Kalziumscoring

Kalziumscoring is a set of imaging-based methods for quantifying calcium deposits in tissues, most notably coronary arteries. The most commonly used metric is the Agatston score, derived from non-contrast cardiac CT scans. In each calcified lesion, regions with attenuation above 130 Hounsfield units (HU) are identified; the lesion area is multiplied by a density factor (1–4) based on peak HU, and the scores for all lesions are summed to yield the total score. This score is used to stratify cardiovascular risk and guide preventive treatment decisions.

In addition to the Agatston score, alternative metrics include calcium volume score, which counts calcified voxels, and calcium mass score, which combines volume with density calibration to estimate the mineral mass. These methods can improve comparability across scanners and protocols and may be less sensitive to imaging settings than the classic Agatston score.

Clinical use and interpretation: Coronary calcium scoring is used primarily in asymptomatic adults to refine risk assessment, especially in intermediate-risk populations. A higher CAC score correlates with higher risk of future coronary events. A zero score is associated with very low short- to medium-term risk. Scores are considered alongside traditional risk factors, and they can influence decisions about preventive therapies such as statins. Limitations include exposure to ionizing radiation, cost, and variability due to scanner type, acquisition parameters, and heart rate; calcium scoring does not diagnose coronary disease and should not be used as the sole diagnostic test in symptomatic patients.