Reporting incidental coronary, aortic valve and cardiac calcification on non-gated thoracic computed tomography, a consensus statement from the BSCI/BSCCT and BSTI

Abstract

Incidental coronary and cardiac calcification are frequent findings on non-gated thoracic computed tomography (CT). We recommend that the heart is reviewed on all CT scans where it is visualised. Coronary artery calcification is a marker of coronary artery disease and it is associated with an adverse prognosis on dedicated cardiac imaging and on non-gated thoracic CT performed for non-cardiac indications, both with and without contrast. We recommend that CAC is reported on all non-gated thoracic CT using a simple patient-based score (none, mild, moderate, severe). Furthermore, we recommend that reports include recommendations for subsequent management, namely the assessment of modifiable cardiovascular risk factors and, if the patient has chest pain, assessment as per standard guidelines. In most cases this will not necessitate additional investigations. Incidental aortic valve calcification may also be identified on non-gated thoracic CT and should be reported, along with ancillary findings such as aortic root dilation. Calcification may occur in other parts of the heart including mitral valve/annulus, pericardium and myocardium, but in many cases these are an incidental finding without clinical significance.

Frequency and spectrum of incidental findings when using chest CT as a primary triage tool for COVID-19

“…[31] Based on our hospital policy, together with recent advice of the ACR and BSCI/BSCCT and BSTI we classified CAC as a potentially significant IF. [22,27,32,33] This difference in definition of a potentially significant IF is hence merely caused by change in insight overtime between the present study and the somewhat older publications of lung cancer screening studies (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015).…”

“…CAC is a biomarker for atherosclerotic burden, and is associated with an increased risk of cardiovascular events, even in asymptomatic patients. [27] Knowing of the presence and extent of CAC may be valuable to patient and rereferring clinician, to increase patients awareness of atherosclerosis and discuss risk modulation interventions such as life style changes and introduction of cholesterol lowering medication (e.g. statin).…”

“…Coronary artery calcifications were classified as potentially significant, according to the recently published guidelines described in a British consensus statement. [27] The detection of an alternative pulmonary infectious disease in our population was not classified as "incidental" but rather as an alternative diagnosis, given the clinical context. Therefore we decided to exclude these diagnoses from IF analysis in 27 patients.…”

Outstanding negative prediction performance of solid pulmonary nodule volume AI for ultra-LDCT baseline lung cancer screening risk stratification

“…recommends that where the heart can be visualized on a CT-scan, it is reviewed. [27] However, in a study which used CT-scans from the NELSON trial, the impact of such incidental extra-pulmonary findings was demonstrated trivial compared to the specific purpose of lung cancer screening, notably without perceivable advantage for the small number of incidental detections. [28] AI has nevertheless proved to be valuable in coronary artery calcium (CAC) scoring of LDCT thorax scans.…”

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

“…In our survey comments included concerns around patient anxiety, unnecessary investigations and increased workload for radiology and cardiology departments. Other concerns that have been The recently published BSCI/BSCCT consensus statement on reporting incidental coronary, aortic valve and cardiac calcification on non-gated thoracic CT aims to address some of the concerns raised in this survey [33]. For coronary artery calcification it suggests a simple patient-based score for coronary artery calcification (none, mild, moderate, severe) and highlights that many patients with incidental calcification do not require further investigation [33].…”