Coronary Artery Calcium Scoring: Is It Time for a Change in Methodology?

Michael J. Blaha, Martin Bødtker Mortensen, Sina Kianoush, Rajesh Tota-Maharaj, Miguel Cainzos-Achirica

Research output: Contribution to journalReview articlepeer-review

187 Scopus citations


Quantification of coronary artery calcium (CAC) has been shown to be reliable, reproducible, and predictive of cardiovascular risk. Formal CAC scoring was introduced in 1990, with early scoring algorithms notable for their simplicity and elegance. Yet, with little evidence available on how to best build a score, and without a conceptual model guiding score development, these scores were, to a large degree, arbitrary. In this review, we describe the traditional approaches for clinical CAC scoring, noting their strengths, weaknesses, and limitations. We then discuss a conceptual model for developing an improved CAC score, reviewing the evidence supporting approaches most likely to lead to meaningful score improvement (for example, accounting for CAC density and regional distribution).

Original languageEnglish (US)
Pages (from-to)923-937
Number of pages15
JournalJACC: Cardiovascular Imaging
Issue number8
StatePublished - Aug 2017


  • cardiac CT
  • cardiovascular disease
  • coronary artery calcium
  • prediction
  • risk
  • score

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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