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

Abstract

Vascular calcification (VC) is common among patients with chronic kidney disease (CKD). The severity of VC is associated with increased risk of cardiovascular events and mortality. Risk factors for VC include traditional cardiovascular risk factors as well as CKD-related risk factors such as increased calcium and phosphate load. VC is observed in arteries of all sizes from small arterioles to aorta, both in the intima and the media of arterial wall. Several imaging techniques have been utilized in the evaluation of the extent and the severity of VC. Plain radiographs are simple and readily available but with the limitation of decreased sensitivity and subjective and semi-quantitative quantification methods. Mammography, especially useful among women, offers a unique way to study breast arterial calcification, which is largely a medial-type calcification. Ultrasonography is suitable for calcification in superficial arteries. Analyses of wall thickness and lumen size are also possible. Computed tomography (CT) scan, the gold standard, is the most sensitive technique for evaluation of VC. CT scan of coronary artery calcification is not only useful for cardiovascular risk stratification but also offers an accurate and an objective analysis of the severity and progression.

Keywords: Aortic calcification; Coronary calcification; Dialysis; Hemodialysis; Mammogram; Plain X-ray; Ultrasound.

Figure 1

Abdominal aortic calcification seen on lateral lumbar spine radiograph.

Figure 2

Aortic arch calcification (arrow) seen on postero-anterior chest radiograph (A) and lateral chest radiograph (B).

Figure 3

Plaque-like intimal calcification (black arrow) and uniform linear railroad track-like medial calcification (white arrow).

Figure 4

Medial calcification in small arteries in hands (A) and foot (B).

Figure 5

Breast arterial calcification with the typical linear tram-track medial-type calcification (arrows).

Figure 6

Coronary artery calcification (marked with colors) and descending thoracic aortic calcification (arrows) seen on non-contrast multislice computed tomography.