Both pelvic radiography and lateral abdominal radiography correlate well with coronary artery calcification measured by computed tomography in hemodialysis patients: A cross‐sectional study

Abstract

Introduction Lateral abdominal radiograph is suggested as an alternative to coronary artery computed tomography (CT) in evaluating vascular calcification. Simple scoring systems including pelvic radiograph scoring and abdominal scoring system were utilized to study their correlation with coronary artery calcification. Methods In 106 MHD patients, coronary artery CT, lateral abdominal, and pelvic radiograph were taken. The Agatston scoring system was applied to evaluate the degree of coronary artery calcification which was categorized according to Agatston coronary artery calcification score (CACS) 30, 100, 400, and 1000. Abdominal aortic calcification was scored by 4-scored and 24-scored systems. Pelvic artery calcification was scored by a 4-scored system. Sensitivities and specificities of abdominal aortic calcification scores and pelvic artery calcification scores to predict different categories of coronary artery calcification were analyzed. We studied the diagnostic capability of abdominal aorta calcification and pelvic artery calcification to predict different CACS categories by calculating likelihood ratios. Receiver operator characteristic curves were used to determine the area under the curve for each of these testing procedures. Findings The prevalence was 48(45.3%), 15 (14.2%), 11 (10.4%), 11 (10.4%), and 11 (10.4%) for CACs > 0, 30, 100, 400, and 1000, respectively. The degree of CACs was positively correlated with patient age, prevalence of diabetes, abdominal aorta scores, and pelvic calcification scores. The areas under the curves for different CACS by all X-ray scoring systems were above 0.70 except pelvic 4-scored system for diagnosing CACS 30, without significant difference (P > 0.05). Discussion Both lateral abdominal and pelvic plain radiographs were demonstrated as acceptable alternatives to CT in evaluating vascular calcification.

Role of vascular calcification inhibitors in preventing vascular dysfunction and mortality in hemodialysis patients

“…Many noninvasive methods have been developed to detect VC and quantitate its severity. Plain radiography, the simplest technique, does not provide sufficient sensitivity and is not used for determining the amount of calcification. Sensitive methods for accurate assessment of calcification, especially in the coronary artery, include electron‐beam computerized tomography and multislice spiral computed tomography, the latter of which is fairly newer .…”

Plain pelvic/aorta radiographs as a simple guideline to predict vascular macro‐calcifications; one step earlier or a late sign to best weight the enemy of coronary calcification and mortality?

“…Furthermore, the primary exposure of interest, whether intima or medial type of calcification could not be differentiated as correctly pointed out by the authors. 1 Could these facts explain the different outcomes described in both important studies published by the authors? 1,2 Furthermore, could different types of vascular calcification (Vc) correlate with significantly different coronary artery calcification (CAc) scores and possibly mortality?…”

“…We praise Hong et al 1 for their excellent study demonstrating that both lateral abdominal and pelvic plain radiographs in hemodialysis patients are acceptable alternatives to computed tomography (CT) to efficiently evaluate vascular macro-calcification (Vmac) meaning that the presence of Vmac detected in series of simple X-rays has similar prognostic and therapeutic implications as modern expensive technologies. However, their earlier study found that coexistence of pelvic and hand artery macrocalcification rather than abdominal aorta calcification itself was associated with mortality in hemodialysis patients.…”

“…2 Complicated risk factors, including local hemodynamic response to fistula construction promoting radial artery calcification, was the explanation for this discrepancy. 1 Although the grading of the disease, absent or present is valid in both articles, 1,2 semiquantitative evaluation of the pelvic arteries/aorta calcifications performing simple soft tissue X-ray techniques are likely to underestimate the true calcium load. 3 For example, discrete arterial wall microcalcifications in all territories, not evident in simple X-rays have zero score like the scenario of no calcifications.…”

Role of different imaging modalities of vascular calcification in predicting outcomes in chronic kidney disease

“…Increased Adragao score in hemodialysis patients was positively correlated with arterial stiffness, future CV events and mortality[33]. The degree of pelvic arterial calcification showed 67% sensitivity and 85% specificity for the prediction of CAC score ≥ 100 and above 80% sensitivity and specificity for the prediction of CAC ≥ 400[34]. …”