Imaging & Diagnostic Scans
Whole-body MRI, coronary artery calcium scores, DEXA body composition, AI cardiac imaging, and more — which scans are worth the investment and what they can actually tell you.
Key Takeaways
- →A coronary artery calcium (CAC) score is the single most cost-effective cardiac imaging test for asymptomatic adults ($75–$200).
- →Whole-body MRI (Prenuvo) can detect cancers, aneurysms, and organ abnormalities, but has a significant false-positive rate.
- →DEXA provides the most accurate non-invasive measurement of body composition (fat, lean mass, bone density).
- →All imaging involves trade-offs between detection benefit, radiation exposure, false positives, and cost.
Blood tests reveal circulating biomarkers, but imaging shows structural and anatomical changes directly. A CAC score reveals calcified plaque in your coronary arteries. A whole-body MRI can detect a tumor before symptoms appear. A DEXA scan quantifies bone density and body fat distribution. Imaging fills critical gaps that no blood test can address — but each modality has specific strengths, limitations, and appropriate use cases.
Coronary Artery Calcium (CAC) Score
The CAC score is a low-dose, non-contrast CT scan of the heart that quantifies calcified plaque in the coronary arteries. Scores are reported as an Agatston score: 0 (no detectable calcium), 1–99 (mild), 100–399 (moderate), and 400+ (severe). The Multi-Ethnic Study of Atherosclerosis (MESA) demonstrated that CAC adds significant predictive value beyond traditional risk factors like age, blood pressure, and cholesterol.
Best value in cardiac imaging
A CAC score of 0 in an asymptomatic individual is associated with a 10-year cardiovascular event rate of less than 2%. This result can reassure patients and potentially defer the need for statin therapy. It is widely recommended by the American College of Cardiology for intermediate-risk adults.
CT Angiography (CTA) with AI Analysis
While CAC detects calcified plaque, CT angiography visualizes the entire coronary artery tree including non-calcified (soft) plaque — the type most prone to rupture and cause heart attacks. Cleerly uses AI to analyze CTA images, characterizing plaque volume, composition, and stenosis. This provides the most detailed non-invasive assessment of coronary artery disease currently available.
Whole-Body MRI
Whole-body MRI scans (offered by Prenuvo and others) use magnetic resonance imaging — no radiation — to screen the entire body for abnormalities including tumors, organ disease, aneurysms, and musculoskeletal conditions. A full scan typically takes 60–90 minutes and produces hundreds of images reviewed by radiologists.
The false-positive problem
Whole-body MRI screening in asymptomatic individuals has a significant incidental finding rate — some studies report findings in 30–40% of healthy adults, the vast majority of which are benign. These findings can lead to additional imaging, biopsies, anxiety, and cost. Discuss the implications with your physician before screening.
DEXA Body Composition
Dual-energy X-ray absorptiometry (DEXA) is the clinical standard for measuring bone mineral density, but modern DEXA also provides precise body composition data: total body fat percentage, regional fat distribution (including visceral fat), lean muscle mass, and appendicular lean mass index. Visceral adipose tissue (VAT) is strongly associated with metabolic syndrome and cardiovascular risk, independent of BMI.
Other Imaging Modalities
- •Carotid Intima-Media Thickness (CIMT) — Ultrasound measurement of carotid artery wall thickness. Non-invasive and radiation-free. Increased CIMT is associated with stroke and MI risk, but its incremental value over CAC is debated in current guidelines.
- •Echocardiogram — Ultrasound of the heart assessing chamber size, valve function, and ejection fraction. Indicated for symptoms of heart failure, murmurs, or family history of cardiomyopathy.
- •Low-dose CT lung screening — Recommended annually by the US Preventive Services Task Force for adults 50–80 with a 20+ pack-year smoking history.