Costal Cartilage Calcification Presenting a Doughnut Appearance on 99mTc-Pyrophosphate Myocardial Imaging

Introduction: Costal cartilage calcification (CCC) is an evident yet usually neglected finding in calcium scoring CT scans. Although CAC score is a well-known predictive marker for CVD, little is known about the potential association between CCC and CVD risk factors (RFs) and events. Hypothesis: CCC is associated with CVD RFs and is predictive of CVD events independent from CAC score. Methods: Cardiac CAC score images from Johns Hopkins Hospital field center acquired within the fifth exam of the MESA cohort (2010-2012) were re-analyzed as part of the MESArthritis ancillary study. The CCC was measured bilaterally for the first pair of cartilages at the superior end of image FOVs using calcium scoring package (VScore, Vitrea 7.11, Vital Images) with a 180 HU cut-off. Outlier values were excluded using the IQR-based outlier fence estimates. Association of CCC with CVD RFs, and CVD and mortality time-to-event was investigated by multivariable linear regression and Cox proportional hazard models, respectively. Results: After exclusion of 3 outliers, 329 participants (53% female) with a mean age of 70.1 (±8.75) were included. In cross-sectional analysis, in addition to age (β=8.86, p:.003) and gender (376.0, p<.001), CCC was associated with diabetes (141.42, p:.019) and glucose level (2.85, p:.006). CCC was correlated with Framingham global CVD risk score (FRS) (coefficient:0.39, p<.001), but not with CAC when adjusted for age and gender. In time-to-event analysis, adjusted CCC was positively associated with CHD (HR:1.17, p:.039) and CVD (1.14, p:.012) risk. Compared with CAC score (C-index: 0.76) and FRS (0.74) individually, models with CCC addition to FRS (0.85) and both CAC and FRS (0.84) had higher C-index for CHD prediction. Conclusions: CCC is associated with diabetes and can be used to predict CHD and CVD events and augment the predictive power of the highly validated CAC and FRS for CHD events. However, this scoring should be validated in other larger cohorts.

Download Full-text

DETERMINATION OF SEX BY COSTAL CARTILAGE CALCIFICATION

American Journal of Roentgenology ◽

10.2214/ajr.108.4.771 ◽

1970 ◽

Vol 108 (4) ◽

pp. 771-774 ◽

Cited By ~ 41

Author(s):

SHIV NAVANI ◽

JAGDISH R. SHAH ◽

PAUL S. LEVY

Keyword(s):

Costal Cartilage ◽

Cartilage Calcification

Download Full-text

Association of Quantified Costal Cartilage Calcification and Long-Term Cumulative Blood Glucose Exposure: The Multi-Ethnic Study of Atherosclerosis

Frontiers in Endocrinology ◽

10.3389/fendo.2021.785957 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mahsima Shabani ◽

Farhad Pishgar ◽

Sepehr Akhtarkhavari ◽

Thiago Quinaglia ◽

Matthew J. Budoff ◽

...

Keyword(s):

Computed Tomography ◽

Blood Glucose ◽

Costal Cartilage ◽

Ct Images ◽

Cumulative Exposure ◽

High Blood Glucose ◽

Ethnic Study ◽

Cartilage Calcification ◽

Glucose Exposure

AimsAnecdotal reports have suggested increased soft tissue calcification in individuals with long-term exposures to high blood glucose. The association of costal cartilage calcification (CCC), a reliably quantifiable marker obtainable from non-contrast cardiac computed tomography (CT) with cumulative fasting blood glucose (FBG) exposure, is unknown. In this study, we aimed to determine the association between quantified CCC and cumulative glucose exposure using non-contrast coronary artery calcium (CAC) scoring computed tomography (CT) images in the Multi-Ethnic Study of Atherosclerosis (MESA).MethodsThe volume of bilateral CCC was quantified in high-density pixels (threshold of Hounsfield Unit>180) using the CAC scoring CT images acquired in the 5th MESA exam. Prior long-term cumulative exposure to FBG was calculated by area under the FBG-time curve over ten years before the time of the CT exam.ResultsA total of 2,305 participants (mean age: 69, female/male: 1.3) were included in this study. The median CCC volume was lower in females than males (1158 mm3 [IQR: 1751] vs. 3054 mm3 [3851], p<0.001). In cross-sectional analysis, quantified CCC was associated with FBG (9% increase per SD) and HbA1c (7% increase per SD) at the CT exam only in female participants after adjustment for age, race, BMI, and glomerular filtration rate. Only in female participants, quantified CCC was also associated with prior cumulative FBG (3% increase per decile change). In the subgroup of females with zero CAC scores, the adjusted CCC was still associated with FBG (13% increase per SD) at the time of CT exam and with prior cumulative FBG exposure (4% increase per decile change) before the CT exam.ConclusionsThe CCC, a reliably quantified marker in non-contrast cardiac CT, is associated with 10-year cumulative FBG exposure only in female participants, even those with zero CAC.

Download Full-text

The Effect of Aging on the Respiratory Movement of Human Rib Cage: Some Preliminaries

Advances in Bioengineering ◽

10.1115/imece2004-59032 ◽

2004 ◽

Author(s):

A. Vaziri ◽

B. Akhavan-Tafti ◽

H. Nayeb-Hashemi

Keyword(s):

Volume Change ◽

Costal Cartilage ◽

Respiratory Muscles ◽

Element Model ◽

Respiratory Volume ◽

Rib Cage ◽

Cartilage Calcification ◽

Age Related ◽

Age Range ◽

Bucket Handle

It is clear that costal cartilage and rib articulation calcification, as well as, weakness of the respiratory muscles reduce the rib cage volume displacement. Usually, calcification begins from costochondral junction and extends toward the sternocostal junction. Teale et al [1] reviewed seven hundred chest radiographs to determine the site and extent of the calcification over an age range of 20 to 90 years. They concluded that the prevalence of the costal cartilage calcification increases from 6% in the 3rd decade to 45% in the 9th and is more common in men. In addition, it is generally assumed that muscle strength decreases 30–40%, between 30 and 80 years of age. The effect of these age-related changes on the respiratory volume change can be realized by studying the transverse and anteroposterior expansion of the ribs during respiration. Here, we try to estimate the respiratory volume change through the changes in the “bucket-handle” movement of the 5th rib utilizing finite element model. The effect of costal cartilages calcification in both transverse and anteroposterior movement of the rib cage can be attained by modeling the total rib cage.

Download Full-text