Coronary artery calcification is common on nongated chest computed tomography imaging

Abstract

Background Coronary artery calcification as assessed by computed tomography (CT) is a validated predictor of cardiovascular risk, whether identified on a dedicated cardiac study or on a routine non‐gated chest CT. The prevalence of incidentally detected coronary artery calcification on non‐gated chest CT imaging and consistency of reporting have not been well characterized. Hypothesis Coronary calcification is present on chest CT in some patients not taking statin therapy and may be under‐reported. Methods Non‐gated chest CT images dated 1/1/2012 to 1/1/2013 were retrospectively reviewed. Demographics and medical history were obtained from charts. Patients with known history of coronary revascularization and/or pacemaker/defibrillator were excluded. Two independent readers with cardiac CT expertise evaluated images for the presence and anatomical distribution of any coronary calcification, blinded to all clinical information including CT reports. Original clinical CT reports were subsequently reviewed. Results Coronary calcification was identified in 204/304 (68%) chest CTs. Patients with calcification were older and had more hyperlipidemia, smoking history, and known coronary artery disease. Of patients with calcification, 43% were on aspirin and 62% were on statin medication at the time of CT. Coronary calcification was identified in 69% of reports when present. Conclusions A high prevalence of coronary calcification was found in non‐gated chest CT scans performed for non‐cardiac indications. In one‐third, coronary calcification was not mentioned in the clinical report when actually present. In this population of patients with cardiac risk factors, standard reporting of the presence of coronary calcification may provide an opportunity for risk factor modification.

Automated coronary calcium scoring using deep learning with multicenter external validation

“…Meanwhile, up to 19 million non-gated chest CT scans were performed in 2014 alone for non-cardiac indications 18 , 46 . Though these exams may demonstrate coronary calcification, up to 80% of radiologist reports do not mention it 47 , 48 . Even if radiologists report incidental coronary calcification, accurate quantitation is difficult as no widely accepted standard currently exists unlike scoring using gated coronary CT.…”

What should we do about Coronary Calcification on Thoracic CT?

“…A survey of 200 United Kingdom radiologists found that 11 % never reported the presence of calcification in the coronary arteries and the radiologists who were not sub-specialists in cardiac imaging were less likely to report calcification in the coronary arteries [45]. Other studies show that incidental calcification in the coronary arteries is not mentioned on between one quarter and one fifth of thoracic CT reports [27,28,46,47]. Automated assessment of calcification on thoracic CT using machine learning techniques may aid the speed and accuracy of radiologist reporting [48].…”

Hallazgos cardíacos incidentales en angiotomografía computarizada con energía dual (TCED) de arterias pulmonares: la importancia de ver siempre el corazón

“…La presencia de calcificaciones debe informarse con regularidad, sobre todo en pacientes jóvenes (< 55 años en hombres y < 65 años en mujeres) en quienes puede ser un indicador de enfermedad coronaria prematura. Es difícil calcular el grado de estenosis relacionada en un estudio sin sincronización cardíaca, aun cuando sea contrastado, por lo cual es recomendable abstenerse de proporcionar una cifra aproximada, a menos que sea muy evidente 1,9,10 .…”