From the Guidelines
Fibrosis and calcification on transthoracic echocardiography (TTE) are distinguished primarily by their echogenicity patterns and acoustic properties, with fibrosis appearing as increased echogenicity without acoustic shadowing and calcification appearing as intensely bright, highly echogenic structures with acoustic shadowing. The distinction between fibrosis and calcification is crucial for accurate diagnosis and management of cardiac conditions. Key characteristics to look for include:
- Echogenicity: Fibrosis typically presents as a homogeneous, moderately echogenic area, while calcification appears as intensely bright, highly echogenic structures 1.
- Acoustic shadowing: Calcification produces acoustic shadowing behind it, which appears as a dark area, whereas fibrosis does not produce significant shadowing.
- Location and pattern: Calcification commonly affects valve leaflets, annular regions, and coronary arteries, and tends to be more focal and discrete with well-defined borders. In contrast, fibrosis is more frequently seen in the myocardium, particularly after infarction, and often has a more diffuse pattern with less distinct margins.
- Clinical context: Understanding the clinical context, including the patient's history and symptoms, is essential for interpreting TTE findings and differentiating between fibrosis and calcification 1. By considering these factors, clinicians can accurately distinguish between fibrosis and calcification on TTE, which is critical for making informed decisions about patient care and management.
From the Research
Distinguishing Fibrosis from Calcification on TTE
- Fibrosis and calcification are two distinct conditions that can be visualized using transthoracic echocardiography (TTE) 2.
- However, there is limited information available on how to distinguish fibrosis from calcification on TTE, as most studies focus on the diagnosis of calcification or fibrosis separately.
- A study on aortic valve calcification found that TTE can be used to assess the degree of calcification, but it does not provide information on how to distinguish calcification from fibrosis 2.
- Another study on musculoskeletal calcifications found that calcifications can be distinguished from ossifications and foreign bodies using radiographs, but it does not provide information on how to distinguish calcification from fibrosis on TTE 3.
- A study on calcium signaling and tissue calcification found that calcification is a regulated physiological process that can occur in soft tissues, but it does not provide information on how to distinguish calcification from fibrosis on TTE 4.
- A study on the predictive value of cardiac CTA, cardiac MRI, and TTE for cardioembolic stroke recurrence found that TTE can be used to detect cardiac sources of emboli, but it does not provide information on how to distinguish fibrosis from calcification 5.
- A study on recent advances in fibrosis and scar segmentation from cardiac MRI found that late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) can be used to segment cardiac fibrosis and scars, but it does not provide information on how to distinguish fibrosis from calcification on TTE 6.
Key Findings
- There is limited information available on how to distinguish fibrosis from calcification on TTE.
- TTE can be used to assess the degree of calcification, but it may not be able to distinguish calcification from fibrosis.
- Other imaging modalities, such as cardiac MRI, may be more effective in segmenting cardiac fibrosis and scars, but more research is needed to determine how to distinguish fibrosis from calcification on TTE 2, 6.