الفهرس 
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Abstract
schaemic heart disease is caused by coronary atherosclerosis.
Plaque disruption with superimposed thrombosis is the underlying
pathology in unstable angina, myocardial infarction and sudden death.
The amount of calcium in calcified plaques is considered to
be associated with the likelihood of future cardiac events.
The progression of calcium score in coronary arteries can be
used as an indicator of atherosclerotic process. Based on the amount
of coronary calcium detected, patients are categorized in different
groups which correspond to different risk cardiac event. Therefore
calcium score which is highly reproducible is of high clinical importance.
The aim of the work is to evaluate the role of multislice computed
tomography in scoring of coronary arteries calcification in patients with
symptoms suggestive of coronary artery disease.
This study included 30 patients, 20 males and 10 females. Their
age ranged from 39 to 73 years old (mean =56 years).The study was done
between March 2012 to March 2013.
An informed consent is taken from each patient and the privacy of
the patient is maintained.
Full history is taken from the patients as regarding personal
history,present history of current illness and past history especially of
cardiac troubles and risk factors of coronary artery disease. Then full
examination is done considering pulse,blood pressure,temperature and
respiratory rate followed by cardiac and chest examination.Evaluation
and analysis of previous investigations is done asECG and
I
echocardiography with emphasis on renal function tests in patient
underwent MSCT with contrast.
The most common risk factors were hypertension and diabetes
mellitus together (9 patients),then hypertension and smoking (5 patients),
however the least common risk factor is smoking alone (1 patient).
The commonest presenting symptoms in the current study were
chest pain and dyspnea together (70%) followed by chest pain only
(26.7%) and the least common clinical presentation was dyspnea only
(3.33%)
The patients were prepared for this examination by no food for 3–4
hours before examination,no caffeine products for 12 hours before
examination.Take all regular medications on the day of examination and
pre-medications for contrast allergy.The patients were instructed to
remove all metallic objects and wear hospital gowns, then the procedure
was explained to the patient for reassurance and the value of remaining
motionless.In patients underwent enhanced study a wide bore cannula is
used for rapid infusion rate of contrast media.The patient is asked to lie in
supine position and the examination is done.
The study is done first without contrast then the images obtained
are used for evaluation and quantification of coronary artery calcification
using Agatson score. 28 patients underwent enhanced study for
evaluation of stenotic lesions after injection of 50-60 cc of high iodine
concentration contrast media to achieve good contrast, injected at rate of
4-7 ml\ second.
20 patients are examined using prospective ECG triggering as these
patients had regular heart rhythm, prospective estimation of the duration
of the next RR interval will position the scan at the mid or late diastole
where the least motion of the heart observed while other 10 patients are
examined by retrospective technique because they had irregular heart
rhythm.
Images are reconstructed in axial plane, three orthogonal planes,
axial, sagittal, and coronal using multiplanar reformatting. The course of
each artery can be followed using curved MPR.The vessel can be
displayed in 3D image using volume rendering.
The images obtained without contrast media are used for
evaluation of coronary artery calcification where patients are classified
into 5 groups according extent of calcification normal(6patients), minimal
(1 patient),mild (10 patients), moderate (7 patients)and extensive group (6
patients). 28 patients underwent MSCT with contrast for evaluation of
stenotic lesions.2 patients from the extensive group not underwent
enhanced study due to localized extensive coronary calcification which
impairs the quality of image that interferes with evaluation of stenosis.
In the present study the commonest age group was between 51-60
years old and the least common affected age group was less than 40 years
old and revealed gender difference between males and females as males
(66.5%) and females (33.5%)
In patients presented with chest pain and dyspnea they were
commonly had mild, moderate or extensive evidence of CAD while
patients presented with chest pain they were commonly had mild
evidence of CAD.The only patient presented with dyspnea had moderate
evidence of CAD.
The higher is the calcium score the greater is the number of
calcified coronary arteries. This commonest site for calcification was the
left anterior descending artery (76.7 %) followed by circumflex artery
(43.3%) then right or left main coronary arteries (40%).
The greater is the extent of coronary arteries calcification, the
higher is risk of having stenotic lesions as 75% of extensive group had
stenotic lesions in contrast to 16.6% of normal group and no patients had
stenotic lesions in the minimal group(one patient only included in the
study).