Visual scoring of coronary artery calcification in lung cancer screening computed tomography

Watts, Jubal R.; Sonavane, Sushilkumar K.; Snell‐Bergeon, Janet K.; Nath, Hrudaya

doi:10.1097/mca.0000000000000189

Cited by 37 publications

(38 citation statements)

References 14 publications

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“…The superiority of CAC score over the classical and novel RF has been demonstrated in different populations with several prospective population studies (24)(25)(26)(27)(28). Furthermore, CAC measurement reclassify high risk groups such as diabetic (29)(30)(31)(32)(33), hypertensives (21,(34)(35)(36), elderly (37) and smokers (38,39). Equally important is the absence of CAC which indicates an excellent prognosis in asymptomatic as well in the high risk groups (40)(41)(42) In this group, 52% of men and women were reclassified, all into more accurate risk categories.…”

Section: Cac In Primary Preventionmentioning

confidence: 97%

Coronary artery calcification in clinical practice: what we have learned and why should it routinely be reported on chest CT?

Shemesh

2016

Ann. Transl. Med.

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The recent acceptance of low dose chest computed tomography (LDCT) as a screening modality for early lung cancer detection will significantly increase the number of LDCT among high risk population. The target subjects are at the same time at high risk to develop cardiovascular (CV) events. The routine report on coronary artery calcification (CAC) will therefore, enhances the screening benefit by providing the clinicians with an additive powerful risk stratification tool for the management or primary prevention of CV events. This review will provide the radiologists with helpful information for the daily practice regarding on what is CAC, its clinical applications and how to diagnose, quantify and report on CAC while reading the LDCT.

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Section: Cac In Primary Preventionmentioning

confidence: 97%

Coronary artery calcification in clinical practice: what we have learned and why should it routinely be reported on chest CT?

Shemesh

2016

Ann. Transl. Med.

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“…Finally, we assessed coronary artery calcium using non-ECG-gated CT in SCCOR participants. However, this technique has been validated by multiple independent investigators (18)(19)(20)(21)(22), and results were HeartSCORE cohort, n = 328 Figure 4. Adjusting the association between reduced FEV 1 and increased carotid plaque or coronary artery calcium for endothelial function had no impact (i.e., endothelial function did not explain the association between expiratory airflow and atherosclerosis).…”

Section: Discussionmentioning

confidence: 99%

“…Calcium scores from non-ECG-gated CT have excellent correlation with scores from gated cardiac CT, and independently predict coronary vascular events and mortality (18)(19)(20)(21)(22). Coronary artery calcium was scored using the Weston method (20).…”

Section: Coronary Artery Calciummentioning

confidence: 99%

Airflow Limitation and Endothelial Dysfunction. Unrelated and Independent Predictors of Atherosclerosis

Chandra¹,

Gupta²,

Strollo³

et al. 2016

Am J Respir Crit Care Med

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Rationale: Lower FEV 1 is associated with increased prevalence of atherosclerosis; however, causal mechanisms remain elusive.Objectives: To determine if systemic endothelial dysfunction mediates the association between reduced FEV 1 and increased atherosclerosis.Methods: Brachial artery endothelial function, pulmonary function, coronary artery calcium, and carotid plaque were assessed in 231 Pittsburgh SCCOR (Specialized Centers for Clinically Oriented Research) study participants; peripheral arterial endothelial function, pulmonary function, and coronary artery calcium were assessed in 328 HeartSCORE (Heart Strategies Concentrating on Risk Evaluation) study participants.Measurements and Main Results: Lower FEV 1 was independently associated with increased atherosclerosis in both cohorts (per 25% lower % predicted FEV 1 : odds ratio [OR], 1.76; 95% confidence interval [CI], 1.30-2.40; P , 0.001 for carotid plaque in SCCOR participants) (per 25% lower % predicted FEV 1 : OR, 1.35; 95% CI, 1.02-1.77; P = 0.03 for coronary artery calcium in HeartSCORE participants). Similarly, reduced endothelial function was independently associated with increased atherosclerosis in both cohorts (per SD lower endothelial function: OR, 1.30; 95% CI, 1.01-1.67; P = 0.04 for carotid plaque in SCCOR participants) (per SD lower endothelial function: OR, 1.38; 95% CI, 1.09-1.76; P = 0.008 and OR, 1.41; 95% CI, 1.07-1.86; P = 0.01 for coronary artery calcium in SCCOR and HeartSCORE participants, respectively). However, there was no association between endothelial dysfunction and FEV 1 , FEV 1 /FVC, low-attenuation area/visual emphysema, and diffusing capacity in SCCOR participants, and between endothelial dysfunction and FEV 1 or FEV 1 /FVC in HeartSCORE participants (all P . 0.05). Adjusting the association between FEV 1 and atherosclerosis for endothelial dysfunction had no impact.Conclusions: Endothelial dysfunction does not mediate the association between airflow limitation and atherosclerosis. Instead, airflow limitation and endothelial dysfunction seem to be unrelated and mutually independent predictors of atherosclerosis.

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“…This study suggests that there is benefit to lung cancer screening in other populations as well. Coronary artery calcification is frequently identified in patients undergoing lung cancer screening with LDCT [11][12][13] . NLST data have shown that the presence of coronary artery calcification is associated with a 3 fold increase in cardiovascular death 12 .…”

Section: Discussionmentioning

confidence: 99%

“…Coronary artery calcification is frequently identified in patients undergoing lung cancer screening with LDCT [11][12][13] . NLST data have shown that the presence of coronary artery calcification is associated with a 3 fold increase in cardiovascular death 12 . These studies suggest a concordance of CAD and lung cancer [11][12][13] .…”

Section: Discussionmentioning

confidence: 99%

Conventional Computed Tomographic Calcium Scoring vs Full Chest CTCS for Lung Cancer Screening: A Cost-Effectiveness Analysis

Jiang¹,

Linden²,

Jarrett³

et al. 2019

Preprint

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Background Conventional CTCS images the mid/lower chest for coronary artery disease (CAD). Because many CAD patients are also at risk for lung malignancy, CTCS often discovers incidental pulmonary nodules (IPN). CTCS excludes the upper chest, where malignancy is common. Full-chest CTCS (FCT) may be a cost-effective screening tool for IPN. Methods A decision tree was created to compare a FCT to CTCS in a hypothetical patient cohort with suspected CAD. (Figure) The design compares the effects of missed cancers on CTCS with the cost of working up non-malignant nodules on FCT. The model was informed by results of the National Lung Screening Trial and literature review, including the rate of malignancy among patients receiving CTCS and the rate of malignancy in upper vs lower portions of the lung. The analysis outcomes are Quality-Adjusted Life Year (QALY) and incremental cost-effectiveness ratio (ICER), which is generally considered beneficial when <$50,000/QALY. Results Literature review suggests that rate of IPNs in the upper portion of the lung varied from 47-76%. Our model assumed that IPNs occur in upper and lower portions of the lung with equal frequency. The model also assumes an equal malignancy potential in upper lung IPNs despite data that malignancy occurs 61-66% in upper lung fields. In the base case analysis, a FCT will lead to an increase of 0.03 QALYs comparing to conventional CTCS (14.54 vs 14.51 QALY, respectively), which translates into an QALY increase of 16 days. The associated incremental cost for FCT is $278 ($1,027 vs $748, FCT vs CTCS respectively. The incremental cost-effectiveness ratio (ICER) is $10,289/QALY, suggesting significant benefit. Sensitivity analysis shows this benefit increases proportional to the rate of malignancy in upper lung fields. Conclusion Conventional CTCS may be a missed opportunity to screen for upper lung field cancers in high risk patients. The ICER of FCT is better than screening for breast cancer screening (mammograms $80k/QALY) and colon cancer (colonoscopy $6k/QALY). Prospective studies are appropriate to define protocols for FCT.

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Visual scoring of coronary artery calcification in lung cancer screening computed tomography

Cited by 37 publications

References 14 publications

Coronary artery calcification in clinical practice: what we have learned and why should it routinely be reported on chest CT?

Coronary artery calcification in clinical practice: what we have learned and why should it routinely be reported on chest CT?

Airflow Limitation and Endothelial Dysfunction. Unrelated and Independent Predictors of Atherosclerosis

Conventional Computed Tomographic Calcium Scoring vs Full Chest CTCS for Lung Cancer Screening: A Cost-Effectiveness Analysis

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