Lung Cancer Screening CT-Based Prediction of Cardiovascular Events

Abstract

Quantification of coronary and aortic calcium volumes in lung cancer screening CT images-information that is readily available-can be used to predict cardiovascular risk. Such an approach might prove useful in the reduction of cardiovascular morbidity and mortality and may enhance the cost-effectiveness of CT-based screening in heavy smokers.

2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology

“…The event frequencies were 12.2% and 4.0% for high and low risk groups respectively. 67 Low dose nongated CT scans were evaluated in 1442 patients in the National Lung Screening Trial. 68 Compared to Agatston scores of 0, scores of 1e100, 101e1000, and greater than 1000 had HR of 1.27 (95% CI: 0.69, 2.53), 3.57 (95% CI: 2.14, 7.48), and 6.63 (95% CI: 3.57, 14.97), respectively.…”

Extracoronary Thoracic and Coronary Artery Calcifications on Chest CT for Lung Cancer Screening

“…The concept of this ''dual purpose'' of screening chest CT has already been pursued by several larger trials, for example, The Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON) and Multicentric Italian Lung Detection (MILD) trial (6,26). It has also been confirmed that calcium scoring according to Agatston is feasible and reliable even if based on data of such nongated low-dose CT studies (28,29).…”

“…Although screening chest CT studies are acquired with low-dose protocols and in a nongated fashion, it has been shown that they can be used to accurately quantify coronary artery calcium (CAC) and extracoronary calcium (ECC) load (2,(25)(26)(27)(28). Being able to not only diagnose lung cancer early but in the same session to also provide information that may be useful for further cardiovascular risk stratification (29) appears to be very attractive and would help further improve the cost-effectiveness of CT for lung cancer screening. Accordingly, a number of trials have investigated the predictive power of coronary and extracoronary artery calcification as determined by nongated chest CT studies obtained for lung cancer screening.…”

Screening for lung cancer – are we nearly there yet?

“…As the NHS runs health checks for individuals aged 40-74 for cardiovascular risk assessment, it seems sensible to combine lung cancer screening and cardiovascular risk assessment, given the population at risk for both conditions. Furthermore, LDCT scans have been shown to be effective at picking up the presence of coronary calcification 14 and it is possible that this may be a useful contributor to assessing cardiovascular risk.…”