasyonu

parlak odak koroner ostium/seyirden ayrı biçimde aort duvarı, aort kapağı ya da mitral anulus üzerinde yer alır.

Kontrastlı lümendeki yoğun iyot

kontrastsız CAC serisi değildir; lümen opasifikasyonu ve eşik ölçümü Agatston hesabını geçersizleştirir.

Hareket artefaktı

kalp hareketi görüntülemeyi güçleştirir; ECG eşzamanlı görüntüleme, hareket artefaktının en az olduğu fazın seçilmesine yardımcı olur.

Tuzaklar

• Skor 0'ı ateroskleroz yokluğu olarak açıklama; kalsifiye olmayan plak Agatston eşiğiyle görünmez.
• Aort kapağı veya mitral anulus kalsiyumunu LAD/LCx skoruna katma; damarın anatomik seyriyle eşleştirme yap.
• Farklı kesit kalınlığı, tüp gerilimi veya rekonstrüksiyon protokolündeki skorları doğrudan aynı ölçüm koşulu gibi karşılaştırma; yöntem raporda belirtilmelidir.
• Tek piksel gürültüsünü kalsifik plak sayma; ölçüm alanını ve koroner duvarla anatomik örtüşmeyi kaynak kesitlerde doğrula.

Kendini dene

1. Kontrastsız BT'de LAD duvarında 180 HU ve 2 mm² ölçülen odak için Agatston yoğunluk faktörü kaçtır?

   • 1
   • 2
   • 3
   • 4
   Cevabı göster

   1. 180 HU, 130–199 HU aralığındadır ve yoğunluk faktörü 1'dir; odak alanı da eşik üstüdür. Faktör 2, 200–299 HU; 3, 300–399 HU; 4 ise en az 400 HU için kullanılır.

2. Agatston skoru 0 olan kontrastsız inceleme için hangi çıkarım doğrudur?

   • Kalsifiye plak yok; yumuşak plak dışlanmaz
   • Lümen darlığı kesin yok
   • Koroner arterler görüntülenmemiş
   • İskemik kalp hastalığı dışlandı
   Cevabı göster

   Kalsifiye plak yok; yumuşak plak dışlanmaz. Sıfır skor, teknik olarak değerlendirilebilir incelemede Agatston eşiğini karşılayan koroner kalsifikasyon bulunmadığını söyler. Kalsifiye olmayan plak veya lümen darlığı hakkında tek başına dışlama yapmaz ve fonksiyonel iskemi testi değildir.

İlgili konular

• Koroner plak tipleri: kalsifiye, kısmen kalsifiye ve kalsifiye olmayan

Kaynaklar

Bu sayfadaki 38 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 3 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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