One-Step Whole-Body Artery Scan: A New Way to Detect Heart and Brain Vessel Disease

Table of Contents

• Key Points
• Understanding the Problem: Atherosclerosis in Heart and Brain Arteries
• What This Study Set Out to Accomplish
• How the Research Was Conducted
• Key Findings: What the Researchers Discovered
• What This Means for Patients and Medical Practice
• Study Limitations: What This Research Cannot Tell Us
• Recommendations for Patients
• Frequently Asked Questions
• Source Information

Key Points

• A one-step CT scan can image heart, neck, and brain arteries in under one second.
• In 300 asymptomatic patients, 63% had plaque in heart or brain arteries.
• Abnormal blood glucose and total cholesterol were linked to soft, vulnerable coronary plaque.
• The average radiation dose was 1.48 mSv, much lower than a standard chest CT.
• The study could not prove causation or predict future heart attacks or strokes.

Understanding the Problem: Atherosclerosis in Heart and Brain Arteries

Atherosclerosis—a condition in which fatty deposits, cholesterol, and other substances build up inside artery walls to form plaque—is the leading cause of two devastating medical events: ischemic stroke (a blockage of blood flow to the brain) and acute coronary syndrome (a sudden reduction of blood flow to the heart, including heart attacks). These conditions are responsible for enormous health burdens worldwide.

One important fact that many people do not realize is that atherosclerosis is rarely limited to just one part of the body. It commonly affects multiple vascular beds—meaning that if a patient has plaque in their heart arteries (coronary arteries), they are more likely to also have plaque in the arteries that supply the brain (carotid and cerebral arteries).

Previous research has shown that plaque buildup in the coronary and carotid arteries shares the same genetic basis, and that carotid and coronary artery disease are closely associated because they share similar risk factors. These shared risk factors include high blood pressure, diabetes, high cholesterol, smoking, and family history of heart disease.

Given this connection, identifying the risk factors for—and the relationship between—coronary and carotid/cerebrovascular atherosclerosis is highly significant. Finding plaques early, before they cause symptoms, enables early treatment and can potentially reduce future vascular events like heart attacks and strokes.

What This Study Set Out to Accomplish

The research team, led by Dr. Shurong Liu and colleagues, aimed to advance a technique called integrated coronary–carotid–cerebral computed tomography angiography (ICCC-CTA). This is a specialized type of CT scan that images three key vascular territories in a single examination:

• The coronary arteries (arteries supplying the heart muscle)
• The carotid arteries (the main arteries in the neck that supply the brain)
• The cerebral arteries (arteries inside the brain)

The primary goals of the study were to:

1. Develop a low-radiation-dose, one-step ICCC-CTA technique that can evaluate all three vascular beds simultaneously
2. Analyze the association between cardiovascular and cerebrovascular atherosclerosis—in other words, whether plaque in the heart arteries predicts plaque in the brain arteries and vice versa
3. Evaluate the risk factors for different plaque types to enable early-stage treatment and reduce the burden of cardiovascular and cerebrovascular disease

The researchers had previously reported in 2015 on using a low-radiation dual-source CT system to evaluate coronary, carotid, and cerebral artery stenosis simultaneously. This new study builds on that earlier work by refining the technique and examining risk factors in greater detail.

How the Research Was Conducted

Study Participants: Who Was Included?

The study was a prospective trial, meaning patients were enrolled and followed forward in time. Between January 2015 and December 2017, a total of 386 consecutive asymptomatic patients with cardiovascular risk factors were enrolled and underwent ICCC-CTA at participating medical centers.

Patients were excluded from the study for the following reasons:

• Iodinated contrast allergies (an allergy to the dye used for CT imaging)
• Renal disease with a serum creatinine concentration of 1.5 mg/mL or higher (because the contrast dye can stress the kidneys)
• Pregnancy
• Irregular heart rate (which can interfere with image quality)

After applying these exclusion criteria, 300 patients (77.7%) remained in the final analysis. Additional exclusions that occurred during the study included poor CTA image quality (n = 6), failure to follow the ICCC-CTA protocol (n = 9), and lack of complete laboratory data (n = 71).

All patients had their baseline demographic data recorded. The clinical and laboratory data collected included:

• Sex, age, height, and weight
• Smoking history and family history
• History of diabetes, blood pressure, and hyperlipidemia (high blood fats)
• Total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride concentrations
• Creatinine concentration (a marker of kidney function)

Definition of Cardiovascular Risk Factors

The study defined the primary cardiovascular risk factors using standard clinical criteria:

• Diabetes mellitus was defined as a fasting glucose concentration of ≥ 6.1 mmol/L, a non-fasting glucose concentration of ≥ 11.1 mmol/L, or use of hypoglycemic therapy (insulin, oral diabetes medications, or dietary advice).
• Hypertension (high blood pressure) was considered present if the patient had a previously established diagnosis, a systolic blood pressure of ≥ 140 mm Hg, a diastolic blood pressure of ≥ 90 mm Hg, or was taking antihypertensive medications.
• Dyslipidemia (abnormal blood fats) was defined according to the patient's medical history or their current use of lipid-lowering drugs (such as statins).
• Smoking status and alcohol consumption were ascertained from the medical history.

The Scanning Technique: How ICCC-CTA Works

The ICCC-CTA procedure is technically sophisticated. Here is how it works, step by step:

1. Patients received a single 0.8 mg dose of nitroglycerin aerosol (a medication that widens blood vessels) three minutes before scanning.
2. Scans were performed using a third-generation dual-source CT scanner (SOMATOM Force; Siemens Healthcare, Forchheim, Germany), equipped with a fully integrated circuit detector system.
3. The contrast agent used was Omnipaque (350 mg/mL iodine concentration), injected through a vein in the arm using a power injector with a 20-gauge needle.
4. The scan was acquired in a caudo-cranial direction (from the diaphragm up to the top of the head), covering the entire area of the heart, neck, and brain in one pass.
5. An automated bolus-tracking technique was used to time the scan precisely when the contrast agent reached the arteries of interest (with a signal attenuation threshold of 100 Hounsfield units in the ascending aorta).
6. Image acquisition was synchronized to the patient's heart rhythm using electrocardiogram (ECG) gating, with images captured at 30% of the RR interval (for heart rates above 65 bpm) or 60% of the RR interval (for heart rates at or below 65 bpm).

Key scanning parameters included:

• Turbo high-pitch acquisition mode (a very fast scanning technique)
• Detector collimation of 2 × 192 × 0.6 mm
• Rotation time of 0.25 seconds
• Pitch of 3.2 (high pitch means faster table movement)
• Automated tube voltage selection and automated tube current modulation (both designed to minimize radiation exposure)
• Contrast volume of only 45 mL at a flow rate of 4.5 mL/s, followed by 45 mL of saline solution at the same flow rate
• Total scan time of 0.78 ± 0.12 seconds—less than one second for the entire heart-to-brain scan

Images were reconstructed using advanced modeled iterative reconstruction at a strength level of 3, with a medium sharp convolution kernel and 0.6-mm section thickness. Multiple image display techniques were used to evaluate the arteries, including curved planar reformatting (thickness 8.0 mm), maximum intensity projection (thickness 10.0 mm), multiplanar reformatting, and volume rendering.

How Arteries and Plaques Were Analyzed

The researchers used internationally recognized anatomical standards to divide the arteries into segments for analysis:

• The coronary tree was subdivided according to American Heart Association (AHA) standards, with segments 1–4 designated as the right coronary artery, segment 5 as the left main coronary artery, segments 6–10 as the left anterior descending artery, segments 11–15 as the left circumflex artery, and segment 16 as an intermediate artery (if present).
• The carotid and cerebrovascular arteries were divided into 40 segments according to the criteria of the North American Symptomatic Carotid Endarterectomy Trial (NASCET). These included the common carotid arteries, carotid bifurcations, external carotid arteries, internal carotid arteries, vertebral arteries, basilar artery, anterior cerebral arteries, middle cerebral arteries, posterior cerebral arteries, anterior communicating artery, and posterior communicating arteries.

Each vascular segment was evaluated for the presence of plaque, and plaques were classified into three types:

• Calcified plaques—hard plaques containing calcium deposits
• Non-calcified plaques—soft plaques without calcium, which are considered more vulnerable to rupture
• Mixed plaques—plaques containing both calcified and non-calcified components

Coronary artery narrowing (stenosis) was quantified using six predefined categories according to the Coronary Artery Disease Reporting and Data System (CAD-RADS): 0%, 1–24%, 25–49%, 50–69%, 70–99%, or 100% (complete blockage). The degree of stenosis was measured as the ratio between the luminal diameter at the obstructed site and the luminal diameter of the most normal-appearing segment immediately upstream of the plaque.

Radiation Dose Measurement

The researchers carefully tracked radiation exposure for every patient. The volume CT dose index and dose–length product (DLP) were automatically recorded at the end of each scan. The effective radiation dose (in millisieverts, mSv) was calculated by multiplying the DLP by conversion factors of 0.026 mSv·mGy⁻¹·cm⁻¹ for cardiovascular imaging and 0.0031 mSv·mGy⁻¹·cm⁻¹ for head and neck imaging.

The average DLP was 138.57 ± 31.6 mGy·cm, which translates to a calculated effective radiation dose of 1.48 ± 0.33 mSv (range: 0.79–2.77 mSv). To put this in perspective, a standard chest CT typically delivers around 7 mSv, and the average American receives about 3 mSv per year from natural background radiation. This new protocol therefore represents a very low radiation exposure.

Statistical Analysis

The research team used standard statistical methods to analyze the data. Continuous variables were presented as mean ± standard deviation (or median with interquartile range for non-normally distributed data). Categorical variables were shown as numbers and percentages. The Student's t-test and Wilcoxon rank-sum test were used to compare continuous variables, while chi-squared and Fisher's exact tests were used for categorical variables. To identify independent risk factors for plaque, they used multivariate logistic regression analysis, reporting results as odds ratios (OR) with 95% confidence intervals (CI). A P-value of less than 0.05 was considered statistically significant.

Key Findings: What the Researchers Discovered

Patient Characteristics: The Study Population at a Glance

The 300 patients in the study had a mean age of 56 ± 10 years (range: 37–92 years). Of these, 66% (199 out of 300) were male. The mean heart rate during the CTA scan was 74 ± 11 beats per minute (range: 40–128 bpm).

When the researchers compared patients with plaques to those without plaques, several notable differences emerged:

• Patients with plaques were older (58 ± 10 years vs. 53 ± 9 years, P = 0.001)
• Hypertension was more common in the plaque group (35.4% vs. 12.6%, P = 0.001)
• Diabetes was significantly more common in the plaque group (28.6% vs. 3.6%, P = 0.001)
• Fasting glucose was higher in the plaque group (5.58 ± 2.50 vs. 4.76 ± 1.31 mmol/L, P = 0.001)
• Total cholesterol was higher in the plaque group (1.82 ± 1.14 vs. 1.66 ± 0.94 mmol/L, P = 0.004)
• LDL cholesterol (the "bad" cholesterol) was higher in the plaque group (2.55 ± 0.90 vs. 2.33 ± 0.59 mmol/L, P = 0.04)
• Diastolic blood pressure was slightly higher in the plaque group (81.73 ± 8.80 vs. 79.48 ± 7.65 mm Hg, P = 0.028)

There were no significant differences between the groups in terms of gender ratio (P = 0.059), heart rate, systolic blood pressure, body mass index (BMI), education level, smoking, alcohol use, physical activity, HDL cholesterol, uric acid, or creatinine levels.

The Prevalence of Plaque: How Common Was Atherosclerosis?

The prevalence of plaque in this asymptomatic population—people with risk factors but no symptoms—was striking:

• 189 out of 300 patients (63%) had plaques in their coronary and/or cerebral arteries
• 111 patients (37%) had no detectable plaques
• 180 patients (60%) had plaques in the coronary (heart) arteries
• 52 patients (17.3%) had plaques in the carotid and cerebral (brain) arteries
• 43 patients (14.3%) had plaques in both the coronary and carotid/cerebral territories simultaneously

Among the 189 patients who had plaques, the distribution was as follows:

• 72.5% had plaques only in the coronary arteries
• 22.8% had plaques only in the cerebrovascular arteries
• 4.8% had plaques in both territories

These numbers reveal an important clinical fact: while coronary plaques are very common, the majority of patients with coronary plaques (76%) do not have detectable cerebrovascular plaques. Conversely, patients who do have cerebrovascular plaques are highly likely to also have coronary disease.

The Link Between Heart and Brain Artery Plaques

The study found a statistically significant association between plaque formation in the coronary arteries and plaque formation in the carotid–cerebral arteries (χ² = 14.22, P = 0.001). This means that a patient who has plaques in one vascular territory is significantly more likely to have plaques in the other territory, compared to what would be expected by chance alone.

When the researchers examined the specific plaque types, they found particularly strong associations:

• Calcified plaques in the carotid–cerebral arteries were strongly associated with calcified plaques in the coronary arteries (χ² = 20.71, P = 0.001). In plain terms, if a patient has hard, calcified plaque in their neck or brain arteries, they are very likely to also have calcified plaque in their heart arteries.
• Mixed plaques (containing both calcified and soft components) also showed a strong association between the two territories (χ² = 8.96, P = 0.003).
• Non-calcified plaques (soft, vulnerable plaques) did not show a statistically significant association between the coronary and carotid–cerebral arteries (χ² = 2.93, P = 0.087). This suggests that the presence of a soft plaque in one territory does not reliably predict a soft plaque in the other.

This finding is clinically important. It indicates that the type of plaque a patient develops may be somewhat specific to each vascular bed, even though the overall disease burden tends to track together.

Risk Factors for Non-Calcified Plaques

The multivariate logistic regression analysis examined which cardiovascular risk factors were independently associated with plaque formation, adjusting for other variables. The analysis included three statistical models: a crude (unadjusted) model, a model adjusted for age, gender, BMI, uric acid, and creatinine, and a fully adjusted model that also accounted for all other cardiovascular and cerebrovascular risk factors.

For non-calcified plaques in the coronary arteries, two risk factors were significant across all statistical models:

• Abnormal blood glucose (fasting glucose): odds ratio = 1.44, 95% CI = 0.12–0.62, P = 0.01. This means higher blood sugar levels were consistently associated with a greater likelihood of having soft coronary plaque, even after adjusting for other risk factors.
• Abnormal total cholesterol: odds ratio = 1.28, 95% CI = 0.07–0.46, P = 0.01. Higher total cholesterol was also consistently linked to the presence of non-calcified coronary plaque.

For non-calcified plaques in the carotid–cerebral arteries, abnormal blood glucose was identified as a risk factor, but only in the crude (unadjusted) model (odds ratio = 1.44, 95% CI = 0.12–0.62, P = 0.01). After adjusting for other factors, this association lost statistical significance (fully adjusted model: OR = 1.32, P = 0.13). This suggests that while blood sugar is an important contributor to brain-vessel soft plaque, its independent effect may be mediated through other risk factors like age, blood pressure, and cholesterol.

Risk Factors for Calcified Plaques

For calcified plaques in the coronary arteries, the analysis identified two risk factors that were significant across all models:

• Abnormal blood glucose: odds ratio = 1.43, 95% CI = 0.11–0.61, P = 0.01
• Abnormal systolic blood pressure (the top number in a blood pressure reading): odds ratio = 1.02, 95% CI = 0.01–0.04, P = 0.02. This means that for every unit increase in systolic blood pressure, the odds of having calcified coronary plaque increased by 2%.

These findings underscore the central role of blood sugar control in preventing atherosclerosis. Abnormal glucose metabolism was the only risk factor that appeared consistently across both plaque types (calcified and non-calcified) and across multiple statistical models. It is worth noting that in the fully adjusted model for non-calcified coronary plaques, uric acid also appeared as a protective factor (OR = 0.84, 95% CI = −0.34 to −0.01, P = 0.04), though this finding is complex and requires further investigation.

What This Means for Patients and Medical Practice

This research demonstrates that a single, one-step CT scan can effectively evaluate atherosclerosis in all three major vascular territories—the coronary arteries feeding the heart, the carotid arteries in the neck, and the cerebral arteries inside the brain—using a remarkably low radiation dose.

The radiation exposure of this technique deserves special emphasis. The total effective radiation dose of the combined scan was 1.48 ± 0.33 mSv. This is dramatically lower than other combined imaging approaches reported in the literature:

• Tognolini and colleagues reported an average radiation dose of 4.3 mSv for a combined carotid and coronary CTA protocol
• Yasmin and colleagues reported doses of 7.3 mSv and 3.8 mSv for separate coronary and carotid CTA scans, respectively
• The new ICCC-CTA technique also uses less contrast agent (45 mL vs. 100 mL for the Tognolini protocol), which reduces the strain on the kidneys

For patients, this means a more thorough evaluation of vascular health with less radiation exposure and less contrast dye entering the body. The ability to perform a "whole-artery check" in under one second of scanning time is also more comfortable for patients and reduces motion artifacts that can degrade image quality.

The finding that abnormal blood glucose is the most consistent risk factor for both calcified and non-calcified plaques, in both the coronary and cerebrovascular territories, has important preventive implications. Diabetes and prediabetes are modifiable conditions—lifestyle changes, including diet, exercise, and weight management, along with appropriate medications, can significantly improve blood sugar control. This study reinforces that managing blood sugar is crucial not just for preventing heart attacks, but also for preventing strokes.

Similarly, the association of elevated total cholesterol with non-calcified coronary plaques highlights the importance of cholesterol screening and management, including the use of statin therapy when appropriate. Soft (non-calcified) plaques are considered the most dangerous type because they are more prone to rupture, and ruptured plaque is what triggers most heart attacks. Early detection of these vulnerable plaques could enable more aggressive preventive treatment.

Study Limitations: What This Research Cannot Tell Us

It is important to understand what this study does and does not prove. Every research study has limitations, and this one is no exception:

• Asymptomatic population only: The study enrolled only patients with cardiovascular risk factors who had no symptoms of heart or brain disease. The findings may not apply to patients who already have symptomatic cardiovascular or cerebrovascular disease, or to the general population without any risk factors.
• Cross-sectional design: The study is a single-timepoint (cross-sectional) analysis. It shows associations between risk factors and plaque presence, but it cannot prove causation—that is, it cannot prove that abnormal blood sugar caused the plaque, only that they are linked.
• No long-term follow-up: The study did not track patients over time to see who eventually developed heart attacks or strokes. Future research with longitudinal follow-up is needed to confirm that detecting plaques with ICCC-CTA actually reduces vascular events.
• Sample size and single-center design: With 300 patients from specific Chinese medical centers, the results may not be fully generalizable to other populations with different ethnic, dietary, or healthcare backgrounds.
• Radiation dose estimation: The effective radiation dose was calculated using conversion factors from previous studies rather than measured directly, which introduces some potential estimation error.
• Non-calcified plaque detection limits: CT angiography is excellent at detecting calcified plaque but can be less sensitive for some non-calcified plaque types. Some small soft plaques may have been missed.
• Table data incompleteness: The published article references risk factor data for calcified carotid-cerebral plaques (Table 6), which is not fully detailed in the available text, so some specific numerical associations for this subgroup were not available for analysis.

Recommendations for Patients

Based on this research and the broader body of medical evidence, here are practical steps patients can consider:

1. Know your numbers. This study reinforces that blood sugar and cholesterol levels are powerful predictors of plaque buildup. Ask your doctor what your fasting glucose, total cholesterol, LDL ("bad") cholesterol, and blood pressure levels are—and what they should be for your specific health profile.
2. Take blood sugar seriously, even if you don't have diabetes. This study found that abnormal blood glucose was the most consistent risk factor for all plaque types. If your fasting glucose is creeping upward (in the "prediabetes" range), this is a red flag that should not be ignored. Dietary changes—particularly reducing refined carbohydrates and added sugars—combined with regular physical activity can significantly improve glucose metabolism.
3. Control your blood pressure. Elevated systolic blood pressure was an independent risk factor for calcified coronary plaque. The American Heart Association recommends maintaining blood pressure below 120/80 mm Hg for most adults. Home blood pressure monitoring can help you track progress.
4. Discuss cholesterol management with your doctor. Total cholesterol elevation was independently associated with non-calcified (vulnerable) coronary plaque. If your cholesterol is high, lifestyle changes (diet, exercise) and, when appropriate, statin therapy can substantially reduce your cardiovascular risk.
5. If you have multiple risk factors, talk to your doctor about advanced screening. The ICCC-CTA technique is an emerging tool that could, in one low-radiation scan, reveal whether you have plaque in your heart, neck, or brain arteries. While this test is not yet a standard screening tool for everyone, it may be valuable for people with multiple risk factors who want a more complete picture of their vascular health.
6. Do not smoke, and limit alcohol. While smoking and alcohol use did not reach statistical significance in this particular multivariate analysis, the broader medical literature overwhelmingly establishes them as major contributors to atherosclerosis.
7. Understand that plaque in one area matters for the whole body. Because plaque tends to affect multiple vascular beds, a diagnosis of coronary artery disease should prompt evaluation of stroke risk—and vice versa. If you know you have plaque in one territory, your doctor should assess the others.

As with all medical decisions, individual risk assessment should be discussed with your healthcare provider. The right screening and prevention strategy depends on your complete medical picture, including age, family history, and existing conditions.

Frequently Asked Questions

What is a one-step whole-body artery scan?

It is a specialized CT scan called integrated coronary–carotid–cerebral computed tomography angiography (ICCC-CTA). It images the heart arteries, neck arteries, and brain arteries in a single, fast scan. The study tested a low-radiation version that took less than one second of scan time and used only 45 mL of contrast dye.

What were the main findings about plaque buildup?

In this group of 300 patients, 63% had plaque in their heart or brain arteries. Specifically, 60% had coronary artery plaque, and 17.3% had carotid or cerebral artery plaque. Higher blood sugar and total cholesterol levels were linked to plaque, especially soft, non-calcified plaques, which are more vulnerable to rupture.

How low was the radiation dose for this scan?

The average radiation dose was 1.48 millisieverts (mSv), with a range of 0.79 to 2.77 mSv. For context, a standard chest CT delivers about 7 mSv, and the average American gets about 3 mSv per year from background radiation. So this combined scan used a very low dose.

What does this scan mean for someone with risk factors?

If you have risk factors like high blood sugar, high cholesterol, or high blood pressure, this scan could potentially detect plaque in your heart or brain arteries before symptoms appear. The study suggests it may help identify at-risk patients earlier and guide prevention. However, it is not yet a standard screening test for everyone.

What are the limitations of this study?

The study only included patients without symptoms and with risk factors, so results may not apply to everyone. It is a cross-sectional look at one point in time, so it cannot prove that high blood sugar or cholesterol caused the plaque. Also, patients were not followed over time to see who later had heart attacks or strokes.

What practical steps should I take based on this research?

Know your blood sugar, cholesterol, and blood pressure numbers. This study found abnormal blood glucose was the most consistent risk factor for plaque, so managing prediabetes or diabetes is important. Control blood pressure and discuss cholesterol management with your doctor. If you have multiple risk factors, ask about advanced screening options.

Source Information

Original Article Title: One-step integrated coronary–carotid–cerebral computed tomography angiography to evaluate cardiovascular and cerebrovascular atherosclerosis

Authors: Shurong Liu, Zhen Zhang, Baoliang Liu, Shanshan Zhou, Jianan Xie, Ruijuan Han, and Sun Kai

Journal: BMC Cardiovascular Disorders (2023) 23:367

DOI: https://doi.org/10.1186/s12872-023-03343-3

Publication Date: 2023

Ethics Approval: The study was approved by the ethics committee of Inner Mongolia Medical University of China (No. YKD2015061) and The Third People's Hospital of Longgang District, Shenzhen. All procedures followed the Declaration of Helsinki, and all patients provided written informed consent.

Funding/Disclosures: The authors declare no competing interests. The study was published under a Creative Commons Attribution 4.0 International License.

This patient-friendly article is based on peer-reviewed research published in an open-access medical journal. The original article can be accessed freely online via the DOI link above. This translation is intended for educational purposes and does not constitute medical advice. Patients should consult their healthcare providers regarding any decisions about screening, diagnosis, or treatment.