Radiologist Opinions Regarding Reporting Incidental Coronary And Cardiac Calcification On Thoracic CT

Williams, Michael J.A.; Weir‐McCall, Jonathan R.; Moss, Alastair J; Schmitt, Matthias; Stirrup, James; Holloway, Benjamin; Gopalan, Deepa; Deshpande, Aparna; Hughes, Gareth Morgan; Agrawal, Bobby; Nicol, Edward; Roditi, Giles; Shambrook, James; Bull, Russell

doi:10.1016/j.jcct.2020.06.103

Cited by 3 publications

(2 citation statements)

References 34 publications

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“…However, to date, no randomized controlled trials that assess the prognostic implications of changing management based on thoracic CT have been performed. Radiologist opinions vary concerning the reporting of calcification in the coronary arteries on thoracic CT [45]. 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].…”

Section: What Is Coronary Artery Calcification?mentioning

confidence: 99%

“…Radiologist opinions vary concerning the reporting of calcification in the coronary arteries on thoracic CT [45]. 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].…”

Section: What Is Coronary Artery Calcification?mentioning

confidence: 99%

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What should we do about Coronary Calcification on Thoracic CT?

Llewellyn

Williams

2022

Rofo

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Purpose Coronary artery calcification is a frequent incidental finding on thoracic computed tomography (CT) performed for non-cardiac indications. On electrocardiogram-gated cardiac CT, it is an established marker of coronary artery disease and is associated with increased risk of subsequent cardiac events. Materials and Methods This review discusses the current evidence and guidelines regarding the reporting of coronary artery calcification on non-electrocardiogram-gated thoracic CT performed for non-cardiac indications. Results For patients undergoing routine thoracic CT, coronary artery calcification is associated with an increased risk of myocardial infarction and mortality. Coronary artery calcification can be accurately assessed on non-gated thoracic CT compared to gated CT. Guidelines support the reporting of coronary artery calcification on thoracic CT. However, radiologist opinions vary. The identification of coronary artery calcification on thoracic CT may identify patients with previously unknown coronary artery disease. For asymptomatic patients this may trigger an assessment of modifiable cardiovascular risk factors and guide the appropriate use of preventative medications. Conclusion Future research will address whether changing management based on calcification on thoracic CT will improve outcomes and automated assessment of calcification using machine learning techniques. Key Points: Citation Format

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Section: What Is Coronary Artery Calcification?mentioning

confidence: 99%

Section: What Is Coronary Artery Calcification?mentioning

confidence: 99%

What should we do about Coronary Calcification on Thoracic CT?

Llewellyn

Williams

2022

Rofo

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Prevalence and clinical implications of coronary artery calcium scoring on non-gated thoracic computed tomography: a systematic review and meta-analysis

Osborne-Grinter,

Ali,

Williams

2023

Eur Radiol

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Objectives Coronary artery calcifications (CACs) indicate the presence of coronary artery disease. CAC can be found on thoracic computed tomography (CT) conducted for non-cardiac reasons. This systematic review and meta-analysis of non-gated thoracic CT aims to assess the clinical impact and prevalence of CAC. Methods Online databases were searched for articles assessing prevalence, demographic characteristics, accuracy and prognosis of incidental CAC on non-gated thoracic CT. Meta-analysis was performed using a random effects model. Results A total of 108 studies (113,406 patients) were included (38% female). Prevalence of CAC ranged from 2.7 to 100% (pooled prevalence 52%, 95% confidence interval [CI] 46–58%). Patients with CAC were older (pooled standardised mean difference 0.88, 95% CI 0.65–1.11, p < 0.001), and more likely to be male (pooled odds ratio [OR] 1.95, 95% CI 1.55–2.45, p < 0.001), with diabetes (pooled OR 2.63, 95% CI 1.95–3.54, p < 0.001), hypercholesterolaemia (pooled OR 2.28, 95% CI 1.33–3.93, p < 0.01) and hypertension (pooled OR 3.89, 95% CI 2.26–6.70, p < 0.001), but not higher body mass index or smoking. Non-gated CT assessment of CAC had excellent agreement with electrocardiogram-gated CT (pooled correlation coefficient 0.96, 95% CI 0.92–0.98, p < 0.001). In 51,582 patients, followed-up for 51.6 ± 27.4 months, patients with CAC had increased all cause mortality (pooled relative risk [RR] 2.13, 95% CI 1.57–2.90, p = 0.004) and major adverse cardiovascular events (pooled RR 2.91, 95% CI 2.26–3.93, p < 0.001). When CAC was present on CT, it was reported in between 18.6% and 93% of reports. Conclusion CAC is a common, but underreported, finding on non-gated CT with important prognostic implications. Clinical relevance statement Coronary artery calcium is an important prognostic indicator of cardiovascular disease. It can be assessed on non-gated thoracic CT and is a commonly underreported finding. This represents a significant population where there is a potential missed opportunity for lifestyle modification recommendations and preventative therapies. This study aims to highlight the importance of reporting incidental coronary artery calcium on non-gated thoracic CT. Key Points • Coronary artery calcification is a common finding on non-gated thoracic CT and can be reliably identified compared to gated-CT. • Coronary artery calcification on thoracic CT is associated with an increased risk of all cause mortality and major adverse cardiovascsular events. • Coronary artery calcification is frequently not reported on non-gated thoracic CT.

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