Moderate-severe coronary calcification predicts long-term cardiovascular death in CT lung cancer screening: The ITALUNG trial

Mascalchi, Mario; Puliti, Donella; Romei, Chiara; Picozzi, Giulia; Liperi, Annalisa De; Diciotti, Stefano; Bartolucci, Maurizio; Grazzini, Maddalena; Vannucchi, L; Falaschi, Fabio; Pistelli, Francesco; Gorini, Giuseppe; Carozzi, Francesca; Rosselli, A; Carrozzi, Laura; Paci, Euǵenio; Zappa, Marco

doi:10.1016/j.ejrad.2021.110040

Cited by 20 publications

(20 citation statements)

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“…Our sample was selected based on the type of CT scanner and acquisition protocol which substantially affect the quantitative assessment of diffuse lung changes [17,18], but was representative of the entire group undergoing LDCT screening in ITALUNG. Also, the prevalence and distribution of pulmonary emphysematous changes [6,14] and CAC [6,[23][24][25] in the sub-cohort were substantially consistent with previous data in subjects undergoing LC screening. So far, quantitative evaluation of pulmonary emphysematous changes in subjects undergoing screening LDCT has been correlated with the incidence of LC [15] and with the Pulmonary Functional Test (PFT) results [30,31].…”

Section: Discussionsupporting

confidence: 88%

“…In the present investigation, we quantitatively assessed pulmonary emphysematous changes in baseline LDCT of one sub-cohort of subjects recruited in the ITALUNG trial and analyzed 13 years after randomization of its potential impact on death and its causes, while controlling for demographic and smoking history variables, as well as CAC that are relevant predictors of overall and CVD mortality in the LC screening population [23][24][25]. Our data, as assessed with both conventional statistics and a machine learning approach, indicate that quantification of emphysematous changes at baseline LDCT independently predicts overall and CVD mortality in heavy smokers and former smokers undergoing LC screening.…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary emphysema and coronary artery calcifications at baseline LDCT and long-term mortality in smokers and former smokers of the ITALUNG screening trial

et al. 2023

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Objectives Cardiovascular disease (CVD), lung cancer (LC), and respiratory diseases are main causes of death in smokers and former smokers undergoing low-dose computed tomography (LDCT) for LC screening. We assessed whether quantification of pulmonary emphysematous changes at baseline LDCT has a predictive value concerning long-term mortality. Methods In this longitudinal study, we assessed pulmonary emphysematous changes with densitometry (volume corrected relative area below − 950 Hounsfield units) and coronary artery calcifications (CAC) with a 0–3 visual scale in baseline LDCT of 524 participants in the ITALUNG trial and analyzed their association with mortality after 13.6 years of follow-up using conventional statistics and a machine learning approach. Results Pulmonary emphysematous changes were present in 32.3% of subjects and were mild (6% ≤ RA950 ≤ 9%) in 14.9% and moderate-severe (RA950 > 9%) in 17.4%. CAC were present in 67% of subjects (mild in 34.7%, moderate-severe in 32.2%). In the follow-up, 81 (15.4%) subjects died (20 of LC, 28 of other cancers, 15 of CVD, 4 of respiratory disease, and 14 of other conditions). After adjusting for age, sex, smoking history, and CAC, moderate-severe emphysema was significantly associated with overall (OR 2.22; 95CI 1.34–3.70) and CVD (OR 3.66; 95CI 1.21–11.04) mortality. Machine learning showed that RA950 was the best single feature predictive of overall and CVD mortality. Conclusions Moderate-severe pulmonary emphysematous changes are an independent predictor of long-term overall and CVD mortality in subjects participating in LC screening and should be incorporated in the post-test calculation of the individual mortality risk profile. Key Points • Densitometry allows quantification of pulmonary emphysematous changes in low-dose CT examinations for lung cancer screening. • Emphysematous lung density changes are an independent predictor of long-term overall and cardio-vascular disease mortality in smokers and former smokers undergoing screening. • Emphysematous changes quantification should be included in the post-test calculation of the individual mortality risk profile.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Pulmonary emphysema and coronary artery calcifications at baseline LDCT and long-term mortality in smokers and former smokers of the ITALUNG screening trial

et al. 2023

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“…CAC are recognized as an independent “risk-enhancing factor” for CV disease [ 64 ], because their severity is associated with an increased risk of CV events and mortality, both in smokers and former smokers [ 65 – 68 ]. CAC can be assessed by LDCT using visual score of varying complexity or using software [ 67 ].…”

Section: Collateral and Incidental Findingsmentioning

confidence: 99%

“…CAC can be assessed by LDCT using visual score of varying complexity or using software [ 67 ]. For screening practice, a swift visual score is emerging [ 68 – 71 ]: 0 = absent; 1 = mild; 2 = moderate; 3 = severe (Fig. 4 ) [ 67 ].…”

Section: Collateral and Incidental Findingsmentioning

confidence: 99%

Low-dose CT for lung cancer screening: position paper from the Italian college of thoracic radiology

et al. 2022

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Smoking is the main risk factor for lung cancer (LC), which is the leading cause of cancer-related death worldwide. Independent randomized controlled trials, governmental and inter-governmental task forces, and meta-analyses established that LC screening (LCS) with chest low dose computed tomography (LDCT) decreases the mortality of LC in smokers and former smokers, compared to no-screening, especially in women. Accordingly, several Italian initiatives are offering LCS by LDCT and smoking cessation to about 10,000 high-risk subjects, supported by Private or Public Health Institutions, envisaging a possible population-based screening program. Because LDCT is the backbone of LCS, Italian radiologists with LCS expertise are presenting this position paper that encompasses recommendations for LDCT scan protocol and its reading. Moreover, fundamentals for classification of lung nodules and other findings at LDCT test are detailed along with international guidelines, from the European Society of Thoracic Imaging, the British Thoracic Society, and the American College of Radiology, for their reporting and management in LCS. The Italian College of Thoracic Radiologists produced this document to provide the basics for radiologists who plan to set up or to be involved in LCS, thus fostering homogenous evidence-based approach to the LDCT test over the Italian territory and warrant comparison and analyses throughout National and International practices.

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“…In particular, the coronary artery calcifications (CAC) assessed semi-quantitatively using visual scores or quantitatively with the Agatston score are correlated with cardio-vascular (CV) risk factors and increased risk of CV events and death in subjects undergoing LC screening [ 84 , 85 , 86 ]. Notably, follow-up of subjects recruited in the trials that demonstrated the efficacy of screening with low-dose CT in decreasing mortality from LC have revealed that CV disease is the first cause of non-cancer death in this population [ 21 , 22 ].…”

Section: Screening Chest Low-dose Ct and Ct Colonographymentioning

confidence: 99%

Single CT Appointment for Double Lung and Colorectal Cancer Screening: Is the Time Ripe?

Mascalchi

Picozzi²,

Puliti³

et al. 2022

Diagnostics

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Annual screening of lung cancer (LC) with chest low-dose computed tomography (CT) and screening of colorectal cancer (CRC) with CT colonography every 5 years are recommended by the United States Prevention Service Task Force. We review epidemiological and pathological data on LC and CRC, and the features of screening chest low-dose CT and CT colonography comprising execution, reading, radiation exposure and harm, and the cost effectiveness of the two CT screening interventions. The possibility of combining chest low-dose CT and CT colonography examinations for double LC and CRC screening in a single CT appointment is then addressed. We demonstrate how this approach appears feasible and is already reasonable as an opportunistic screening intervention in 50–75-year-old subjects with smoking history and average CRC risk. In addition to the crucial role Computer Assisted Diagnosis systems play in decreasing the test reading times and the need to educate radiologists in screening chest LDCT and CT colonography, in view of a single CT appointment for double screening, the following uncertainties need to be solved: (1) the schedule of the screening CT; (2) the effectiveness of iterative reconstruction and deep learning algorithms affording an ultra-low-dose CT acquisition technique and (3) management of incidental findings. Resolving these issues will imply new cost-effectiveness analyses for LC screening with chest low dose CT and for CRC screening with CT colonography and, especially, for the double LC and CRC screening with a single-appointment CT.

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Moderate-severe coronary calcification predicts long-term cardiovascular death in CT lung cancer screening: The ITALUNG trial

Cited by 20 publications

References 23 publications

Pulmonary emphysema and coronary artery calcifications at baseline LDCT and long-term mortality in smokers and former smokers of the ITALUNG screening trial

Pulmonary emphysema and coronary artery calcifications at baseline LDCT and long-term mortality in smokers and former smokers of the ITALUNG screening trial

Low-dose CT for lung cancer screening: position paper from the Italian college of thoracic radiology

Single CT Appointment for Double Lung and Colorectal Cancer Screening: Is the Time Ripe?

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