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DOI:10.2214/AJR.07.3112
AJR 2008; 191:32-37
© American Roentgen Ray Society

Original Research

Coronary Artery Disease After Radiation Therapy for Hodgkin's Lymphoma: Coronary CT Angiography Findings and Calcium Scores in Nine Asymptomatic Patients

Jürgen Rademaker1, Heiko Schöder1, Nikki S. Ariaratnam2, Harry W. Strauss1, Joachim Yahalom3, Richard Steingart4 and Kevin C. Oeffinger5

1 Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1270 York Ave., New York, NY 10021.
2 Department of Radiology, New York-Presbyterian Hospital, New York, NY.
3 Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY.
4 Department of Cardiology, Memorial Sloan-Kettering Cancer Center, New York, NY.
5 Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY.

OBJECTIVE. Long-term survivors of Hodgkin's lymphoma treated with radiation therapy have an increased incidence of coronary artery disease. The purpose of this study is to describe the coronary CT angiography findings and calcium scores of asymptomatic patients who had mediastinal irradiation for Hodgkin's lymphoma and to evaluate the impact of coronary CT angiography on patient management.

MATERIALS AND METHODS. We evaluated nine consecutive patients, age range 35–60 years, who had been treated for Hodgkin's lymphoma by radiation therapy between the ages of 11 and 27 years. The total mediastinal dose ranged from 34 to 45 Gy. All patients were evaluated with 64-MDCT with calcium scoring followed by CT angiography of the coronary arteries. Imaging findings and clinical follow-up were analyzed.

RESULTS. Eight of nine patients had coronary artery disease. CT showed long segments of diffuse disease; areas of stenosis from soft plaque; and calcification in the proximal right coronary, left anterior descending, and left circumflex arteries. Calcium scores were significantly higher than in other patients of this age group. Additional tests, including selective coronary angiography, were necessary in patients with diffuse disease with calcifications. CT evaluation led to bypass surgery and angioplasty in two patients.

CONCLUSION. Coronary CT angiography and calcium scores are useful tools for evaluation of irradiation-related coronary artery disease. Complementary tests might be necessary in selected patients. Prospective larger studies are needed to better define the role of coronary CT angiography and calcium scores and to establish an algorithm for evaluation and treatment of these patients.

Keywords: calcium score • coronary artery disease • coronary CT angiography • Hodgkin's disease • mantle field radiation


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