Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Clinical imaging of vascular disease in chronic kidney disease


Arterial wall calcification, once considered an incidental finding, is now known to be a consistent and strong predictor of cardiovascular events in patients with chronic renal insufficiency. It is also commonly encountered in radiologic examinations as an incidental finding. Forthcoming bench, translational, and clinical data seek to establish this and pre-calcification changes as surrogate imaging biomarkers for noninvasive prognostication and treatment follow-up. Emerging paradigms seek to establish vascular calcification as a surrogate marker of disease. Imaging of pre-calcification and decalcification events may prove more important than imaging of the calcification itself. Data-driven approaches to screening will be necessary to limit radiation exposure and prevent over-utilization of expensive imaging techniques.

This is a preview of subscription content, log in to check access.


  1. 1.

    Al Aly Z, Edwards JC (2004) Vascular biology in uremia: insights into novel mechanisms of vascular injury. Adv Chronic Kidney Dis 11(3):310–318

  2. 2.

    Schlieper G, Schurgers L, Brandenburg V, Reutlingsperger C, Floege J (2015) Vascular calcification in chronic kidney disease: an update. Nephrol Dial Transpl. doi:10.1093/ndt/gfv111

  3. 3.

    Assimes TL, Knowles JW, Basu A, Iribarren C, Southwick A, Tang H, Absher D, Li J, Fair JM, Rubin GD, Sidney S, Fortmann SP, Go AS, Hlatky MA, Myers RM, Risch N, Quertermous T (2008) Susceptibility locus for clinical and subclinical coronary artery disease at chromosome 9p21 in the multi-ethnic ADVANCE study. Hum Mol Genet 17(15):2320–2328. doi:10.1093/hmg/ddn132

  4. 4.

    Rutsch F, Nitschke Y, Terkeltaub R (2011) Genetics in arterial calcification: pieces of a puzzle and cogs in a wheel. Circ Res 109(5):578–592. doi:10.1161/circresaha.111.247965

  5. 5.

    Meema HE, Oreopoulos DG, deVeber GA (1976) Arterial calcifications in severe chronic renal disease and their relationship to dialysis treatment, renal transplant, and parathyroidectomy. Radiology 121(2):315–321. doi:10.1148/121.2.315

  6. 6.

    Adragao T, Pires A, Birne R, Curto JD, Lucas C, Goncalves M, Negrao AP. A plain X-ray vascular calcification score is associated with arterial stiffness and mortality in dialysis patients (1460-2385 (Electronic))

  7. 7.

    Kauppila LI, Polak JF, Cupples LA, Hannan MT, Kiel DP, Wilson PW. New indices to classify location, severity and progression of calcific lesions in the abdominal aorta: a 25-year follow-up study. (0021-9150 (Print))

  8. 8.

    Mettler FA Jr, Huda W, Yoshizumi TT, Mahesh M (2008) Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 248(1):254–263. doi:10.1148/radiol.2481071451

  9. 9.

    Dweck MR, Chow MWL, Joshi NV, Williams MC, Jones C, Fletcher AM, Richardson H, White A, McKillop G, van Beek EJR, Boon NA, Rudd JHF, Newby DE (2012) Coronary arterial 18F-sodium fluoride uptake: a novel marker of plaque biology. J Am Coll Cardiol 59(17):1539–1548. doi:10.1016/j.jacc.2011.12.037

  10. 10.

    Joshi NV, Vesey AT, Williams MC, Shah ASV, Calvert PA, Craighead FHM, Yeoh SE, Wallace W, Salter D, Fletcher AM, van Beek EJR, Flapan AD, Uren NG, Behan MWH, Cruden NLM, Mills NL, Fox KAA, Rudd JHF, Dweck MR, Newby DE (2014) 18F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial. Lancet 383(9918):705–713. doi:10.1016/S0140-6736(13)61754-7

  11. 11.

    Aikawa E, Nahrendorf M, Figueiredo J-L, Swirski FK, Shtatland T, Kohler RH, Jaffer FA, Aikawa M, Weissleder R (2007) Osteogenesis associates with inflammation in early-stage atherosclerosis evaluated by molecular imaging in vivo. Circulation 116(24):2841–2850. doi:10.1161/circulationaha.107.732867

  12. 12.

    Otsuka F, Sakakura K, Yahagi K, Joner M, Virmani R (2014) Has our understanding of calcification in human coronary atherosclerosis progressed? Arterioscler Thromb Vasc Biol 34(4):724–736. doi:10.1161/atvbaha.113.302642

  13. 13.

    Evrard S, Delanaye P, Kamel S, Cristol JP, Cavalier E (2015) Vascular calcification: from pathophysiology to biomarkers. Clin Chim Acta 438:401–414. doi:10.1016/j.cca.2014.08.034

  14. 14.

    Kapustin AN, Chatrou ML, Drozdov I, Zheng Y, Davidson SM, Soong D, Furmanik M, Sanchis P, De Rosales RT, Alvarez-Hernandez D, Shroff R, Yin X, Muller K, Skepper JN, Mayr M, Reutelingsperger CP, Chester A, Bertazzo S, Schurgers LJ, Shanahan CM. Vascular smooth muscle cell calcification is mediated by regulated exosome secretion (1524-4571 (Electronic))

  15. 15.

    Kathiresan S, Voight BF, Purcell S, Musunuru K, Ardissino D, Mannucci PM, Anand S, Engert JC, Samani NJ, Schunkert H, Erdmann J (2009) Genome-wide association of early-onset myocardial infarction with single nucleotide polymorphisms and copy number variants. Nat Genet 41(3):334–341. http://www.nature.com/ng/journal/v41/n3/suppinfo/ng.327_S1.html

  16. 16.

    Seidensticker R, Ricke J, Seidensticker M (2015) Integration of chemoembolization and radioembolization into multimodal treatment of cholangiocarcinoma. Best Pract Res Clin Gastroenterol 29(2):319–332. doi:10.1016/j.bpg.2015.02.009

  17. 17.

    Miura JT, Gamblin TC (2015) Transarterial chemoembolization for primary liver malignancies and colorectal liver metastasis. Surg Oncol Clin N Am 24(1):149–166. doi:10.1016/j.soc.2014.09.004

  18. 18.

    Hofmann Bowman MA, McNally EM (2012) Genetic pathways of vascular calcification. Trends Cardiovasc Med 22(4):93–98. doi:10.1016/j.tcm.2012.07.002

  19. 19.

    Boehm LM, Jayakrishnan TT, Miura JT, Zacharias AJ, Johnston FM, Turaga KK, Gamblin TC (2015) Comparative effectiveness of hepatic artery based therapies for unresectable intrahepatic cholangiocarcinoma. J Surg Oncol 111(2):213–220. doi:10.1002/jso.23781

  20. 20.

    Al-Adra DP, Gill RS, Axford SJ, Shi X, Kneteman N, Liau SS (2015) Treatment of unresectable intrahepatic cholangiocarcinoma with yttrium-90 radioembolization: a systematic review and pooled analysis. Eur J Surg Oncol 41(1):120–127. doi:10.1016/j.ejso.2014.07.007

  21. 21.

    Filippi L, Pelle G, Cianni R, Scopinaro F, Bagni O (2015) Change in total lesion glycolysis and clinical outcome after 90Y radioembolization in intrahepatic cholangiocarcinoma. Nucl Med Biol 42(1):59–64. doi:10.1016/j.nucmedbio.2014.08.011

  22. 22.

    Hu MC, Shi M, Zhang J, Quinones H, Griffith C, Kuro-o M, Moe OW (2011) Klotho deficiency causes vascular calcification in chronic kidney disease. J Am Soc Nephrol 22(1):124–136. doi:10.1681/asn.2009121311

  23. 23.

    Lindberg K, Olauson H, Amin R, Ponnusamy A, Goetz R, Taylor RF, Mohammadi M, Canfield A, Kublickiene K, Larsson TE (2013) Arterial klotho expression and FGF23 effects on vascular calcification and function. PLoS One 8(4):e60658. doi:10.1371/journal.pone.0060658

  24. 24.

    London GM, Guerin AP, Marchais SJ, Metivier F, Pannier B, Adda H (2003) Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transpl 18(9):1731–1740

  25. 25.

    Afzali BGDBovcickdIU, Post TW (Ed), UpToDate, Waltham, MA. Accessed 13 July 2015

  26. 26.

    Zoccali C, London G (2015) Con: vascular calcification is a surrogate marker, but not the cause of ongoing vascular disease, and it is not a treatment target in chronic kidney disease. Nephrol Dial Transpl 30(3):352–357. doi:10.1093/ndt/gfv021

  27. 27.

    Afzali BGDVcickdIU, Post TW (Ed), UpToDate, Waltham, MA. Accessed 13 July 2015

  28. 28.

    Kramer H, Toto R, Peshock R, Cooper R, Victor R (2005) Association between chronic kidney disease and coronary artery calcification: the Dallas Heart Study. J Am Soc Nephrol 16(2):507–513. doi:10.1681/asn.2004070610

  29. 29.

    Qunibi WY, Abouzahr F, Mizani MR, Nolan CR, Arya R, Hunt KJ (2005) Cardiovascular calcification in Hispanic Americans (HA) with chronic kidney disease (CKD) due to type 2 diabetes. Kidney Int 68(1):271–277. doi:10.1111/j.1523-1755.2005.00402.x

  30. 30.

    Haydar AA, Hujairi NM, Covic AA, Pereira D, Rubens M, Goldsmith DJ (2004) Coronary artery calcification is related to coronary atherosclerosis in chronic renal disease patients: a study comparing EBCT-generated coronary artery calcium scores and coronary angiography. Nephrol Dial Transplant 19(9):2307–2312. doi:10.1093/ndt/gfh120

  31. 31.

    Matsuoka M, Iseki K, Tamashiro M, Fujimoto N, Higa N, Touma T, Takishita S (2004) Impact of high coronary artery calcification score (CACS) on survival in patients on chronic hemodialysis. Clin Exp Nephrol 8(1):54–58. doi:10.1007/s10157-003-0260-0

  32. 32.

    Sigrist MK, Taal MW, Bungay P, McIntyre CW (2007) Progressive vascular calcification over 2 years is associated with arterial stiffening and increased mortality in patients with stages 4 and 5 chronic kidney disease. Clin J Am Soc Nephrol CJASN 2(6):1241–1248. doi:10.2215/cjn.02190507

  33. 33.

    Jamal SA, Vandermeer B, Raggi P, Mendelssohn DC, Chatterley T, Dorgan M, Lok CE, Fitchett D, Tsuyuki RT (2013) Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis. Lancet 382(9900):1268–1277. doi:10.1016/S0140-6736(13)60897-1

  34. 34.

    Callister TQ, Cooil B, Raya SP, Lippolis NJ, Russo DJ, Raggi P (1998) Coronary artery disease: improved reproducibility of calcium scoring with an electron-beam CT volumetric method. Radiology 208(3):807–814

  35. 35.

    Puri R, Nicholls SJ, Shao M, Kataoka Y, Uno K, Kapadia SR, Tuzcu EM, Nissen SE (2015) Impact of statins on serial coronary calcification during atheroma progression and regression. J Am Coll Cardiol 65(13):1273–1282. doi:10.1016/j.jacc.2015.01.036

  36. 36.

    Awan Z, Denis M, Roubtsova A, Essalmani R, Marcinkiewicz J, Awan A, Gram H, Seidah NG, Genest J (2015) Reducing vascular calcification by anti-IL-1beta monoclonal antibody in a mouse model of familial hypercholesterolemia. Angiology. doi:10.1177/0003319715583205

  37. 37.

    Bjornstad P, Maahs DM, Wadwa RP, Pyle L, Rewers M, Eckel RH, Snell-Bergeon JK (2014) Plasma triglycerides predict incident albuminuria and progression of coronary artery calcification in adults with type 1 diabetes: the Coronary Artery Calcification in Type 1 Diabetes Study. J Clin Lipidol 8(6):576–583. doi:10.1016/j.jacl.2014.08.008

  38. 38.

    Lomashvili KA, Monier-Faugere M-C, Wang X, Malluche HH, O’Neill WC (2009) Effect of bisphosphonates on vascular calcification and bone metabolism in experimental renal failure. Kidney Int 75(6):617–625

  39. 39.

    Fleckenstein-Grün G, Thimm F, Czirfuzs A, Matyas S, Frey M (1994) Experimental vasoprotection by calcium antagonists against calcium-mediated arteriosclerotic alterations. J Cardiovasc Pharmacol 24:S75–S84

  40. 40.

    Motro M, Shemesh J (2001) Calcium channel blocker nifedipine slows down progression of coronary calcification in hypertensive patients compared with diuretics. Hypertension 37(6):1410–1413

  41. 41.

    Mathews SJ, de las Fuentes L, Podaralla P, Cabellon A, Zheng S, Bierhals A, Spence K, Slatopolsky E, Davila-Roman VG, Delmez JA (2011) Effects of sodium thiosulfate on vascular calcification in end-stage renal disease: a pilot study of feasibility, safety and efficacy. Am J Nephrol 33(2):131–138. doi:10.1159/000323550

  42. 42.

    Westenfeld R, Krueger T, Schlieper G, Cranenburg EC, Magdeleyns EJ, Heidenreich S, Holzmann S, Vermeer C, Jahnen-Dechent W, Ketteler M, Floege J, Schurgers LJ (2012) Effect of vitamin K2 supplementation on functional vitamin K deficiency in hemodialysis patients: a randomized trial. Am J Kidney Dis 59(2):186–195. doi:10.1053/j.ajkd.2011.10.041

  43. 43.

    Pilkey RM, Morton AR, Boffa MB, Noordhof C, Day AG, Su Y, Miller LM, Koschinsky ML, Booth SL (2007) Subclinical vitamin K deficiency in hemodialysis patients. Am J Kidney Dis 49(3):432–439. doi:10.1053/j.ajkd.2006.11.041

  44. 44.

    Kohlmeier M, Saupe J, Shearer MJ, Schaefer K, Asmus G (1997) Bone health of adult hemodialysis patients is related to vitamin K status. Kidney Int 51(4):1218–1221

  45. 45.

    Cranenburg ECM, Schurgers LJ, Uiterwijk HH, Beulens JWJ, Dalmeijer GW, Westerhuis R, Magdeleyns EJ, Herfs M, Vermeer C, Laverman GD (2012) Vitamin K intake and status are low in hemodialysis patients. Kidney Int 82(5):605–610

  46. 46.

    McCabe KM, Adams MA, Holden RM (2013) Vitamin K status in chronic kidney disease. Nutrients 5(11):4390–4398. doi:10.3390/nu5114390

  47. 47.

    Hashiba H, Aizawa S, Tamura K, Shigematsu T, Kogo H (2004) Inhibitory effects of etidronate on the progression of vascular calcification in hemodialysis patients. Ther Apher Dial 8(3):241–247. doi:10.1111/j.1526-0968.2004.00136.x

  48. 48.

    Nitta K, Akiba T, Suzuki K, Uchida K, Watanabe R, Majima K, Aoki T, Nihei H (2004) Effects of cyclic intermittent etidronate therapy on coronary artery calcification in patients receiving long-term hemodialysis. Am J Kidney Dis 44(4):680–688

  49. 49.

    Rosenblum IY, Black HE, Ferrell JF (1977) The effects of various diphosphonates on a rat model of cardiac calciphylaxis. Calcif Tissue Res 23(2):151–159

  50. 50.

    Fleckenstein-Grun G, Thimm F, Frey M, Matyas S (1995) Progression and regression by verapamil of vitamin D3-induced calcific medial degeneration in coronary arteries of rats. J Cardiovasc Pharmacol 26(2):207–213

  51. 51.

    Covic A, Kanbay M, Voroneanu L, Turgut F, Serban DN, Serban IL, Goldsmith DJ (2010) Vascular calcification in chronic kidney disease. Clin Sci (London, England: 1979) 119(3):111–121. doi:10.1042/cs20090631

  52. 52.

    Bleyer AJ, Burkart J, Piazza M, Russell G, Rohr M, Carr JJ (2005) Changes in cardiovascular calcification after parathyroidectomy in patients with ESRD. Am J Kidney Dis 46(3):464–469. doi:10.1053/j.ajkd.2005.04.035

  53. 53.

    Moe SM, O’Neill KD, Reslerova M, Fineberg N, Persohn S, Meyer CA (2004) Natural history of vascular calcification in dialysis and transplant patients. Nephrol Dial Transpl 19(9):2387–2393. doi:10.1093/ndt/gfh303

  54. 54.

    Oschatz E, Benesch T, Kodras K, Hoffmann U, Haas M (2006) Changes of coronary calcification after kidney transplantation. Am J Kidney Dis 48(2):307–313. doi:10.1053/j.ajkd.2006.04.066

  55. 55.

    Nahrendorf M, Keliher E, Panizzi P, Zhang H, Hembrador S, Figueiredo J-L, Aikawa E, Kelly K, Libby P, Weissleder R (2009) 18F-4V for PET–CT imaging of VCAM-1 expression in atherosclerosis. JACC Cardiovasc Imaging 2(10):1213–1222. doi:10.1016/j.jcmg.2009.04.016

  56. 56.

    Kaufmann BA, Sanders JM, Davis C, Xie A, Aldred P, Sarembock IJ, Lindner JR (2007) Molecular imaging of inflammation in atherosclerosis with targeted ultrasound detection of vascular cell adhesion molecule-1. Circulation 116(3):276–284. doi:10.1161/circulationaha.106.684738

  57. 57.

    McAteer MA, Schneider JE, Ali ZA, Warrick N, Bursill CA, von zur Muhlen C, Greaves DR, Neubauer S, Channon KM, Choudhury RP (2008) Magnetic resonance imaging of endothelial adhesion molecules in mouse atherosclerosis using dual-targeted microparticles of iron oxide. Arterioscler Thromb Vasc Biol 28(1):77–83. doi:10.1161/atvbaha.107.145466

  58. 58.

    Rogers IS, Nasir K, Figueroa AL, Cury RC, Hoffmann U, Vermylen DA, Brady TJ, Tawakol A (2010) Feasibility of FDG imaging of the coronary arteries: comparison between acute coronary syndrome and stable angina. JACC Cardiovasc Imaging 3(4):388–397. doi:10.1016/j.jcmg.2010.01.004

  59. 59.

    Kooi ME, Cappendijk VC, Cleutjens KB, Kessels AG, Kitslaar PJ, Borgers M, Frederik PM, Daemen MJ, van Engelshoven JM (2003) Accumulation of ultrasmall superparamagnetic particles of iron oxide in human atherosclerotic plaques can be detected by in vivo magnetic resonance imaging. Circulation 107(19):2453–2458. doi:10.1161/01.cir.0000068315.98705.cc

  60. 60.

    Razavian M, Tavakoli S, Zhang J, Nie L, Dobrucki LW, Sinusas AJ, Azure M, Robinson S, Sadeghi MM (2011) Atherosclerosis plaque heterogeneity and response to therapy detected by in vivo molecular imaging of matrix metalloproteinase activation. J Nucl Med 52(11):1795–1802. doi:10.2967/jnumed.111.092379

  61. 61.

    Hyafil F, Vucic E, Cornily J-C, Sharma R, Amirbekian V, Blackwell F, Lancelot E, Corot C, Fuster V, Galis ZS, Feldman LJ, Fayad ZA (2011) Monitoring of arterial wall remodelling in atherosclerotic rabbits with a magnetic resonance imaging contrast agent binding to matrix metalloproteinases. Eur Heart J 32(12):1561–1571

  62. 62.

    Lancelot E, Amirbekian V, Brigger I, Raynaud J-S, Ballet S, David C, Rousseaux O, Le Greneur S, Port M, Lijnen HR, Bruneval P, Michel J-B, Ouimet T, Roques B, Amirbekian S, Hyafil F, Vucic E, Aguinaldo JGS, Corot C, Fayad ZA (2008) Evaluation of matrix metalloproteinases in atherosclerosis using a novel noninvasive imaging approach. Arterioscler Thromb Vasc Biol 28(3):425–432. doi:10.1161/atvbaha.107.149666

  63. 63.

    J-o Deguchi, Aikawa M, Tung C-H, Aikawa E, Kim D-E, Ntziachristos V, Weissleder R, Libby P (2006) Inflammation in atherosclerosis: visualizing matrix metalloproteinase action in macrophages in vivo. Circulation 114(1):55–62. doi:10.1161/circulationaha.106.619056

  64. 64.

    Kietselaer BLJH, Reutelingsperger CPM, Heidendal GAK, Daemen MJAP, Mess WH, Hofstra L, Narula J (2004) Noninvasive detection of plaque instability with use of radiolabeled annexin A5 in patients with carotid-artery atherosclerosis. N Engl J Med 350(14):1472–1473. doi:10.1056/NEJM200404013501425

  65. 65.

    Laufer EM, Winkens MHM, Narula J, Hofstra L (2009) Molecular imaging of macrophage cell death for the assessment of plaque vulnerability. Arterioscler Thromb Vasc Biol 29(7):1031–1038. doi:10.1161/atvbaha.108.165522

  66. 66.

    Ramstrom S, O’neill S, Dunne E, Kenny D (2010) Annexin V binding to platelets is agonist, time and temperature dependent. Platelets 21(4):289–296. doi:10.3109/09537101003660564

  67. 67.

    Einhorn TA, Vigorita VJ, Aaron A (1986) Localization of technetium-99m methylene diphosphonate in bone using microautoradiography. J Orthop Res 4(2):180–187

  68. 68.

    Grynpas MD (1990) Fluoride effects on bone crystals. J Bone Miner Res 5(SUPPL. 1):S169–S175

  69. 69.

    Messa C, Goodman WG, Hoh CK, Choi Y, Nissenson AR, Salusky IB, Phelps ME, Hawkins RA (1993) Bone metabolic activity measured with positron emission tomography and [18F]fluoride ion in renal osteodystrophy: correlation with bone histomorphometry. J Clin Endocrinol Metab 77(4):949–955

  70. 70.

    Piert M, Zittel TT, Becker GA, Jahn M, Stahlschmidt A, Maier G, Machulla HJ, Bares R (2001) Assessment of porcine bone metabolism by dynamic [18F]fluoride ion PET: correlation with bone histomorphometry. J Nucl Med 42(7):1091–1100

  71. 71.

    Sprague JE, Kitaura H, Zou W, Ye Y, Achilefu S, Weilbaecher KN, Teitelbaum SL, Anderson CJ. Noninvasive imaging of osteoclasts in parathyroid hormone-induced osteolysis using a 64Cu-labeled RGD peptide (0161-5505 (Print))

  72. 72.

    Tranaeus S, Shi XQ, Angmar-Mansson B. Caries risk assessment: methods available to clinicians for caries detection (0301-5661 (Print))

  73. 73.

    Zaheer A, Murshed M, De Grand AM, Morgan TG, Karsenty G, Frangioni JV (2006) Optical imaging of hydroxyapatite in the calcified vasculature of transgenic animals. Arterioscler Thromb Vasc Biol 26(5):1132–1136. doi:10.1161/01.ATV.0000210016.89991.2a

  74. 74.

    Dinah C, Sandinha T (2014) Enhanced depth imaging as an adjunctive tool in the diagnosis of decalcified choroidal osteoma. Eye 28(3):356–358. doi:10.1038/eye.2013.272

  75. 75.

    Kowada T, Kikuta J, Kubo A, Ishii M, Maeda H, Mizukami S, Kikuchi K (2011) In vivo fluorescence imaging of bone-resorbing osteoclasts. J Am Chem Soc 133(44):17772–17776. doi:10.1021/ja2064582

  76. 76.

    KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) (2009) Kidney Int Suppl (113):S1-130. doi:10.1038/ki.2009.188

Download references

Author information

Correspondence to Mehmet Kanbay.

Ethics declarations

Conflict of interest

Authors have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sag, A.A., Covic, A., London, G. et al. Clinical imaging of vascular disease in chronic kidney disease. Int Urol Nephrol 48, 827–837 (2016). https://doi.org/10.1007/s11255-016-1240-0

Download citation


  • Chronic kidney disease
  • Vascular calcification
  • Atherosclerosis
  • Coronary artery disease
  • Cardiac imaging techniques