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Osborne-Grinter M, Ali A, Williams MC. Prevalence and clinical implications of coronary artery calcium scoring on non-gated thoracic computed tomography: a systematic review and meta-analysis. Eur Radiol 2024; 34:4459-4474. [PMID: 38133672 PMCID: PMC11213779 DOI: 10.1007/s00330-023-10439-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/02/2023] [Accepted: 09/07/2023] [Indexed: 12/23/2023]
Abstract
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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Affiliation(s)
- Maia Osborne-Grinter
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
- University of Bristol, Bristol, UK.
| | - Adnan Ali
- School of Medicine, University of Dundee, Dundee, UK
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
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2
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Malik RF, Sun KJ, Azadi JR, Lau BD, Whelton S, Arbab-Zadeh A, Wilson RF, Johnson PT. Opportunistic Screening for Coronary Artery Disease: An Untapped Population Health Resource. J Am Coll Radiol 2024; 21:880-889. [PMID: 38382860 DOI: 10.1016/j.jacr.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Coronary artery disease is the leading cause of death in the United States. At-risk asymptomatic adults are eligible for screening with electrocardiogram-gated coronary artery calcium (CAC) CT, which aids in risk stratification and management decision-making. Incidental CAC (iCAC) is easily quantified on chest CT in patients imaged for noncardiac indications; however, radiologists do not routinely report the finding. OBJECTIVE To determine the clinical significance of CAC identified incidentally on routine chest CT performed for noncardiac indications. DESIGN An informationist developed search strategies in MEDLINE, Embase, and SCOPUS, and two reviewers independently screened results at both the abstract and full text levels. Data extracted from eligible articles included age, rate of iCAC identification, radiologist reporting frequency, impact on downstream medical management, and association of iCAC with patient outcomes. RESULTS From 359 unique citations, 83 research publications met inclusion criteria. The percentage of patients with iCAC ranged from 9% to 100%. Thirty-one investigations measured association(s) between iCAC and cardiovascular morbidity and mortality, and 29 identified significant correlations, including nonfatal myocardial infarction, fatal myocardial infarction, major adverse cardiovascular event, cardiovascular death, and all-cause death. iCAC was present in 20% to 100% of the patients in these cohorts, but when present, iCAC was reported by radiologists in only 31% to 44% of cases. Between 18% and 77% of patients with iCAC were not on preventive medications in studies that reported these data. Seven studies measured the effect of reporting on guideline directed medical therapy, and 5 (71%) reported an increase in medication prescriptions after diagnosis of iCAC, with one confirming reductions in low-density lipoprotein levels. Twelve investigations reported good concordance between CAC grade on noncardiac CT and Agatston score on electrocardiogram-gated cardiac CT, and 10 demonstrated that artificial intelligence tools can reliably calculate an Agatston score on noncardiac CT. CONCLUSION A body of evidence demonstrates that patients with iCAC on routine chest CT are at risk for cardiovascular disease events and death, but they are often undiagnosed. Uniform reporting of iCAC in the chest CT impression represents an opportunity for radiology to contribute to early identification of high-risk individuals and potentially reduce morbidity and mortality. AI tools have been validated to calculate Agatston score on routine chest CT and hold the best potential for facilitating broad adoption.
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Affiliation(s)
- Rubab F Malik
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristie J Sun
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Javad R Azadi
- Assistant Professor of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brandyn D Lau
- Assistant Professor of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Seamus Whelton
- Associate Professor of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Armin Arbab-Zadeh
- Director of Cardiac CT, Professor of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Renee F Wilson
- Evidence Based Practice Center, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Pamela T Johnson
- Vice President of Care Transformation, Vice Chair of Quality and Safety in Radiology, and Professor of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Kasprzyk P, Undrunas A, Dziadziuszko K, Dziedzic R, Kuziemski K, Szurowska E, Rzyman W, Zdrojewski T. Evaluation of Conventional Cardiovascular Risk Factors and Ordinal Coronary Artery Calcium Scoring in a Lung Cancer Screening Cohort. J Cardiovasc Dev Dis 2024; 11:16. [PMID: 38248886 PMCID: PMC10816916 DOI: 10.3390/jcdd11010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
(1) Background: Lung cancer screening (LCS) consists of low-dose computed tomography (LDCT) results to reduce lung cancer-related mortality. The LCS program has a unique opportunity to impact CVD mortality by providing tools for CVD risk assessment and implementing preventative strategies. In this study, we estimated standardized CVD risk (SCORE) and assessed the prevalence of coronary artery calcium (CAC) in a Polish LCS cohort. (2) Methods: In this observational study, 494 LCS participants aged 50-79 years with a cigarette smoking history of at least 30 pack-years were included. Medical history, anthropometric measurements, blood pressure measurements, serum glucose, and cholesterol levels were assessed in one visit. CVD risk assessment using SCORE tables was performed. The results were compared to the general population (NATPOL 2011 study). On LDCT scans, CAC was classified using an Ordinal Score ranging from 0 to 12. (3) Results: The prevalence of classic cardiovascular risk factors was very high. Among study participants, 83.7% of men and 40.7% of women were classified with a very high CVD SCORE risk (>10%). CAC was reported in 190 (47%) participants. Calcification was categorized as severe (CAC ≥ 4) in 84 (21%) participants. (4) Conclusions: Due to the high cardiovascular risk, intensive preventive strategies are recommended for LCS participants.
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Affiliation(s)
- Piotr Kasprzyk
- First Department of Cardiology, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- Department of Preventive Medicine and Education, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (A.U.); (T.Z.)
| | - Aleksandra Undrunas
- Department of Preventive Medicine and Education, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (A.U.); (T.Z.)
| | - Katarzyna Dziadziuszko
- II Department of Radiology, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (K.D.); (E.S.)
| | - Robert Dziedzic
- Department of Thoracic Surgery, Medical University of Gdańsk, 80-210 Gdańsk, Poland (W.R.)
| | - Krzysztof Kuziemski
- Department of Allergology and Pneumonology, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Edyta Szurowska
- II Department of Radiology, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (K.D.); (E.S.)
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdańsk, 80-210 Gdańsk, Poland (W.R.)
| | - Tomasz Zdrojewski
- Department of Preventive Medicine and Education, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (A.U.); (T.Z.)
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4
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Ruggirello M, Valsecchi C, Ledda RE, Sabia F, Vigorito R, Sozzi G, Pastorino U. Long-term outcomes of lung cancer screening in males and females. Lung Cancer 2023; 185:107387. [PMID: 37801898 PMCID: PMC10788694 DOI: 10.1016/j.lungcan.2023.107387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND This study explored female and male overall mortality and lung cancer (LC) survival in two LC screening (LCS) populations, focusing on the predictive value of coronary artery calcification (CAC) at baseline low-dose computed tomography (LDCT). METHODS This retrospective study analysed data of 6495 heavy smokers enrolled in the MILD and BioMILD LCS trials between 2005 and 2016. The primary objective of the study was to assess sex differences in all-cause mortality and LC survival. CAC scores were automatically calculated on LDCT images by a validated artificial intelligence (AI) software. Sex differences in 12-year cause-specific mortality rates were stratified by age, pack-years and CAC score. RESULTS The study included 2368 females and 4127 males. The 12-year all-cause mortality rates were 4.1 % in females and 7.7 % in males (p < 0.0001), and median CAC score was 8.7 vs. 41 respectively (p < 0.0001). All-cause mortality increased with rising CAC scores (log-rank test, p < 0.0001) for both sexes. Although LC incidence was not different between the two sexes, females had lower rates of 12-year LC mortality (1.0 % vs. 1.9 %, p = 0.0052), and better LC survival from diagnosis (72.3 % vs. 51.7 %; p = 0.0005), with a similar proportion of stage I (58.1 % vs. 51.2 %, p = 0.2782). CONCLUSIONS Our findings demonstrate that female LCS participants had lower rates of all-cause mortality at 12 years and better LC survival than their male counterparts, with similar LC incidence rates and stage at diagnosis. The lower CAC burden observed in women at all ages might contribute to explain their lower rates of all-cause mortality and better LC survival.
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Affiliation(s)
- Margherita Ruggirello
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Camilla Valsecchi
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta Eufrasia Ledda
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Federica Sabia
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Raffaella Vigorito
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriella Sozzi
- Tumour Genomics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ugo Pastorino
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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5
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Ali AH, Nakhla M, Cho L, Seballos R, Lang R, Feinleib S, Flamm S, Schoenhagen P, Wang T, Desai MY. Use of Coronary Artery Calcium Quantification and Distribution for Coronary Vascular Disease Risk Reclassification in a Primary Prevention Setting. Am J Cardiol 2023; 206:303-308. [PMID: 37722228 DOI: 10.1016/j.amjcard.2023.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/06/2023] [Accepted: 08/13/2023] [Indexed: 09/20/2023]
Abstract
In a large screening program of asymptomatic middle-aged individuals, we sought to assess the degree of risk reclassification provided by comparing multiethnic study on subclinical atherosclerosis coronary artery calcium scoring (CACS) versus atherosclerotic cardiovascular disease (ASCVD) and Reynolds risk score (RRS) score. All 5,324 consecutive patients (aged 57 ± 8 years, 76% male) who underwent CACS screening at the Cleveland Clinic as part of a primary prevention executive health between March 16 and October 21 were included. The 10-year ASCVD, RRS, and multiethnic study on subclinical atherosclerosis CACS (MESA-CACS) risk scores were calculated and categorized as <1, 1 to 4.99, 5 to 9.99, and ≥10%. Compared with ASCVD, using MESA-CACS resulted in a downgraded risk in 1,667 subjects (31%), whereas 738 (14%) had an upgrade in risk (total of 45% reclassification). Similarly, compared with RRS, using MESA-CACS resulted in an upgraded risk in 797 (15%) and a downgrade in 1,380 (26%) subjects (total of 41% reclassification). However, by further dividing by the distribution of the coronary calcification, ASCVD overestimates the risk only for patients with coronary artery calcium (CAC) in 0 or 1 coronary artery only, whereas MESA-CACS overestimates if the CAC was noted in ≥2 arteries. Similarly, RRS only overestimates the risk for patients with 0 CAC, whereas it underestimates the risk for patients with any CAC. In conclusion, the use of MESA-CACS, along with CAC distribution in primary prevention clinics, results in differential and significant reclassification of traditional scores when calculating the 10-years coronary vascular disease risk. Overall, RRS underestimates and ASCVD overestimates the cardiovascular disease risk compared with MESA-CACS.
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Affiliation(s)
- Adel Hajj Ali
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Michael Nakhla
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Leslie Cho
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Raul Seballos
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Richard Lang
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Steve Feinleib
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Scott Flamm
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Tom Wang
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Milind Y Desai
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio.
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6
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O'Dowd EL, Tietzova I, Bartlett E, Devaraj A, Biederer J, Brambilla M, Brunelli A, Chorostowska J, Decaluwe H, Deruysscher D, De Wever W, Donoghue M, Fabre A, Gaga M, van Geffen W, Hardavella G, Kauczor HU, Kerpel-Fronius A, van Meerbeeck J, Nagavci B, Nestle U, Novoa N, Prosch H, Prokop M, Putora PM, Rawlinson J, Revel MP, Snoeckx A, Veronesi G, Vliegenthart R, Weckbach S, Blum TG, Baldwin DR. ERS/ESTS/ESTRO/ESR/ESTI/EFOMP statement on management of incidental findings from low dose CT screening for lung cancer. Eur J Cardiothorac Surg 2023; 64:ezad302. [PMID: 37804174 PMCID: PMC10876118 DOI: 10.1093/ejcts/ezad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/06/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost effectiveness. This European Respiratory Society (ERS) task force was formed to provide an expert consensus for the management of incidental findings which can be adapted and followed during implementation. METHODS A multi-European society collaborative group was convened. 23 topics were identified, primarily from an ERS statement on lung cancer screening, and a systematic review of the literature was conducted according to ERS standards. Initial review of abstracts was completed and full text was provided to members of the group for each topic. Sections were edited and the final document approved by all members and the ERS Science Council. RESULTS Nine topics considered most important and frequent were reviewed as standalone topics (interstitial lung abnormalities, emphysema, bronchiectasis, consolidation, coronary calcification, aortic valve disease, mediastinal mass, mediastinal lymph nodes and thyroid abnormalities). Other topics considered of lower importance or infrequent were grouped into generic categories, suitable for general statements. CONCLUSIONS This European collaborative group has produced an incidental findings statement that can be followed during lung cancer screening. It will ensure that an evidence-based approach is used for reporting and managing incidental findings, which will mean that harms are minimised and any programme is as cost-effective as possible.
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Affiliation(s)
- Emma L O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Ilona Tietzova
- Charles University, First Faculty of Medicine, Department of Tuberculosis and Respiratory Diseases, Prague, Czech Republic
| | - Emily Bartlett
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Anand Devaraj
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Jürgen Biederer
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
- University of Latvia, Faculty of Medicine, Riga, Latvia
- Christian-Albrechts-Universität zu Kiel, Faculty of Medicine, Kiel, Germany
| | - Marco Brambilla
- Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy
| | | | - Joanna Chorostowska
- Institute of Tuberculosis and Lung Diseases, Warsaw, Genetics and Clinical Immunology, Warsaw, Poland
| | | | - Dirk Deruysscher
- Maastricht University Medical Centre, Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Limburg, The Netherlands
| | - Walter De Wever
- Universitaire Ziekenhuizen Leuven, Radiology, Leuven, Belgium
| | | | - Aurelie Fabre
- University College Dublin School of Medicine, Histopathology, Dublin, Ireland
| | - Mina Gaga
- Sotiria General Hospital of Chest Diseases of Athens, 7th Respiratory Medicine Department, Athens, Greece
| | - Wouter van Geffen
- Medical Centre Leeuwarden, Department of Respiratory Medicine, Leeuwarden, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - Georgia Hardavella
- Sotiria General Hospital of Chest Diseases of Athens, Respiratory Medicine, Athens, Greece
| | - Hans-Ulrich Kauczor
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
| | - Anna Kerpel-Fronius
- National Koranyi Institute of Pulmonology, Department of Radiology, Budapest, Hungary
| | | | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ursula Nestle
- Kliniken Maria Hilf GmbH Monchengladbach, Nordrhein-Westfalen, Germany
| | - Nuria Novoa
- University Hospital of Salamanca, Thoracic Surgery, Salamanca, Spain
| | - Helmut Prosch
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna, Austria
| | - Mathias Prokop
- Radboud University Nijmegen Medical Center, Department of Radiology, Nijmegen, The Netherlands
| | - Paul Martin Putora
- Kantonsspital Sankt Gallen, Radiation Oncology, Sankt Gallen, Switzerland
- Inselspital Universitatsspital Bern, Radiation Oncology, Bern, Switzerland
| | | | - Marie-Pierre Revel
- Cochin Hospital, APHP, Radiology Department, Paris, France
- Université de Paris, Paris, France
| | | | - Giulia Veronesi
- Humanitas Research Hospital, Division of Thoracic and General Surgery, Rozzano, Italy
| | | | - Sabine Weckbach
- UniversitatsKlinikum Heidelberg, Heidelberg, Germany
- Bayer AG, Research and Development, Pharmaceuticals, Radiology, Berlin, Germany
| | - Torsten G Blum
- HELIOS Klinikum Emil von Behring GmbH, Lungenklinik Heckeshorn, Berlin, Germany
| | - David R Baldwin
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Department of Respiratory Medicine, Nottingham, UK
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7
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O'Dowd EL, Tietzova I, Bartlett E, Devaraj A, Biederer J, Brambilla M, Brunelli A, Chorostowska-Wynimko J, Decaluwe H, Deruysscher D, De Wever W, Donoghue M, Fabre A, Gaga M, van Geffen W, Hardavella G, Kauczor HU, Kerpel-Fronius A, van Meerbeeck J, Nagavci B, Nestle U, Novoa N, Prosch H, Prokop M, Putora PM, Rawlinson J, Revel MP, Snoeckx A, Veronesi G, Vliegenthart R, Weckbach S, Blum TG, Baldwin DR. ERS/ESTS/ESTRO/ESR/ESTI/EFOMP statement on management of incidental findings from low dose CT screening for lung cancer. Eur Respir J 2023; 62:2300533. [PMID: 37802631 DOI: 10.1183/13993003.00533-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/06/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost effectiveness. This European Respiratory Society (ERS) task force was formed to provide an expert consensus for the management of incidental findings which can be adapted and followed during implementation. METHODS A multi-European society collaborative group was convened. 23 topics were identified, primarily from an ERS statement on lung cancer screening, and a systematic review of the literature was conducted according to ERS standards. Initial review of abstracts was completed and full text was provided to members of the group for each topic. Sections were edited and the final document approved by all members and the ERS Science Council. RESULTS Nine topics considered most important and frequent were reviewed as standalone topics (interstitial lung abnormalities, emphysema, bronchiectasis, consolidation, coronary calcification, aortic valve disease, mediastinal mass, mediastinal lymph nodes and thyroid abnormalities). Other topics considered of lower importance or infrequent were grouped into generic categories, suitable for general statements. CONCLUSIONS This European collaborative group has produced an incidental findings statement that can be followed during lung cancer screening. It will ensure that an evidence-based approach is used for reporting and managing incidental findings, which will mean that harms are minimised and any programme is as cost-effective as possible.
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Affiliation(s)
- Emma L O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Ilona Tietzova
- Charles University, First Faculty of Medicine, Department of Tuberculosis and Respiratory Diseases, Prague, Czech Republic
| | - Emily Bartlett
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Anand Devaraj
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Jürgen Biederer
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
- University of Latvia, Faculty of Medicine, Riga, Latvia
- Christian-Albrechts-Universität zu Kiel, Faculty of Medicine, Kiel, Germany
| | - Marco Brambilla
- Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy
| | | | | | | | - Dirk Deruysscher
- Maastricht University Medical Centre, Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Limburg, The Netherlands
| | - Walter De Wever
- Universitaire Ziekenhuizen Leuven, Radiology, Leuven, Belgium
| | | | - Aurelie Fabre
- University College Dublin School of Medicine, Histopathology, Dublin, Ireland
| | - Mina Gaga
- Sotiria General Hospital of Chest Diseases of Athens, 7th Respiratory Medicine Department, Athens, Greece
| | - Wouter van Geffen
- Medical Centre Leeuwarden, Department of Respiratory Medicine, Leeuwarden, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - Georgia Hardavella
- Sotiria General Hospital of Chest Diseases of Athens, Respiratory Medicine, Athens, Greece
| | - Hans-Ulrich Kauczor
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
| | - Anna Kerpel-Fronius
- National Koranyi Institute of Pulmonology, Department of Radiology, Budapest, Hungary
| | | | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ursula Nestle
- Kliniken Maria Hilf GmbH Monchengladbach, Nordrhein-Westfalen, Germany
| | - Nuria Novoa
- University Hospital of Salamanca, Thoracic Surgery, Salamanca, Spain
| | - Helmut Prosch
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna, Austria
| | - Mathias Prokop
- Radboud University Nijmegen Medical Center, Department of Radiology, Nijmegen, The Netherlands
| | - Paul Martin Putora
- Kantonsspital Sankt Gallen, Radiation Oncology, Sankt Gallen, Switzerland
- Inselspital Universitatsspital Bern, Radiation Oncology, Bern, Switzerland
| | | | - Marie-Pierre Revel
- Cochin Hospital, APHP, Radiology Department, Paris, France
- Université de Paris, Paris, France
| | | | - Giulia Veronesi
- Humanitas Research Hospital, Division of Thoracic and General Surgery, Rozzano, Italy
| | | | - Sabine Weckbach
- UniversitatsKlinikum Heidelberg, Heidelberg, Germany
- Bayer AG, Research and Development, Pharmaceuticals, Radiology, Berlin, Germany
| | - Torsten G Blum
- HELIOS Klinikum Emil von Behring GmbH, Lungenklinik Heckeshorn, Berlin, Germany
| | - David R Baldwin
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
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Peng AW, Dudum R, Jain SS, Maron DJ, Patel BN, Khandwala N, Eng D, Chaudhari AS, Sandhu AT, Rodriguez F. Association of Coronary Artery Calcium Detected by Routine Ungated CT Imaging With Cardiovascular Outcomes. J Am Coll Cardiol 2023; 82:1192-1202. [PMID: 37704309 PMCID: PMC11009374 DOI: 10.1016/j.jacc.2023.06.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Coronary artery calcium (CAC) is a strong predictor of cardiovascular events across all racial and ethnic groups. CAC can be quantified on nonelectrocardiography (ECG)-gated computed tomography (CT) performed for other reasons, allowing for opportunistic screening for subclinical atherosclerosis. OBJECTIVES The authors investigated whether incidental CAC quantified on routine non-ECG-gated CTs using a deep-learning (DL) algorithm provided cardiovascular risk stratification beyond traditional risk prediction methods. METHODS Incidental CAC was quantified using a DL algorithm (DL-CAC) on non-ECG-gated chest CTs performed for routine care in all settings at a large academic medical center from 2014 to 2019. We measured the association between DL-CAC (0, 1-99, or ≥100) with all-cause death (primary outcome), and the secondary composite outcomes of death/myocardial infarction (MI)/stroke and death/MI/stroke/revascularization using Cox regression. We adjusted for age, sex, race, ethnicity, comorbidities, systolic blood pressure, lipid levels, smoking status, and antihypertensive use. Ten-year atherosclerotic cardiovascular disease risk was calculated using the pooled cohort equations. RESULTS Of 5,678 adults without ASCVD (51% women, 18% Asian, 13% Hispanic/Latinx), 52% had DL-CAC >0. Those with DL-CAC ≥100 had an average 10-year ASCVD risk of 24%; yet, only 26% were on statins. After adjustment, patients with DL-CAC ≥100 had increased risk of death (HR: 1.51; 95% CI: 1.28-1.79), death/MI/stroke (HR: 1.57; 95% CI: 1.33-1.84), and death/MI/stroke/revascularization (HR: 1.69; 95% CI: 1.45-1.98) compared with DL-CAC = 0. CONCLUSIONS Incidental CAC ≥100 was associated with an increased risk of all-cause death and adverse cardiovascular outcomes, beyond traditional risk factors. DL-CAC from routine non-ECG-gated CTs identifies patients at increased cardiovascular risk and holds promise as a tool for opportunistic screening to facilitate earlier intervention.
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Affiliation(s)
- Allison W Peng
- Department of Medicine, Stanford University, Stanford, California, USA; Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA. https://twitter.com/AllisonWPeng
| | - Ramzi Dudum
- Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Sneha S Jain
- Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - David J Maron
- Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA; Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California, USA
| | - Bhavik N Patel
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
| | | | - David Eng
- Bunkerhill Health, Palo Alto, California, USA
| | - Akshay S Chaudhari
- Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; Department of Radiology, Stanford University, Stanford, California, USA; Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Alexander T Sandhu
- Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA; Veteran's Affairs Palo Alto Healthcare System, Palo Alto, California, USA. https://twitter.com/ATSandhu
| | - Fatima Rodriguez
- Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.
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9
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Balbi M, Sabia F, Ledda RE, Milanese G, Ruggirello M, Silva M, Marchianò AV, Sverzellati N, Pastorino U. Automated Coronary Artery Calcium and Quantitative Emphysema in Lung Cancer Screening: Association With Mortality, Lung Cancer Incidence, and Airflow Obstruction. J Thorac Imaging 2023; 38:W52-W63. [PMID: 36656144 PMCID: PMC10287055 DOI: 10.1097/rti.0000000000000698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess automated coronary artery calcium (CAC) and quantitative emphysema (percentage of low attenuation areas [%LAA]) for predicting mortality and lung cancer (LC) incidence in LC screening. To explore correlations between %LAA, CAC, and forced expiratory value in 1 second (FEV 1 ) and the discriminative ability of %LAA for airflow obstruction. MATERIALS AND METHODS Baseline low-dose computed tomography scans of the BioMILD trial were analyzed using an artificial intelligence software. Univariate and multivariate analyses were performed to estimate the predictive value of %LAA and CAC. Harrell C -statistic and time-dependent area under the curve (AUC) were reported for 3 nested models (Model survey : age, sex, pack-years; Model survey-LDCT : Model survey plus %LAA plus CAC; Model final : Model survey-LDCT plus selected confounders). The correlations between %LAA, CAC, and FEV 1 and the discriminative ability of %LAA for airflow obstruction were tested using the Pearson correlation coefficient and AUC-receiver operating characteristic curve, respectively. RESULTS A total of 4098 volunteers were enrolled. %LAA and CAC independently predicted 6-year all-cause (Model final hazard ratio [HR], 1.14 per %LAA interquartile range [IQR] increase [95% CI, 1.05-1.23], 2.13 for CAC ≥400 [95% CI, 1.36-3.28]), noncancer (Model final HR, 1.25 per %LAA IQR increase [95% CI, 1.11-1.37], 3.22 for CAC ≥400 [95%CI, 1.62-6.39]), and cardiovascular (Model final HR, 1.25 per %LAA IQR increase [95% CI, 1.00-1.46], 4.66 for CAC ≥400, [95% CI, 1.80-12.58]) mortality, with an increase in concordance probability in Model survey-LDCT compared with Model survey ( P <0.05). No significant association with LC incidence was found after adjustments. Both biomarkers negatively correlated with FEV 1 ( P <0.01). %LAA identified airflow obstruction with a moderate discriminative ability (AUC, 0.738). CONCLUSIONS Automated CAC and %LAA added prognostic information to age, sex, and pack-years for predicting mortality but not LC incidence in an LC screening setting. Both biomarkers negatively correlated with FEV 1 , with %LAA enabling the identification of airflow obstruction with moderate discriminative ability.
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Affiliation(s)
- Maurizio Balbi
- Departments of Thoracic Surgery
- Department of Medicine and Surgery, Section of Radiology, University of Parma, Parma, Italy
| | | | - Roberta E. Ledda
- Departments of Thoracic Surgery
- Department of Medicine and Surgery, Section of Radiology, University of Parma, Parma, Italy
| | - Gianluca Milanese
- Department of Medicine and Surgery, Section of Radiology, University of Parma, Parma, Italy
| | | | - Mario Silva
- Department of Medicine and Surgery, Section of Radiology, University of Parma, Parma, Italy
| | | | - Nicola Sverzellati
- Department of Medicine and Surgery, Section of Radiology, University of Parma, Parma, Italy
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10
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Al-Mallah MH, Bateman TM, Branch KR, Crean A, Gingold EL, Thompson RC, McKenney SE, Miller EJ, Murthy VL, Nieman K, Villines TC, Yester MV, Einstein AJ, Mahmarian JJ. 2022 ASNC/AAPM/SCCT/SNMMI guideline for the use of CT in hybrid nuclear/CT cardiac imaging. J Nucl Cardiol 2022; 29:3491-3535. [PMID: 36056224 DOI: 10.1007/s12350-022-03089-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 01/29/2023]
Affiliation(s)
- Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
| | - Timothy M Bateman
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Kelley R Branch
- Division of Cardiovascular, University of Washington, Seattle, WA, USA
| | - Andrew Crean
- Division of Cardiovascular Medicine, Ottawa Heart Institute, Ottawa, ON, Canada
| | - Eric L Gingold
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Randall C Thompson
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Sarah E McKenney
- Department of Radiology, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Koen Nieman
- Departments of Cardiovascular Medicine and Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Michael V Yester
- Department of Radiology, School of Medicine, University of Alabama Medical Center, Birmingham, AL, USA
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - John J Mahmarian
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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11
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Yu J, Qian L, Sun W, Nie Z, Zheng D, Han P, Shi H, Zheng C, Yang F. Automated total and vessel-specific coronary artery calcium (CAC) quantification on chest CT: direct comparison with CAC scoring on non-contrast cardiac CT. BMC Med Imaging 2022; 22:177. [PMID: 36241978 PMCID: PMC9563469 DOI: 10.1186/s12880-022-00907-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/04/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the artificial intelligence (AI)-based coronary artery calcium (CAC) quantification and regional distribution of CAC on non-gated chest CT, using standard electrocardiograph (ECG)-gated CAC scoring as the reference. METHODS In this retrospective study, a total of 405 patients underwent non-gated chest CT and standard ECG-gated cardiac CT. An AI-based algorithm was used for automated CAC scoring on chest CT, and Agatston score on cardiac CT was manually quantified. Bland-Altman plots were used to evaluate the agreement of absolute Agatston score between the two scans at the patient and vessel levels. Linearly weighted kappa (κ) was calculated to assess the reliability of AI-based CAC risk categorization and the number of involved vessels on chest CT. RESULTS The AI-based algorithm showed moderate reliability for the number of involved vessels in comparison to measures on cardiac CT (κ = 0.75, 95% CI 0.70-0.79, P < 0.001) and an assignment agreement of 76%. Considerable coronary arteries with CAC were not identified with a per-vessel false-negative rate of 59.3%, 17.8%, 34.9%, and 34.7% for LM, LAD, CX, and RCA on chest CT. The leading causes for false negatives of LM were motion artifact (56.3%, 18/32) and segmentation error (43.8%, 14/32). The motion artifact was almost the only cause for false negatives of LAD (96.6%, 28/29), CX (96.7%, 29/30), and RCA (100%, 34/34). Absolute Agatston scores on chest CT were underestimated either for the patient and individual vessels except for LAD (median difference: - 12.5, - 11.3, - 5.6, - 18.6 for total, LM, CX, and RCA, all P < 0.01; - 2.5 for LAD, P = 0.18). AI-based total Agatston score yielded good reliability for risk categorization (weighted κ 0.86, P < 0.001) and an assignment agreement of 86.7% on chest CT, with a per-patient false-negative rate of 15.2% (28/184) and false-positive rate of 0.5% (1/221) respectively. CONCLUSIONS AI-based per-patient CAC quantification on non-gated chest CT achieved a good agreement with dedicated ECG-gated CAC scoring overall and highly reliable CVD risk categorization, despite a slight but significant underestimation. However, it is challenging to evaluate the regional distribution of CAC without ECG-synchronization.
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Affiliation(s)
- Jie Yu
- grid.412839.50000 0004 1771 3250Department of Radiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, 1277 Jiefang Ave., Wuhan, 430022 Hubei Province China ,grid.412839.50000 0004 1771 3250Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 Hubei Province China
| | - Lijuan Qian
- grid.412839.50000 0004 1771 3250Department of Radiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, 1277 Jiefang Ave., Wuhan, 430022 Hubei Province China ,grid.412839.50000 0004 1771 3250Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 Hubei Province China
| | - Wengang Sun
- grid.412839.50000 0004 1771 3250Department of Radiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, 1277 Jiefang Ave., Wuhan, 430022 Hubei Province China ,grid.412839.50000 0004 1771 3250Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 Hubei Province China
| | - Zhuang Nie
- grid.412839.50000 0004 1771 3250Department of Radiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, 1277 Jiefang Ave., Wuhan, 430022 Hubei Province China ,grid.412839.50000 0004 1771 3250Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 Hubei Province China
| | - DanDan Zheng
- ShuKun (BeiJing) Technology Co. Ltd., Jinhui Bd, Qiyang Rd, Beijing, 100000 China
| | - Ping Han
- grid.412839.50000 0004 1771 3250Department of Radiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, 1277 Jiefang Ave., Wuhan, 430022 Hubei Province China ,grid.412839.50000 0004 1771 3250Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 Hubei Province China
| | - Heshui Shi
- grid.412839.50000 0004 1771 3250Department of Radiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, 1277 Jiefang Ave., Wuhan, 430022 Hubei Province China ,grid.412839.50000 0004 1771 3250Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 Hubei Province China
| | - Chuansheng Zheng
- grid.412839.50000 0004 1771 3250Department of Radiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, 1277 Jiefang Ave., Wuhan, 430022 Hubei Province China ,grid.412839.50000 0004 1771 3250Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 Hubei Province China
| | - Fan Yang
- grid.412839.50000 0004 1771 3250Department of Radiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, 1277 Jiefang Ave., Wuhan, 430022 Hubei Province China ,grid.412839.50000 0004 1771 3250Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 Hubei Province China
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12
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Choi JH, Cha MJ, Cho I, Kim WD, Ha Y, Choi H, Lee SH, You SC, Chang JS. Validation of deep learning-based fully automated coronary artery calcium scoring using non-ECG-gated chest CT in patients with cancer. Front Oncol 2022; 12:989250. [PMID: 36203468 PMCID: PMC9530804 DOI: 10.3389/fonc.2022.989250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
This study aimed to demonstrate clinical feasibility of deep learning (DL)-based fully automated coronary artery calcium (CAC) scoring software using non-electrocardiogram (ECG)-gated chest computed tomography (CT) from patients with cancer. Overall, 913 patients with colorectal or gastric cancer who underwent non-contrast-enhanced chest CT between 2013 and 2015 were included. Agatston scores obtained by manual segmentation of CAC on chest CT were used as reference. Reliability of automated CAC score acquisition was evaluated using intraclass correlation coefficients (ICCs). The agreement for cardiovascular disease (CVD) risk stratification was assessed with linearly weighted k statistics. ICCs between the manual and automated CAC scores were 0.992 (95% CI, 0.991 and 0.993, p<0.001) for total Agatston scores, 0.863 (95% CI, 0.844 and 0.880, p<0.001) for the left main, 0.964 (95% CI, 0.959 and 0.968, p<0.001) for the left anterior descending, 0.962 (95% CI, 0.956 and 0.966, p<0.001) for the left circumflex, and 0.980 (95% CI, 0.978 and 0.983, p<0.001) for the right coronary arteries. The agreement for cardiovascular risk was excellent (k=0.946, p<0.001). Current DL-based automated CAC software showed excellent reliability for Agatston score and CVD risk stratification using non-ECG gated CT scans and might allow the identification of high-risk cancer patients for CVD.
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Affiliation(s)
- Joo Hyeok Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
- *Correspondence: Min Jae Cha, ; Iksung Cho,
| | - Iksung Cho
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Min Jae Cha, ; Iksung Cho,
| | - William D. Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yera Ha
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Hyewon Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Sun Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Seng Chan You
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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13
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Majeed A, Ruane B, Shusted CS, Austin M, Mirzozoda K, Pimpinelli M, Vojnika J, Ward L, Sundaram B, Lakhani P, Kane G, Lev Y, Barta JA. Frequency of Statin Prescription Among Individuals with Coronary Artery Calcifications Detected Through Lung Cancer Screening. Am J Med Qual 2022; 37:388-395. [PMID: 35302536 DOI: 10.1097/jmq.0000000000000053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Individuals eligible for lung cancer screening (LCS) are at risk for atherosclerotic cardiovascular disease (ASCVD) due to smoking history. Coronary artery calcifications (CAC), a common incidental finding on low-dose CT (LDCT) for LCS, is a predictor of cardiovascular events. Despite findings of high ASCVD risk and CAC, a substantial proportion of LCS patients are not prescribed primary preventive statin therapy for ASCVD. We assessed the frequency of statin prescription in LCS patients with moderate levels of CAC. Among 259 individuals with moderate CAC, 95% had ASCVD risk ≥ 7.5%. Despite this, 27% of patients were statin-free prior to LDCT and 21.2% remained statin-free after LDCT showing moderate CAC. Illustratively, while a substantial proportion of LCS patients are statin-eligible, many lack a statin prescription, even after findings of CAC burden. CAC reporting should be standardized, and interdisciplinary communication should be optimized to ensure that LCS patients are placed on appropriate preventive therapy.
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Affiliation(s)
- Amry Majeed
- Sidney Kimmel Medical College at Thomas Jefferson University
| | - Brooke Ruane
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University
| | - Christine S Shusted
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University
| | - Melissa Austin
- Sidney Kimmel Medical College at Thomas Jefferson University
| | - Khulkar Mirzozoda
- Department of Medicine, Division of Internal Medicine, Thomas Jefferson University
| | | | - Jetmir Vojnika
- Department of Medicine, Division of Internal Medicine, Thomas Jefferson University
| | - Lawrence Ward
- Department of Medicine, Division of Internal Medicine, Thomas Jefferson University
| | | | - Paras Lakhani
- Department of Radiology, Thomas Jefferson University
| | - Gregory Kane
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University
| | - Yair Lev
- Division of Cardiology, Thomas Jefferson University
| | - Julie A Barta
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University
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14
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Llewellyn O, Williams MC. What should we do about Coronary Calcification on Thoracic CT? ROFO-FORTSCHR RONTG 2022; 194:833-840. [PMID: 35272359 DOI: 10.1055/a-1752-0577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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 · Coronary artery calcification is a frequent incidental finding on thoracic CT.. · The presence and severity of coronary artery calcification is associated with cardiac outcomes and mortality.. · Reporting coronary artery calcification on thoracic CT is supported by national and international guidelines.. CITATION FORMAT · Williams MC, Llewellyn O, . What Should We Do About Coronary Calcification on Thoracic CT?. Fortschr Röntgenstr 2022; 194: 833 - 840.
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Affiliation(s)
- Oliver Llewellyn
- Department of Radiology, Royal Infirmary of Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Michelle C Williams
- Centre for Cardiovascular Science, The University of Edinburgh Centre for Cardiovascular Science, Edinburgh, United Kingdom of Great Britain and Northern Ireland
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15
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Utility of Noncancerous Chest CT Features for Predicting Overall Survival and Noncancer Death in Patients With Stage I Lung Cancer Treated With Stereotactic Body Radiotherapy. AJR Am J Roentgenol 2022; 219:579-589. [PMID: 35416054 DOI: 10.2214/ajr.22.27484] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Noncancerous imaging markers can be readily derived from pretreatment diagnostic and radiotherapy planning chest CT examinations. Objective: To explore the ability of noncancerous features on chest CT to predict overall survival (OS) and noncancer-related death in patients with stage I lung cancer treated with stereotactic body radiation therapy (SBRT). Methods: This retrospective study included 282 patients (168 female, 114 male; median age, 75 years) with stage I lung cancer treated with SBRT between January 2009 and June 2017. Pretreatment chest CT was used to quantify coronary artery calcium (CAC) score, pulmonary artery (PA)-to-aorta ratio, emphysema, and body composition in terms of the cross-sectional area and attenuation of skeletal muscle and subcutaneous adipose tissue at the T5, T8, and T10 vertebral levels. Associations of clinical and imaging features with OS were quantified using a multivariable Cox proportional hazards (PH) model. Penalized multivariable Cox PH models to predict OS were constructed using clinical features only and using both clinical and imaging features. Models' discriminatory ability was assessed by constructing time-varying ROC curves and computing AUC at prespecified times. Results: After a median OS of 60.8 months (95% CI 55.8-68.9), 148 (52.5%) patients died, including 83 (56.1%) with noncancer deaths. Higher CAC score (11-399: hazard ratio [HR] 1.83 [95% CI 1.15-2.91], P=.01; ≥400: HR 1.63 [95% CI 1.01-2.63], P=.04), higher PA-to-aorta ratio (HR 1.33 [95% CI 1.16-1.52], P<.001, per 0.1-unit increase), and lower thoracic skeletal muscle index (HR 0.88 [95% CI 0.79-0.98], P=.02, per 10 cm2/m2 increase) were independently associated with shorter OS. Discriminatory ability for 5-year OS was greater for the model including clinical and imaging features than for the model including clinical features only (AUC, 0.75 [95% CI 0.68-0.83] versus 0.61 [95% CI 0.53-0.70], p < .01). The model's most important clinical or imaging feature based on mean standardized regression coefficients was the PA-to-aorta ratio. Conclusions: In patients undergoing SBRT for stage I lung cancer, higher CAC score, higher PA-to-aorta ratio, and lower thoracic skeletal muscle index independently predicted worse OS. Clinical Impact: Noncancerous imaging features on chest CT performed before SBRT improve survival prediction compared with clinical features alone.
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16
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Improving Cardiovascular Disease Prediction Using Automated Coronary Artery Calcium Scoring from Existing Chest CTs. J Digit Imaging 2022; 35:962-969. [PMID: 35296940 PMCID: PMC9485503 DOI: 10.1007/s10278-021-00575-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 10/21/2021] [Accepted: 12/21/2021] [Indexed: 10/18/2022] Open
Abstract
Cardiovascular disease (CVD) prediction models are widely used in modern medicine and are incorporated into prominent guidelines. Coronary artery calcium (CAC) is a marker of coronary atherosclerotic disease and has proven utility for predicting cardiovascular disease. Despite this, current guidelines recommend against including CAC scores in CVD prediction models due to the medical and financial costs of acquiring it, and the insufficient evidence concerning its ability to improve existing models. Modern machine learning models are capable of automatically extracting coronary calcium scores from existing chest computed tomography (CT) scans, negating these costs. To determine whether the inclusion of CAC scores, automatically extracted using a machine learning algorithm from chest CTs performed for any reason, improves the performance of the American Heart Association/American College of Cardiology 2013 pooled cohort equations (PCE). A retrospective cohort of patients with available chest CTs prior to an index date (2012) was used to compare the performance of the PCE model and an augmented-PCE model which utilizes the CT-based CAC scores on top of the existing model. The PCE and the augmented-PCE predictions were calculated as of an index date (2012) using data from the electronic health record and existing chest CTs. The performance of both models was evaluated by comparing their predictions to cardiovascular events that occurred during a 5-year follow-up period (until 2017). A total of 14,135 patients aged 40-79 years were included in the study, of whom 470 (3.3%) had documented CVD events during the follow-up. The augmented-PCE model showed a significant improvement in c-statistic (0.64 ≥ 0.69, Δ = 0.05, 95% CI: 0.03 to 0.06), sensitivity (53% ≥ 57%, Δ = 4.7%, 95% CI: 0-9.0%), specificity (67% ≥ 70%, Δ = 2.8%, 95% CI: 0.9-5.1%), in positive predictive value (5% ≥ 6%, Δ = 0.9%, 95% CI: 0.4 to 1.4%), negative predictive value (97.7% ≥ 97.9%, Δ = 0.3%, 95% CI: 0.1 to 0.5%), and in the categorical net reclassification index (7.4%, 95% CI: 2.4 to 12.1%). Automatically generated CAC scores from existing CTs can aid in CVD risk determination, improving model performance when used on top of existing predictors. Use of existing CTs avoids most pitfalls currently cited against the routine use of CAC in CVD predictions (e.g., additional radiation exposure), and thus affords a net gain in predictive accuracy.
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Mascalchi M, Puliti D, Romei C, Picozzi G, De Liperi A, Diciotti S, Bartolucci M, Grazzini M, Vannucchi L, Falaschi F, Pistelli F, Gorini G, Carozzi F, Rosselli A, Carrozzi L, Paci E, Zappa M. Moderate-severe coronary calcification predicts long-term cardiovascular death in CT lung cancer screening: The ITALUNG trial. Eur J Radiol 2021; 145:110040. [PMID: 34814037 DOI: 10.1016/j.ejrad.2021.110040] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/19/2021] [Accepted: 10/13/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE Coronary artery calcifications (CAC) are very strong indicators for increased cardio-vascular (CV) risk and can be evaluated also in low-dose computed tomography (LDCT) for lung cancer screening. We assessed whether a simple and fast CAC visual score is associated with CV mortality. METHODS CAC were retrospectively assessed by two observers using a 4-score (absent, mild, moderate and severe) scale in baseline LDCT obtained in 1364 participants to the ITALUNG trial who had 55-69 years of age and a smoking history ≥20 pack-years. Correlations with CV risk factors at baseline and with CV mortality after 11 years of follow-up were investigated. RESULTS CAC were absent in 470 (34.5%), mild in 433 (31.7%), moderate in 357 (26.2%) and severe in 104 (7.6%) subjects. CAC severity correlated (≤0.001) with age, male sex, pack-years, history of arterial hypertension or diabetes, obesity and treated hypercholesterolemia. Twenty-one CV deaths occurred. Moderate or severe CAC were significantly associated with higher CV mortality after adjustment for all other known risk factors (ARR = 2.72; 95 %CI:1.04-7.11). Notably, also in subjects with none or one only additional CV risk factor, the presence of moderate-severe CAC allowed to identify a subgroup of subjects with higher CV death risk (RR = 3.66; CI95%:1.06-12.6). CONCLUSIONS Moderate or severe CAC visually assessed in LDCT examinations for lung cancer screening are independently associated with CV mortality.
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Affiliation(s)
- Mario Mascalchi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Clinical Epidemiology and Clinical Governance Support Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy.
| | - Donella Puliti
- Clinical Epidemiology and Clinical Governance Support Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Chiara Romei
- Radiodiagnostic Unit 2, Department of Diagnostic Imaging, Cisanello University Hospital of Pisa, Pisa, Italy
| | - Giulia Picozzi
- Clinical Epidemiology and Clinical Governance Support Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Annalisa De Liperi
- Radiodiagnostic Unit 2, Department of Diagnostic Imaging, Cisanello University Hospital of Pisa, Pisa, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | | | | | | | - Fabio Falaschi
- Radiodiagnostic Unit 2, Department of Diagnostic Imaging, Cisanello University Hospital of Pisa, Pisa, Italy
| | - Francesco Pistelli
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Giuseppe Gorini
- Clinical Epidemiology and Clinical Governance Support Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Francesca Carozzi
- Cancer Prevention Regional Laboratory, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | | | - Laura Carrozzi
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Eugenio Paci
- Clinical Epidemiology and Clinical Governance Support Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Marco Zappa
- Clinical Epidemiology and Clinical Governance Support Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
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18
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Lee K, Kim HR, Park SI, Kim DK, Kim YH, Choi S, Lee GD. Natural Progression of Ground-glass Nodules after Curative Resection for Non-small Cell Lung Cancer. J Korean Med Sci 2021; 36:e266. [PMID: 34751007 PMCID: PMC8575765 DOI: 10.3346/jkms.2021.36.e266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/03/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This retrospective study investigated the natural course of synchronous ground-glass nodules (GGNs) that remained after curative resection for non-small-cell lung cancer (NSCLC). METHODS Prospectively collected retrospective data were reviewed concerning 2,276 patients who underwent curative resection for NSCLC between 2008 and 2017. High-resolution computed tomography or thin-section computed tomography data of 82 patients were included in the study. Growth in size was considered the most valuable outcome, and patients were grouped according to GGN size change. Patient demographic data (e.g., age, sex, and smoking history), perioperative data (e.g., GGN characteristics, histopathology and pathological stage of the resected tumours), and other medical history were evaluated in a risk factor analysis concerning GGN size change. RESULTS The median duration of follow-up was 36.0 months (interquartile range, 23.0-59.3 months). GGN size decreased in 6 patients (7.3%), was stationary in 43 patients (52.4%), and increased in 33 patients (40.2%). In univariate analysis, male sex, the GGN size on initial CT, part-solid GGN and smoking history (≥ 10 pack-years) were significant risk factors. Among them, multivariate analysis revealed that lager GGN size, part-solid GGN and smoking history were independent risk factors. CONCLUSION During follow-up, 40.2% of GGNs increased in size, emphasising that patients with larger GGNs, part-solid GGN or with a smoking history should be observed.
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Affiliation(s)
- Kanghoon Lee
- Department of Thoracic and Cardiovascular Surgery, International St. Mary's Hospital, Catholic Kwandong University, College of Medicine, Incheon, Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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19
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Yu C, Ng ACC, Ridley L, Anjaria M, Meier S, Yiannikas J, Kritharides L, Naoum C. Incidentally identified coronary artery calcium on non-contrast CT scan of the chest predicts major adverse cardiac events among hospital inpatients. Open Heart 2021; 8:openhrt-2021-001695. [PMID: 34635575 PMCID: PMC8506889 DOI: 10.1136/openhrt-2021-001695] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/23/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Coronary artery calcium (CAC) identified on non-gated CT scan of the chest is predictive of major adverse cardiac events (MACE) in multiple studies with guidelines therefore recommending the routine reporting of incidental CAC. These studies have been limited however to the outpatient setting. We aimed to determine the prognostic utility of incidentally identified CAC on CT scan of the chest among hospital inpatients. METHODS AND RESULTS Consecutive patients (n=740) referred for inpatient non-contrast CT scan of the chest at a tertiary referral hospital (January 2011 to March 2017) were included (n=280) if they had no known history of coronary artery disease, active malignancy or died within 30 days of admission. Scans were assessed for the presence of CAC by visual assessment and quantified by Agatston scoring. Median age was 69 years (IQR: 54-82) and 51% were male with a median CAC score of 7 (IQR 0-205). MACE occurred in 140 (50%) patients at 3.5 years median follow-up including 98 deaths. Half of all events occurred within 18 months. Visible CAC was associated with increased MACE (HR) 6.0 (95% CI: 3.7 to 9.7) compared with patients with no visible CAC. This finding persisted after adjusting for cardiovascular risk factors HR 2.4 (95% CI: 1.3 to 4.3) and with both absolute CAC score and CAC score ≥50th percentile. CONCLUSION Incidental CAC identified on CT scan of the chest among hospital inpatients provides prognostic information that is independent of cardiovascular risk factors. These patients may benefit from aggressive risk factor modification given the high event rate in the short term.
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Affiliation(s)
- Christopher Yu
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Austin C C Ng
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Lloyd Ridley
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Mekhala Anjaria
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Silvan Meier
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Department of Cardiology, Municipal Hospital Triemli, Zurich, Zürich, Switzerland
| | - John Yiannikas
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Naoum
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia .,Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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20
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Imaging in CABG Patients. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00922-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Snoeckx A, Franck C, Silva M, Prokop M, Schaefer-Prokop C, Revel MP. The radiologist's role in lung cancer screening. Transl Lung Cancer Res 2021; 10:2356-2367. [PMID: 34164283 PMCID: PMC8182709 DOI: 10.21037/tlcr-20-924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lung cancer is still the deadliest cancer in men and women worldwide. This high mortality is related to diagnosis in advanced stages, when curative treatment is no longer an option. Large randomized controlled trials have shown that lung cancer screening (LCS) with low-dose computed tomography (CT) can detect lung cancers at earlier stages and reduce lung cancer-specific mortality. The recent publication of the significant reduction of cancer-related mortality by 26% in the Dutch-Belgian NELSON LCS trial has increased the likelihood that implementation of LCS in Europe will move forward. Radiologists are important stakeholders in numerous aspects of the LCS pathway. Their role goes beyond nodule detection and nodule management. Being part of a multidisciplinary team, radiologists are key players in numerous aspects of implementation of a high quality LCS program. In this non-systematic review we discuss the multifaceted role of radiologists in LCS.
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Affiliation(s)
- Annemiek Snoeckx
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Caro Franck
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Marie-Pierre Revel
- Department of Radiology, Cochin Hospital, APHP Centre, Université de Paris, Paris, France
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22
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de Vos BD, Lessmann N, de Jong PA, Išgum I. Deep Learning-Quantified Calcium Scores for Automatic Cardiovascular Mortality Prediction at Lung Screening Low-Dose CT. Radiol Cardiothorac Imaging 2021; 3:e190219. [PMID: 33969304 DOI: 10.1148/ryct.2021190219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/05/2021] [Accepted: 01/20/2021] [Indexed: 01/06/2023]
Abstract
Purpose To examine the prognostic value of location-specific arterial calcification quantities at lung screening low-dose CT for the prediction of cardiovascular disease (CVD) mortality. Materials and Methods This retrospective study included 5564 participants who underwent low-dose CT from the National Lung Screening Trial between August 2002 and April 2004, who were followed until December 2009. A deep learning network was trained to quantify six types of vascular calcification: thoracic aorta calcification (TAC); aortic and mitral valve calcification; and coronary artery calcification (CAC) of the left main, the left anterior descending, and the right coronary artery. TAC and CAC were determined in six evenly distributed slabs spatially aligned among chest CT images. CVD mortality prediction was performed with multivariable logistic regression using least absolute shrinkage and selection operator. The methods were compared with semiautomatic baseline prediction using self-reported participant characteristics, such as age, history of smoking, and history of illness. Statistical significance between the prediction models was tested using the nonparametric DeLong test. Results The prediction model was trained with data from 4451 participants (median age, 61 years; 37.9% women) and then tested on data from 1113 participants (median age, 61 years; 37.9% women). The prediction model using calcium scores achieved a C statistic of 0.74 (95% CI: 0.69, 0.79), and it outperformed the baseline model using only participant characteristics (C statistic, 0.69; P = .049). Best results were obtained when combining all variables (C statistic, 0.76; P < .001). Conclusion Five-year CVD mortality prediction using automatically extracted image-based features is feasible at lung screening low-dose CT.© RSNA, 2021.
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Affiliation(s)
- Bob D de Vos
- Department of Biomedical Engineering and Physics (B.D.d.V., I.I.), Cardiovascular Institute (B.D.d.V., I.I.), and Department of Radiology and Nuclear Medicine (I.I.), Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, the Netherlands; and Image Sciences Institute (B.D.d.V., N.L., I.I.) and Department of Radiology (P.A.d.J., I.I.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nikolas Lessmann
- Department of Biomedical Engineering and Physics (B.D.d.V., I.I.), Cardiovascular Institute (B.D.d.V., I.I.), and Department of Radiology and Nuclear Medicine (I.I.), Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, the Netherlands; and Image Sciences Institute (B.D.d.V., N.L., I.I.) and Department of Radiology (P.A.d.J., I.I.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pim A de Jong
- Department of Biomedical Engineering and Physics (B.D.d.V., I.I.), Cardiovascular Institute (B.D.d.V., I.I.), and Department of Radiology and Nuclear Medicine (I.I.), Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, the Netherlands; and Image Sciences Institute (B.D.d.V., N.L., I.I.) and Department of Radiology (P.A.d.J., I.I.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ivana Išgum
- Department of Biomedical Engineering and Physics (B.D.d.V., I.I.), Cardiovascular Institute (B.D.d.V., I.I.), and Department of Radiology and Nuclear Medicine (I.I.), Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, the Netherlands; and Image Sciences Institute (B.D.d.V., N.L., I.I.) and Department of Radiology (P.A.d.J., I.I.), University Medical Center Utrecht, Utrecht, the Netherlands
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23
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Shipe ME, Maiga AW, Deppen SA, Edwards GC, Marmor HN, Pinkerman R, Smith GT, Lio E, Wright JL, Shah C, Nesbitt JC, Grogan EL. Preoperative coronary artery calcifications in veterans predict higher all-cause mortality in early-stage lung cancer: a cohort study. J Thorac Dis 2021; 13:1427-1433. [PMID: 33841935 PMCID: PMC8024847 DOI: 10.21037/jtd-20-2102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Lung cancer patients often have comorbidities that may impact survival. This observational cohort study examines whether coronary artery calcifications (CAC) impact all-cause mortality in patients with resected stage I non-small cell lung cancer (NSCLC). Methods Veterans with stage I NSCLC who underwent resection at a single institution between 2005 and 2018 were selected from a prospectively collected database. Radiologists blinded to patient outcomes graded CAC severity (mild, moderate, or severe) in preoperative CT scans using a visual estimation scoring system. Inter-rater reliability was calculated using the kappa statistic. All-cause mortality was the primary outcome. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to compare time-to-death by varying CAC. Results The Veteran patients (n=195) were predominantly older (median age of 67) male (98%) smokers (96%). The majority (68%) were pathologic stage IA. Overall, 12% of patients had no CAC, 27% mild, 26% moderate, and 36% severe CAC. Median unadjusted survival was 8.8 years for patients with absent or mild CAC versus 6.3 years for moderate and 5.9 years for severe CAC (P=0.01). The adjusted hazard ratio for moderate CAC was 1.44 (95% CI, 0.85–2.46) and for severe CAC was 1.73 (95% CI, 1.03–2.88; P for trend <0.05). Conclusions The presence of severe CAC on preoperative imaging significantly impacted the all-cause survival of patients undergoing resection for stage I NSCLC. This impact on mortality should be taken into consideration by multidisciplinary teams when making treatment plans for patients with early-stage disease.
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Affiliation(s)
- Maren E Shipe
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amelia W Maiga
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Surgery, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Stephen A Deppen
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Surgery, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Gretchen C Edwards
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Surgery, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Hannah N Marmor
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rhonda Pinkerman
- Department of Surgery, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Gary T Smith
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Radiology, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Elizabeth Lio
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Johnny L Wright
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chirayu Shah
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Radiology, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Jonathan C Nesbitt
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Surgery, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Eric L Grogan
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Surgery, Tennessee Valley Healthcare System, Nashville, TN, USA
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24
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Tailor TD, Chiles C, Yeboah J, Rivera MP, Tong BC, Schwartz FR, Benefield T, Lane LM, Stashko I, Thomas SM, Henderson LM. Cardiovascular Risk in the Lung Cancer Screening Population: A Multicenter Study Evaluating the Association Between Coronary Artery Calcification and Preventive Statin Prescription. J Am Coll Radiol 2021; 18:1258-1266. [PMID: 33640340 DOI: 10.1016/j.jacr.2021.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Coronary artery calcification (CAC) is a marker of atherosclerotic cardiovascular disease (ASCVD), the leading cause of death in individuals receiving lung cancer screening (LCS) with low-dose CT. Our purpose was to determine the proportion of the LCS population eligible for primary ASCVD preventive statin therapy by American College of Cardiology/American Heart Association guidelines, assess statin prescription rates among statin-eligible individuals, and determine associations of CAC on downstream statin prescribing within 90 days of LCS. METHODS Individuals receiving LCS between January 1, 2016, and December 31, 2018, across three centers were retrospectively enrolled. Statin eligibility in individuals without pre-existing ASCVD was determined by 2013 American College of Cardiology/American Heart Association guidelines: (1) low-density lipoprotein ≥190 mg/dL, (2) diabetes, or (3) ASCVD risk score ≥7.5%. CAC presence and severity (mild, moderate, heavy) were extracted from LCS reports. Variation in statin prescription rates and associations between CAC and statin prescription were determined using mixed-effects logistic regression. RESULTS Of 5,495 individuals receiving LCS, 31.4% (1,724 of 5,495) had pre-existing ASCVD. Of the remaining 3,771 individuals, 73.6% were statin eligible (2,777 of 3,771). However, most lacked statin prescription (60.5%, 1,681 of 2,777). CAC was associated with downstream statin prescribing (adjusted odds ratio = 2.60, 95% confidence interval: 1.12-6.02), with a higher likelihood of statin prescribing with increasing CAC severity (adjusted odds ratio = 2.21, 95% confidence interval: 1.35-3.60). CONCLUSION Although most of the LCS population is eligible for guideline-directed statin therapy, statins are underprescribed in this group. Radiologist reporting of CAC at LCS reflects a potential opportunity to raise awareness of ASCVD risk and improve preventive statin prescribing.
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Affiliation(s)
- Tina D Tailor
- Fellowship Director of Cardiothoracic Radiology, Research Director, Duke Lung Cancer Screening Program, Department of Radiology, Duke University Medical Center, Durham, North Carolina.
| | - Caroline Chiles
- Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest, North Carolina
| | - Joseph Yeboah
- Department of Cardiology, Wake Forest Baptist Medical Center, Wake Forest, North Carolina
| | - M Patricia Rivera
- Medical Director, Pulmonary Function Test and Bronchoscopy Services; Service Chief, Pulmonary Inpatient Service, Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine; Director, Lung Cancer Screening Program, University of North Carolina School of Medicine., Chapel Hill, North Carolina
| | - Betty C Tong
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Clinical Director, Lung Cancer Screening Program, Duke University Health System, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Fides R Schwartz
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Thad Benefield
- Department of Radiology, University of North Carolina School of Medicine., Chapel Hill, North Carolina
| | - Lindsay M Lane
- Department of Radiology, University of North Carolina School of Medicine., Chapel Hill, North Carolina
| | - Ilona Stashko
- Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Samantha M Thomas
- Manager, Duke Cancer Institute (DCI) Biostatistics Shared Resource and Internship Director, Biostatistics Core Training and Internship Program, Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina
| | - Louise M Henderson
- Director Epidemiology Research Team, Director Carolina Mammography Registry; Co-Lead, Cancer Epidemiology Program at Lineberger Comprehensive Cancer Center; Department of Radiology, University of North Carolina School of Medicine., Chapel Hill, North Carolina
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25
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Machine Learning and Deep Neural Network Applications in the Thorax: Pulmonary Embolism, Chronic Thromboembolic Pulmonary Hypertension, Aorta, and Chronic Obstructive Pulmonary Disease. J Thorac Imaging 2021; 35 Suppl 1:S40-S48. [PMID: 32271281 DOI: 10.1097/rti.0000000000000492] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The radiologic community is rapidly integrating a revolution that has not fully entered daily practice. It necessitates a close collaboration between computer scientists and radiologists to move from concepts to practical applications. This article reviews the current littérature on machine learning and deep neural network applications in the field of pulmonary embolism, chronic thromboembolic pulmonary hypertension, aorta, and chronic obstructive pulmonary disease.
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26
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Zeleznik R, Foldyna B, Eslami P, Weiss J, Alexander I, Taron J, Parmar C, Alvi RM, Banerji D, Uno M, Kikuchi Y, Karady J, Zhang L, Scholtz JE, Mayrhofer T, Lyass A, Mahoney TF, Massaro JM, Vasan RS, Douglas PS, Hoffmann U, Lu MT, Aerts HJWL. Deep convolutional neural networks to predict cardiovascular risk from computed tomography. Nat Commun 2021; 12:715. [PMID: 33514711 PMCID: PMC7846726 DOI: 10.1038/s41467-021-20966-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022] Open
Abstract
Coronary artery calcium is an accurate predictor of cardiovascular events. While it is visible on all computed tomography (CT) scans of the chest, this information is not routinely quantified as it requires expertise, time, and specialized equipment. Here, we show a robust and time-efficient deep learning system to automatically quantify coronary calcium on routine cardiac-gated and non-gated CT. As we evaluate in 20,084 individuals from distinct asymptomatic (Framingham Heart Study, NLST) and stable and acute chest pain (PROMISE, ROMICAT-II) cohorts, the automated score is a strong predictor of cardiovascular events, independent of risk factors (multivariable-adjusted hazard ratios up to 4.3), shows high correlation with manual quantification, and robust test-retest reliability. Our results demonstrate the clinical value of a deep learning system for the automated prediction of cardiovascular events. Implementation into clinical practice would address the unmet need of automating proven imaging biomarkers to guide management and improve population health.
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Affiliation(s)
- Roman Zeleznik
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Borek Foldyna
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Parastou Eslami
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jakob Weiss
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Ivanov Alexander
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jana Taron
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Chintan Parmar
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Raza M Alvi
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dahlia Banerji
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mio Uno
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yasuka Kikuchi
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Cause of Death Investigation, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Julia Karady
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Lili Zhang
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jan-Erik Scholtz
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas Mayrhofer
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Asya Lyass
- Department of Mathematics and Statistics, Boston University, Boston, MA, USA
| | - Taylor F Mahoney
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Joseph M Massaro
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Ramachandran S Vasan
- National Heart, Lung, and Blood Institute and Boston University, Framingham Heart Study, Framingham, MA, USA
- Departments of Cardiology and Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Pamela S Douglas
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC, USA
| | - Udo Hoffmann
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael T Lu
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hugo J W L Aerts
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA.
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
- Department of Radiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
- Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, The Netherlands.
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Hain E, Barat M, Da Costa C, Dautry R, Baillard C, Bonnet S, Dousset B, Soyer P, Dohan A, Fuks D, Gaujoux S. Preoperative assessment of patient comorbidities before left colectomy: Comparison between ASA performance status scale and a new computed tomography physical status score. Diagn Interv Imaging 2020; 102:313-319. [PMID: 33257202 DOI: 10.1016/j.diii.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare a newly developed preoperative computed tomography physical status (CT-PS) score with the American Society of Anesthesiology performance status (ASA-PS) scale in the assessment of patient preoperative health status and stratification of perioperative risk before left colectomy. MATERIALS AND METHODS Preoperative chest-abdomen-pelvis CT examinations of patients who were scheduled to undergo elective laparoscopic left colonic resection for cancer in two centers were reviewed by two radiologists blinded to clinical data for the presence of several key imaging features in order to assess general, cardiac, pulmonary, abdominal, renal, vascular and musculoskeletal status. CT examinations of patients from center 1 were used to build a CT-PS score to predict ASA-PS≥III. CT-PS score was further validated using an external cohort of patients from center 2. RESULTS During a 2-year period, 117 consecutive patients (63 men, 54 women; mean age, 65±13 [SD] years; age range: 53-90 years) who underwent laparoscopic left colectomy for cancer in center 1 (66 patients, building cohort) and center 2 (51 patients, validation cohort) were retrospectively included. Ninety-one percent of patients were ASA-PS 1-2. Overall postoperative morbidity was 23% and severe morbidity 12%. The area under the receiver operating characteristic curve of CT-PS score was 0.968 (95% CI: 0.901-1.000) in the building cohort and 0.828 (95% CI: 0.693-0.963) in the validation cohort. The optimal thresholds yielded 87% (95% CI: 83-91%) sensitivity and 100% (95% CI: 91-100%) specificity in the building cohort and 75% (95% CI: 69-81%) sensitivity and 83% (95% CI: 77-88%) specificity in the validation cohort for the prediction of ASA-PS. CONCLUSION Preoperative chest-abdomen-pelvis CT thoroughly and wisely read is highly accurate to differentiate patients with ASA-PS I/II from those with ASA-PS III/IV before left colectomy.
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Affiliation(s)
- Elisabeth Hain
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France
| | - Maxime Barat
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Radiology, Cochin hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Inserm U1016, CNRS UMR 8104, Institut Cochin, 75014 Paris, France.
| | - Carla Da Costa
- Department of Radiology, Cochin hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Raphael Dautry
- Department of Radiology, Cochin hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Christophe Baillard
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Anesthesiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Stéphane Bonnet
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Monsouris, 75013 Paris, France
| | - Bertrand Dousset
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France
| | - Philippe Soyer
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Radiology, Cochin hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Anthony Dohan
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Radiology, Cochin hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - David Fuks
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Monsouris, 75013 Paris, France
| | - Sébastien Gaujoux
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France
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Waltz J, Kocher M, Kahn J, Dirr M, Burt JR. The Future of Concurrent Automated Coronary Artery Calcium Scoring on Screening Low-Dose Computed Tomography. Cureus 2020; 12:e8574. [PMID: 32670710 PMCID: PMC7358941 DOI: 10.7759/cureus.8574] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/11/2020] [Indexed: 12/19/2022] Open
Abstract
Low-dose computed tomography (LDCT) has been extensively validated for lung cancer screening in selected patient populations. Additionally, the use of gated cardiac CT to assess coronary artery calcium (CAC) burden has been validated to determine a patient's risk for major cardiovascular adverse events. This is typically performed by calculating an Agatston score based on density and overall burden of calcified plaque within the coronary arteries. Patients that qualify for LDCT for lung cancer screening commonly share major risk factors for coronary artery disease and would frequently benefit from an additional gated cardiac CT for the assessment of CAC. Given the widespread use of LDCT for lung cancer screening, we evaluated current literature regarding the use of non-gated chest CT, specifically LDCT, for the detection and grading of coronary artery calcifications. Additionally, given the evolving and increasing use of artificial intelligence (AI) in the interpretation of radiologic studies, current literature for the use of AI in CAC assessment was reviewed. We reviewed primary scientific literature dating up to April 2020 using Pubmed and Google Scholar, with the search terms low dose CT, lung cancer screening, coronary artery calcium, EKG/cardiac gated CT, deep learning, machine learning, and AI. These publications were then independently evaluated by each member of our team. Overall, there was a consensus within these papers that LDCT for lung cancer screening plays a role in the evaluation of CAC. Most studies note the inherent problems with the evaluation of the density of coronary calcifications on LDCT to give an accurate numeric calcium or Agatston score. The current method of evaluating CAC on LDCT involves using a qualitative categorical system (none, mild, moderate, or severe). When performed by cardiac imaging experts, this method broadly correlates with traditional CAC score groups (0, 1 to 100, 101 to 400, and > 400). Furthermore, given the high sensitivity of a properly protocolled LDCT for coronary calcium, a negative study for CAC precludes the need for a dedicated gated CT assessment. However, qualitative methods are not as accurate or reproducible when performed by general radiologists. The implementation of AI in the LDCT screening process has the potential to give a quantifiable and reproducible numeric value to the calcium score, based on whole heart volume scoring of calcium. This more closely aligns with the Agatston score and serves as a better guide for treatment and risk assessment using current guidelines. We conclude that CAC should be assessed on all LDCT performed for lung cancer screening and that a qualitative categorical scoring system should be provided in the impression for each patient. Early studies involving AI for the assessment of CAC are promising, but more extensive studies are needed before a final recommendation for its use can be given. The implementation of an accurate, automated AI CAC assessment tool would improve radiologist compliance and ease of overall workflow. Ultimately, the potential end result would be improved turnaround time, better patient outcomes, and reduced healthcare costs by maximizing preventative care in this high-risk population.
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Affiliation(s)
- Jeffrey Waltz
- Diagnostic Radiology, Medical University of South Carolina, Charleston, USA
| | - Madison Kocher
- Radiology, Medical University of South Carolina, Charleston, USA
| | - Jacob Kahn
- Radiology, Medical University of South Carolina, Charleston, USA
| | - McKenzie Dirr
- Radiology, Medical University of South Carolina, Charleston, USA
| | - Jeremy R Burt
- Radiology, Medical University of South Carolina, Charleston, USA
- Cardiothoracic Imaging, Medical University of South Carolina, Charleston, USA
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van den Oever LB, Cornelissen L, Vonder M, Xia C, van Bolhuis JN, Vliegenthart R, Veldhuis RNJ, de Bock GH, Oudkerk M, van Ooijen PMA. Deep learning for automated exclusion of cardiac CT examinations negative for coronary artery calcium. Eur J Radiol 2020; 129:109114. [PMID: 32531719 DOI: 10.1016/j.ejrad.2020.109114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/20/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Coronary artery calcium (CAC) score has shown to be an accurate predictor of future cardiovascular events. Early detection by CAC scoring might reduce the number of deaths by cardiovascular disease (CVD). Automatically excluding scans which test negative for CAC could significantly reduce the workload of radiologists. We propose an algorithm that both excludes negative scans and segments the CAC. METHOD The training and internal validation data were collected from the ROBINSCA study. The external validation data were collected from the ImaLife study. Both contain annotated low-dose non-contrast cardiac CT scans. 60 scans of participants were used for training and 2 sets of 50 CT scans of participants without CAC and 50 CT scans of participants with an Agatston score between 10 and 20 were collected for both internal and external validation. The effect of dilated convolutional layers was tested by using 2 CNN architectures. We used the patient-level accuracy as metric for assessing the accuracy of our pipeline for detection of CAC and the Dice coefficient score as metric for the segmentation of CAC. RESULTS Of the 50 negative cases in the internal and external validation set, 62 % and 86 % were classified correctly, respectively. There were no false negative predictions. For the segmentation task, Dice Coefficient scores of 0.63 and 0.84 were achieved for the internal and external validation datasets, respectively. CONCLUSIONS Our algorithm excluded 86 % of all scans without CAC. Radiologists might need to spend less time on participants without CAC and could spend more time on participants that need their attention.
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Affiliation(s)
- Leonardus B van den Oever
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Ludo Cornelissen
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Marleen Vonder
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Congying Xia
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | | | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - Raymond N J Veldhuis
- University of Twente, Department of Electrical Engineering, Computer Science and Mathematics, Enschede, the Netherlands
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Matthijs Oudkerk
- University of Groningen, Faculty of Medical Sciences, Groningen, the Netherlands
| | - Peter M A van Ooijen
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands.
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Ruparel M, Quaife SL, Dickson JL, Horst C, Burke S, Taylor M, Ahmed A, Shaw P, Soo MJ, Nair A, Devaraj A, O'Dowd EL, Bhowmik A, Navani N, Sennett K, Duffy SW, Baldwin DR, Sofat R, Patel RS, Hingorani A, Janes SM. Evaluation of cardiovascular risk in a lung cancer screening cohort. Thorax 2019; 74:1140-1146. [PMID: 31558626 PMCID: PMC6902068 DOI: 10.1136/thoraxjnl-2018-212812] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 07/16/2019] [Accepted: 08/07/2019] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Lung cancer screening (LCS) by low-dose computed tomography (LDCT) offers an opportunity to impact both lung cancer and coronary heart disease mortality through detection of coronary artery calcification (CAC). Here, we explore the value of CAC and cardiovascular disease (CVD) risk assessment in LCS participants in the Lung Screen Uptake Trial (LSUT). METHODS In this cross-sectional study, current and ex-smokers aged 60-75 were invited to a 'lung health check'. Data collection included a CVD risk assessment enabling estimation of 10 year CVD risk using the QRISK2 score. Participants meeting the required lung cancer risk underwent an ungated, non-contrast LDCT. Descriptive data, bivariate associations and a multivariate analysis of predictors of statin use are presented. RESULTS Of 1005 individuals enrolled, 680 were included in the final analysis. 421 (61.9%) had CAC present and in 49 (7.2%), this was heavy. 668 (98%) of participants had a QRISK2≥10% and QRISK2 was positively associated with increasing CAC grade (OR 4.29 (CI 0.93 to 19.88) for QRISK2=10%-20% and 12.29 (CI 2.68 to 56.1) for QRISK2≥20% respectively). Of those who qualified for statin primary prevention (QRISK2≥10%), 56.8% did not report a history of statin use. In the multivariate analysis statin use was associated with age, body mass index and history of hypertension and diabetes. CONCLUSIONS LCS offers an important opportunity for instituting CVD risk assessment in all LCS participants irrespective of the presence of LDCT-detected CAC. Further studies are needed to determine whether CAC could enhance uptake and adherence to primary preventative strategies.
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Affiliation(s)
- Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Samantha L Quaife
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Jennifer L Dickson
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Carolyn Horst
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Stephen Burke
- Department of Radiology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Magali Taylor
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Asia Ahmed
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Penny Shaw
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - May-Jan Soo
- Department of Radiology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Arjun Nair
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, UK
| | - Emma Louise O'Dowd
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Angshu Bhowmik
- Respiratory Medicine, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
- Thoracic Department, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Stephen W Duffy
- Wolfson Institute of Preventive Medicine, Barts and London, London, UK
| | - David R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Reecha Sofat
- Institute of Cardiovascular Science, University College London, London, UK
| | - Riyaz S Patel
- Institute of Cardiovascular Science, University College London, London, UK
| | - Aroon Hingorani
- Institute of Cardiovascular Science, University College London, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
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The Association Between Marital Status, Coronary Computed Tomography Imaging Biomarkers, and Mortality in a Lung Cancer Screening Population. J Thorac Imaging 2019; 35:204-209. [PMID: 31651690 DOI: 10.1097/rti.0000000000000457] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to elucidate the impact of being unmarried on coronary computed tomography (CT) imaging biomarkers and mortality in a lung cancer screening population. MATERIALS AND METHODS In this retrospective case-control study, 5707 subjects (3777 married; mean age: 61.9±5.1 y and 1930 unmarried; mean age: 61.9±5.3 y) underwent low-dose CT as part of the National Lung Screening Trial (NLST). The median follow-up time was 6.5 (Q1-Q3: 5.6 to 6.9) years. Being unmarried was defined as never married, widowed, separated, or divorced. Being married was defined as married or living as married. Our primary endpoint was cardiovascular disease (CVD)-related death; our secondary endpoint was all-cause mortality. Coronary CT imaging biomarkers (calcium score, density, and volume) on low-dose chest CT scan were calculated using dedicated automatic software. Weighted Cox proportional-hazards regression was performed to examine the association between marital status and death. Kaplan-Meier curves were generated to visualize subject survival. RESULTS Being unmarried was significantly associated with an increased risk for CVD-related death (hazard ratio [HR]: 1.58; 95% confidence interval [CI]: 1.31-1.91) and all-cause mortality (HR: 1.39; 95% CI: 1.26-1.53), which remained significant even after adjusting for traditional cardiovascular risk factors (HR CVD death: 1.75; 1.44-2.12 and HR all-cause mortality: 1.58; 95% CI: 1.43-1.74) and coronary calcium score (HR CVD death: 1.58; 95% CI: 1.31-1.91 and HR all-cause mortality: 1.40; 95% CI: 1.27-1.54). CONCLUSIONS Being unmarried is associated with an increased CVD-related death and all-cause mortality mainly due to cardiovascular etiology. On the basis of this, marital status might be taken into consideration when assessing individuals' health status.
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Puliti D, Mascalchi M, Carozzi FM, Carrozzi L, Falaschi F, Paci E, Lopes Pegna A, Aquilini F, Barchielli A, Bartolucci M, Grazzini M, Picozzi G, Pistelli F, Rosselli A, Zappa M. Decreased cardiovascular mortality in the ITALUNG lung cancer screening trial: Analysis of underlying factors. Lung Cancer 2019; 138:72-78. [PMID: 31654837 DOI: 10.1016/j.lungcan.2019.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES In the ITALUNG lung cancer screening trial after 9.3 years of follow-up we observed an unexpected significant decrease of cardiovascular (CV) mortality in subjects invited for low-dose CT (LDCT) screening as compared to controls undergoing usual care. Herein we extended the mortality follow-up and analyzed the potential factors underlying such a decrease. MATERIALS AND METHODS The following factors were assessed in screenes and controls: burden of CV disease at baseline, changes in smoking habits, use of CV drugs and frequency of planned vascular procedures after randomisation. Moreover, in the screenes we evaluated inclusion of presence of coronary artery calcification (CAC) in the LDCT report form that was transmitted to the participant and his/her General Practitioner. RESULTS The 2-years extension of follow-up confirmed a significant decrease of CV mortality in the subjects of the active group compared to control subjects (15.6 vs 34.0 per 10,000; p = 0.001) that was not observed in the drops-out of the active group. None of the explaining factors we considered significantly differed between active and control group. However, the subjects of the active group with reported CAC experienced a not significantly lower CV mortality and showed a significantly higher use of CV drugs and frequency of planned vascular procedures than the control group. CONCLUSIONS LDCT screening for lung cancer offers the opportunity for detection of CAC that is an important CV risk factor. Although the underlying mechanisms are not clear, our results suggest that the inclusion of information about CAC presence in the LDCT report may represent a candidate factor to explain the decreased CV mortality observed in screened subjects of the ITALUNG trial, possibly resulting in intervention for patient care to prevent CV deaths. Further studies investigating whether prospective reporting and rating of CAC have independent impact on such interventions and CV mortality are worthy.
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Affiliation(s)
- Donella Puliti
- Clinical Epidemiology Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy.
| | - Mario Mascalchi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Italy.
| | - Francesca Maria Carozzi
- Regional Prevention Laboratory Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy.
| | - Laura Carrozzi
- Cardiothoracic and Vascular Department, University Hospital of Pisa, Italy; Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Italy.
| | - Fabio Falaschi
- Radiology Department, University Hospital of Pisa, Italy.
| | - Eugenio Paci
- Clinical Epidemiology Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy.
| | | | - Ferruccio Aquilini
- Cardiothoracic and Vascular Department, University Hospital of Pisa, Italy.
| | - Alessandro Barchielli
- Clinical Epidemiology Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy.
| | | | | | - Giulia Picozzi
- Radiodiagnostic Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy.
| | - Francesco Pistelli
- Cardiothoracic and Vascular Department, University Hospital of Pisa, Italy.
| | | | - Marco Zappa
- Clinical Epidemiology Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy.
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Leigh A, McEvoy JW, Garg P, Carr JJ, Sandfort V, Oelsner EC, Budoff M, Herrington D, Yeboah J. Coronary Artery Calcium Scores and Atherosclerotic Cardiovascular Disease Risk Stratification in Smokers. JACC Cardiovasc Imaging 2019; 12:852-861. [PMID: 29454784 PMCID: PMC6085167 DOI: 10.1016/j.jcmg.2017.12.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/21/2017] [Accepted: 12/23/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study assessed the utility of the pooled cohort equation (PCE) and/or coronary artery calcium (CAC) for atherosclerotic cardiovascular disease (ASCVD) risk assessment in smokers, especially those who were lung cancer screening eligible (LCSE). BACKGROUND The U.S. Preventive Services Task Force recommended and the Centers for Medicare & Medicaid Services currently pays for annual screening for lung cancer with low-dose computed tomography scans in a specified group of cigarette smokers. CAC can be obtained from these low-dose scans. The incremental utility of CAC for ASCVD risk stratification remains unclear in this high-risk group. METHODS Of 6,814 MESA (Multi-Ethnic Study of Atherosclerosis) participants, 3,356 (49.2% of total cohort) were smokers (2,476 former and 880 current), and 14.3% were LCSE. Kaplan-Meier, Cox proportional hazards, area under the curve, and net reclassification improvement (NRI) analyses were used to assess the association between PCE and/or CAC and incident ASCVD. Incident ASCVD was defined as coronary death, nonfatal myocardial infarction, or fatal or nonfatal stroke. RESULTS Smokers had a mean age of 62.1 years, 43.5% were female, and all had a mean of 23.0 pack-years of smoking. The LCSE sample had a mean age of 65.3 years, 39.1% were female, and all had a mean of 56.7 pack-years of smoking. After a mean of 11.1 years of follow-up 13.4% of all smokers and 20.8% of LCSE smokers had ASCVD events; 6.7% of all smokers and 14.2% of LCSE smokers with CAC = 0 had an ASCVD event during the follow-up. One SD increase in the PCE 10-year risk was associated with a 68% increase risk for ASCVD events in all smokers (hazard ratio: 1.68; 95% confidence interval: 1.57 to 1.80) and a 22% increase in risk for ASCVD events in the LCSE smokers (hazard ratio: 1.22; 95% confidence interval: 1.00 to 1.47). CAC was associated with increased ASCVD risk in all smokers and in LCSE smokers in all the Cox models. The C-statistic of the PCE for ASCVD was higher in all smokers compared with LCSE smokers (0.693 vs. 0.545). CAC significantly improved the C-statistics of the PCE in all smokers but not in LCSE smokers. The event and nonevent net reclassification improvements for all smokers and LCSE smokers were 0.018 and -0.126 versus 0.16 and -0.196, respectively. CONCLUSIONS In this well-characterized, multiethnic U.S. cohort, CAC was predictive of ASCVD in all smokers and in LCSE smokers but modestly improved discrimination over and beyond the PCE. However, 6.7% of all smokers and 14.2% of LCSE smokers with CAC = 0 had an ASCVD event during follow-up.
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Affiliation(s)
- Adam Leigh
- Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - John W McEvoy
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Parveen Garg
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - J Jeffrey Carr
- Departments of Cardiology and Radiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Veit Sandfort
- Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Elizabeth C Oelsner
- Departments of Medicine and Epidemiology, Columbia University, New York, New York
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute at Harbor-University of California, Los Angeles, Torrance California
| | - David Herrington
- Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Joseph Yeboah
- Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston Salem, North Carolina.
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Early imaging biomarkers of lung cancer, COPD and coronary artery disease in the general population: rationale and design of the ImaLife (Imaging in Lifelines) Study. Eur J Epidemiol 2019; 35:75-86. [PMID: 31016436 PMCID: PMC7058676 DOI: 10.1007/s10654-019-00519-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/10/2019] [Indexed: 12/17/2022]
Abstract
Lung cancer, chronic obstructive pulmonary disease (COPD), and coronary artery disease (CAD) are expected to cause most deaths by 2050. State-of-the-art computed tomography (CT) allows early detection of lung cancer and simultaneous evaluation of imaging biomarkers for the early stages of COPD, based on pulmonary density and bronchial wall thickness, and of CAD, based on the coronary artery calcium score (CACS), at low radiation dose. To determine cut-off values for positive tests for elevated risk and presence of disease is one of the major tasks before considering implementation of CT screening in a general population. The ImaLife (Imaging in Lifelines) study, embedded in the Lifelines study, is designed to establish the reference values of the imaging biomarkers for the big three diseases in a well-defined general population aged 45 years and older. In total, 12,000 participants will undergo CACS and chest acquisitions with latest CT technology. The estimated percentage of individuals with lung nodules needing further workup is around 1–2%. Given the around 10% prevalence of COPD and CAD in the general population, the expected number of COPD and CAD is around 1000 each. So far, nearly 4000 participants have been included. The ImaLife study will allow differentiation between normal aging of the pulmonary and cardiovascular system and early stages of the big three diseases based on low-dose CT imaging. This information can be finally integrated into personalized precision health strategies in the general population.
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Garg PK, Jorgensen NW, McClelland RL, Leigh JA, Greenland P, Blaha MJ, Yoon AJ, Wong ND, Yeboah J, Budoff MJ. Use of coronary artery calcium testing to improve coronary heart disease risk assessment in a lung cancer screening population: The Multi-Ethnic Study of Atherosclerosis (MESA). J Cardiovasc Comput Tomogr 2018; 12:493-499. [PMID: 30297128 DOI: 10.1016/j.jcct.2018.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/19/2018] [Accepted: 10/01/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Assessment of coronary artery calcium (CAC) during lung cancer screening chest computed tomography (CT) represents an opportunity to identify asymptomatic individuals at increased coronary heart disease (CHD) risk. We determined the improvement in CHD risk prediction associated with the addition of CAC testing in a population recommended for lung cancer screening. METHODS We included 484 out of 6814 Multi-Ethnic Study of Atherosclerosis (MESA) participants without baseline cardiovascular disease who met U.S. Preventive Service Task Force CT lung cancer screening criteria and underwent gated CAC testing. 10 year-predicted CHD risks with and without CAC were calculated using a validated MESA-based risk model and categorized into low (<5%), intermediate (5%-10%), and high (≥10%). The net reclassification improvement (NRI) and change in Harrell's C-statistic by adding CAC to the risk model were subsequently determined. RESULTS Of 484 included participants (mean age = 65; 39% women; 32% black), 72 (15%) experienced CHD events over the course of follow-up (median = 12.5 years). Adding CAC to the MESA CHD risk model resulted in 17% more participants classified into the highest or lowest risk categories and a NRI of 0.26 (p = 0.001). The C-statistic improved from 0.538 to 0.611 (p = 0.01). CONCLUSIONS CHD event rates were high in this lung cancer screening eligible population. These individuals represent a high-risk population who merit consideration for CHD prevention measures regardless of CAC score. Although overall discrimination remained poor with inclusion of CAC scores, determining whether those reclassified to an even higher risk would benefit from more aggressive preventive measures may be important.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, United States.
| | - Neal W Jorgensen
- Department of Biostatistics, University of Washington, Seattle, WA, United States.
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, WA, United States.
| | - J Adam Leigh
- Division of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
| | - Michael J Blaha
- Divisions of Cardiology and Epidemiology, Johns Hopkins School of Medicine, Baltimore, MD, United States.
| | - Andrew J Yoon
- Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, United States.
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California at Irvine, Irvine, CA, United States.
| | - Joseph Yeboah
- Division of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, United States.
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Dorbala S, Ananthasubramaniam K, Armstrong IS, Chareonthaitawee P, DePuey EG, Einstein AJ, Gropler RJ, Holly TA, Mahmarian JJ, Park MA, Polk DM, Russell R, Slomka PJ, Thompson RC, Wells RG. Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging Guidelines: Instrumentation, Acquisition, Processing, and Interpretation. J Nucl Cardiol 2018; 25:1784-1846. [PMID: 29802599 DOI: 10.1007/s12350-018-1283-y] [Citation(s) in RCA: 212] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Sharmila Dorbala
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | - Andrew J Einstein
- Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | | | - Thomas A Holly
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John J Mahmarian
- Houston Methodist Hospital and Weill Cornell Medical College, Houston, TX, USA
| | | | - Donna M Polk
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | - R Glenn Wells
- University of Ottawa Heart Institute, Ottawa, Canada
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Fan R, Shi X, Qian Y, Wang Y, Fan L, Chen R, Xiao Y, Liu S. Optimized categorization algorithm of coronary artery calcification score on non-gated chest low-dose CT screening using iterative model reconstruction technique. Clin Imaging 2018; 52:287-291. [PMID: 30193187 DOI: 10.1016/j.clinimag.2018.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/16/2018] [Accepted: 08/22/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the optimized categorization algorithm of coronary artery calcification score (CACS) for more accurate risk assessment on non-gated chest low-dose CT (LDCT) screening using iterative model reconstruction (IMR) technique. METHODS We enrolled 102 patients who required coronary artery CTA examination and had coronary artery calcification (CAC) in this study. The CACS on non-gated LDCT and ECG-gated CT images were both measured by Agatston analysis software on Philips workstation. RESULTS According to the original algorithm (1-100, 100-400 and >400), the CACS measured by non-gated LDCT scan showed a good agreement with ECG-gated CT scan (weighted kappa value of 0.602, P < 0.05). Two ROC curves were drawn to evaluate the accuracy of CACS categorization. The cutoff values were 87.44 and 255.26 respectively. Based on the best diagnostic cutoff value, the CACS measured by the non-gated LDCT scan showed an excellent agreement with ECG-gated CT scan (weighted kappa value of 0.781, P < 0.05). CONCLUSIONS The CACS on non-gated LDCT may have been underestimated. We therefore developed an optimized categorization algorithm of non-gated CACS in this study.
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Affiliation(s)
- Rongrong Fan
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiaolei Shi
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yi Qian
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Yun Wang
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Li Fan
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Rutan Chen
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yi Xiao
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Shiyuan Liu
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Abstract
Lung cancer screening has been shown in the National Lung Screening Trial (NLST) to result in a statistically significant decrease in lung cancer specific mortality. Also within that trial there was shown to be a 7% decrease in all-cause mortality. While the reasons for this benefit are not entirely clear, it may relate to the detection and treatment of other important findings. Smokers not only have a higher risk of lung cancer, but also increased risk of atherosclerosis. The latter can be detected by the discovery of aortic and/or coronary artery calcium on unenhanced CT. As coronary artery calcium scoring can be used as a screening tool to detect asymptomatic coronary artery atherosclerosis, its detection on lung cancer screening exams has the potential to provide both a teachable moment and treatment aimed at the reduction of major coronary artery events and mortality. In this review we will discuss the use of coronary artery calcium scoring for the detection of atherosclerotic disease and its potential application to lung cancer screening populations.
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Affiliation(s)
- James G Ravenel
- Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - John W Nance
- Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC, USA
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Fan L, Fan K. Lung cancer screening CT-based coronary artery calcification in predicting cardiovascular events: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e10461. [PMID: 29768322 PMCID: PMC5976344 DOI: 10.1097/md.0000000000010461] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Coronary artery calcificition (CAC) is a well-established predictor of cardiovascular events (CVEs). We aimed to evaluate whether lung cancer screening computed tomography (CT)-based CAC score has a good cost-effectiveness for predicting CVEs in heavy smokers. METHODS A literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pubmed, EMBASE, and Cochrane library databases were systematically searched for relevant studies that investigated the association between lung cancer screening CT-based CAC and CVEs up to December 31, 2017. We selected fixed-effect model for analysis of data heterogeneity. Statistical analyses were performed by using Review Manager Version 5.3 for Windows. RESULTS Four randomized controlled trials with 5504 participants were included. Our results demonstrated that CVEs were significantly associated with the presence of CAC (relative risk [RR] 2.85, 95% confidence interval [CI] 2.02-4.02, P < .00001). Moreover, higher CAC score (defined as CAC score >400 or >1000) was associated with a significant increased CVE count (RR 3.47, 95% CI 2.65-4.53, P < .00001). However, the prevalence of CVEs was not different between male and female groups (RR 2.46, 95% CI 0.44-13.66, P = .30). CONCLUSION CAC Agatston score evaluated by lung cancer screening CT had potential in predicting the likelihood of CVEs in the early stage without sexual difference. Thus, it may guide clinicians to intervene those heavy smokers with increased risk of CVEs earlier by CAC score through lung cancer screening CT.
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Affiliation(s)
- Lili Fan
- Department of Lung Disease, Henan Traditional Chinese Medicine Hospital
| | - Kaikai Fan
- Department of Cardiac Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Malcolm KB, Dinwoodey DL, Cundiff MC, Regis SM, Kitts AKB, Wald C, Lynch ML, Al-Husami W, McKee AB, McKee BJ. Qualitative coronary artery calcium assessment on CT lung screening exam helps predict first cardiac events. J Thorac Dis 2018; 10:2740-2751. [PMID: 29997936 DOI: 10.21037/jtd.2018.04.76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Results A total of 1,513 individuals underwent CTLS. Downstream data, pre-test cardiac risk factors and CAC scores were available for 88.3% (1,336/1,513). The average length of follow-up was 2.64 (SD ±0.72) years. There were a total of 43 events, occurring in 1.55% (6/386) of patients with mild CAC, 3.24% (11/339) of patients with moderate CAC, and 8.90% (26/292) of patients with marked CAC. There were no events among patients with no reported CAC (0/319). Using multivariable logistic modeling, the increased odds of an initial cardiac event was 2.56 (95% CI, 1.76-3.92, P<0.001) for mild CAC, 6.57 (95% CI, 3.10-15.4, P<0.001) for moderate CAC, and 16.8 (95% CI, 5.46-60.3, P<0.001) for marked CAC, as compared to individuals with no CAC. Time to event analysis showed distinct differences among the four CAC categories (P<0.001). Conclusions Qualitative coronary artery calcification scoring of CTLS exams may provide a novel method to help select individuals at elevated risk for an initial cardiac event.
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Affiliation(s)
- Katherine B Malcolm
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA.,Department of Internal Medicine, University of California, San Francisco, CA, USA
| | - Danya L Dinwoodey
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Michael C Cundiff
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Shawn M Regis
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Andrea K Borondy Kitts
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Christoph Wald
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Miranda L Lynch
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Wael Al-Husami
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Andrea B McKee
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Brady J McKee
- Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
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Vonder M, Vliegenthart R, Kaatee MA, van der Aalst CM, van Ooijen PMA, de Bock GH, Gratama JW, Kuijpers D, de Koning HJ, Oudkerk M. High-pitch versus sequential mode for coronary calcium in individuals with a high heart rate: Potential for dose reduction. J Cardiovasc Comput Tomogr 2018; 12:298-304. [PMID: 29551663 DOI: 10.1016/j.jcct.2018.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/09/2018] [Accepted: 02/26/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND To determine the impact of high-pitch spiral acquisition on radiation dose and cardiovascular disease (CVD) risk stratification by coronary artery calcium (CAC) assessment with computed tomography in individuals with a high heart rate. METHODS Of the ROBINSCA trial, 1990 participants with regular rhythm and heart rates >65 beats per minute (bpm) were included. As reference, 390 participants with regular heart rates ≤65 bpm were used. All participants underwent prospectively electrocardiographically(ECG)-triggered imaging of the coronary arteries using dual source CT at 120 kVp, 80 ref mAs using both high-pitch spiral mode and sequential mode. Radiation dose, Agatston score, number of positive scores, as well as median absolute difference of the Agatston score were determined and participants were stratified into CVD risk categories. RESULTS A similar percentage of participants with low heart rates and high heart rates had a positive CAC score in data sets acquired in high-pitch spiral (low heart rate: 57.7%, high heart rate: 55.8%) and sequential mode (58.0%, 54.7%, p = n.s.). The median absolute difference in Agatston scores between acquisition modes was 14.2% and 9.2%, for the high and low heart rate groups, respectively. Excellent agreement for risk categorization between the two data acquisition modes was found for the high (κ = 0.927) and low (κ = 0.946) heart rate groups. Radiation dose was 48% lower for high-pitch spiral versus sequential acquisitions. CONCLUSION Radiation dose for the quantification of coronary calcium can be reduced by 48% when using the high-pitch spiral acquisition mode compared to the sequential mode in participants with a regular high heart rate. CVD risk stratification agreement between the two modes of data acquisition is excellent.
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Affiliation(s)
- Marleen Vonder
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands.
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands.
| | - Merel A Kaatee
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands.
| | | | - Peter M A van Ooijen
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands.
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands.
| | - Jan Willem Gratama
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands; Gelre Ziekenhuizen, Dept. of Radiology, Apeldoorn, The Netherlands.
| | - Dirkjan Kuijpers
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands; HMC-Bronovo, Dept. of Radiology, The Hague, The Netherlands.
| | | | - Matthijs Oudkerk
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands.
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Phillips WJ, Johnson C, Law A, Turek M, Small AR, Inacio JR, Dent S, Ruddy T, Beanlands RS, Chow BJW, Small GR. Reporting of coronary artery calcification on chest CT studies in breast cancer patients at high risk of cancer therapy related cardiac events. IJC HEART & VASCULATURE 2018; 18:12-16. [PMID: 29750180 PMCID: PMC5941242 DOI: 10.1016/j.ijcha.2018.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/03/2018] [Indexed: 11/25/2022]
Abstract
Background The identification of coronary artery calcification (CAC) detected coincidentally on chest CT exams could assist in cardiovascular risk assessment but may not be reported consistently on clinical studies. Cardiovascular risk factor stratification is important to predict short term cardiac events during cancer therapy and long term cardiac event free survival in cancer patients. We sought to determine the prevalence of CAC and clinical reporting rates in a cohort of cancer patients at high risk of cancer therapy related cardiac events. Methods 408 Breast cancer patients who were referred to a cardiac oncology clinic were screened. Inclusion criteria included having had a CT chest and the absence of known coronary disease. Among those screened 263 patients were included in the study. Results CAC was identified in 70 patients (26%). CAC was reported in 18% of studies. The reporting rates of CAC increased with the extent of coronary calcification (p < 0.01) and increased during the period of the study (p < 0.05). Conclusions CAC was commonly detected on chest CT studies in this observational study of breast cancer patients at high risk of cardiac oncology events. The presence of CAC was often not reported clinically but reporting rates have increased over time. Recent SCCT/STR guidelines recommend reporting the presence of CAC on routine chest CT scans in recognition of the importance of CAC as a predictor of cardiovascular events. Reporting of CAC on chest CTs may help to further risk stratify breast cancer patients and improve cardiovascular outcomes in this vulnerable population.
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Affiliation(s)
| | - Christopher Johnson
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Angeline Law
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Michele Turek
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Alex R Small
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Joao R Inacio
- Department of Radiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Susan Dent
- Department of Medicine (Oncology), Ottawa, Ontario, Canada
| | - Terrence Ruddy
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Rob S Beanlands
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Benjamin J W Chow
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Gary R Small
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
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Pakdaman MN, Rozanski A, Berman DS. Incidental coronary calcifications on routine chest CT: Clinical implications. Trends Cardiovasc Med 2017; 27:475-480. [DOI: 10.1016/j.tcm.2017.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 04/20/2017] [Accepted: 04/20/2017] [Indexed: 01/07/2023]
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Shao L, Yan AT, Lebovic G, Wong HH, Kirpalani A, Deva DP. Prognostic value of visually detected coronary artery calcification on unenhanced non-gated thoracic computed tomography for prediction of non-fatal myocardial infarction and all-cause mortality. J Cardiovasc Comput Tomogr 2017; 11:196-202. [PMID: 28411031 DOI: 10.1016/j.jcct.2017.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/16/2017] [Accepted: 03/26/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE To determine the prognostic value of visually detected coronary artery calcification (CAC) on unenhanced non-gated thoracic computed tomography (CT) for non-fatal myocardial infarction (MI) and all-cause mortality. METHODS This retrospective single-centre cohort study comprised of 410 consecutive patients aged 40-80 years without any known cardiovascular disease at baseline. CT images without electrocardiogram-gating were acquired for a variety of respiratory medicine indications. CAC was examined by a single reader blinded to clinical data and outcome, using 1) the Agatston coronary calcium score (CCS), 2) visual CAC and 3) number of visually calcified coronary arteries. RESULTS Visible CAC was identified in 201 (49.0%) of the 410 patients (60.5 ± 10.0 years old, 42.4% males). After a median follow up of 7.0 years, 39 patients (9.5%) experienced an event (death or non-fatal MI). After adjustment for cardiovascular risk factors, those with 1) higher CCS, 2) presence of visual CAC or 3) greater number of calcified coronary arteries by visual assessment, had an increased risk of adverse outcome (all p-value <0.05). There was no significant difference in c-statistics of the three methods of assessment (0.81, 0.80, 0.81 respectively), indicating that simple visual assessment of CAC may have a prognostic value similar to CCS. CONCLUSION Among patients with no known cardiovascular disease who underwent unenhanced non-gated CT for a pulmonary-related indication, visually detected CAC was a strong independent predictor of non-fatal MI and all-cause mortality.
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Affiliation(s)
- Lisa Shao
- University of Toronto, 27, King's College Circle, Toronto, Ontario M5S 1A1, Canada
| | - Andrew T Yan
- Division of Cardiology, St. Michael's Hospital, University of Toronto, 30, Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Gerald Lebovic
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, 30, Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Harvey H Wong
- Division of Respirology, St. Michael's Hospital, University of Toronto, 30, Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Anish Kirpalani
- Department of Medical Imaging, St. Michael's Hospital, University of Toronto, 30, Bond Street, Toronto, Ontario M5B 1W8, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario M5B 1T8, Canada
| | - Djeven P Deva
- Department of Medical Imaging, St. Michael's Hospital, University of Toronto, 30, Bond Street, Toronto, Ontario M5B 1W8, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario M5B 1T8, Canada.
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Silva M, Pastorino U, Sverzellati N. Lung cancer screening with low-dose CT in Europe: strength and weakness of diverse independent screening trials. Clin Radiol 2017; 72:389-400. [PMID: 28168954 DOI: 10.1016/j.crad.2016.12.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/27/2016] [Accepted: 12/29/2016] [Indexed: 12/17/2022]
Abstract
A North American trial reported a significant reduction of lung cancer mortality and overall mortality as a result of annual screening using low-dose computed tomography (LDCT). European trials prospectively tested a variety of possible screening strategies. The main topics of current discussion regarding the optimal screening strategy are pre-test selection of the high-risk population, interval length of LDCT rounds, definition of positive finding, and post-test apportioning of lung cancer risk based on LDCT findings. Despite the current lack of statistical evidence regarding mortality reduction, the European independent diverse strategies offer a multi-perspective view on screening complexity, with remarkable indications for improvements in cost-effectiveness and harm-benefit balance. The UKLS trial reported the advantage of a comprehensive and simple risk model for selection of patients with 5% risk of lung cancer in 5 years. Subjective risk prediction by biological sampling is under investigation. The MILD trial reported equal efficiency for biennial and annual screening rounds, with a significant reduction in the total number of LDCT examinations. The NELSON trial introduced volumetric quantification of nodules at baseline and volume-doubling time (VDT) for assessment of progression. Post-test risk refinement based on LDCT findings (qualitative or quantitative) is under investigation. Smoking cessation remains the most appropriate strategy for mortality reduction, and it must therefore remain an integral component of any lung cancer screening programme.
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Affiliation(s)
- M Silva
- Section of Radiology, Department of Surgical Sciences, University Hospital of Parma, Parma, Italy
| | - U Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - N Sverzellati
- Section of Radiology, Department of Surgical Sciences, University Hospital of Parma, Parma, Italy.
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Sathiyakumar V, Blumenthal RS, Nasir K, Martin SS. Addressing Knowledge Gaps in the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: a Review of Recent Coronary Artery Calcium Literature. Curr Atheroscler Rep 2017; 19:7. [DOI: 10.1007/s11883-017-0643-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Baldwin D, Callister M. What is the Optimum Screening Strategy for the Early Detection of Lung Cancer. Clin Oncol (R Coll Radiol) 2016; 28:672-681. [DOI: 10.1016/j.clon.2016.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/04/2016] [Accepted: 07/11/2016] [Indexed: 01/26/2023]
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National trends among radiologists in reporting coronary artery calcium in non-gated chest computed tomography. Int J Cardiovasc Imaging 2016; 33:251-257. [DOI: 10.1007/s10554-016-0986-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 09/23/2016] [Indexed: 01/08/2023]
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Makinson A, Le Moing V, Reynes J, Ferry T, Lavole A, Poizot-Martin I, Pujol JL, Spano JP, Milleron B. Lung Cancer Screening with Chest Computed Tomography in People Living with HIV: A Review by the Multidisciplinary CANCERVIH Working Group. J Thorac Oncol 2016; 11:1644-52. [PMID: 27449803 DOI: 10.1016/j.jtho.2016.06.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/16/2016] [Accepted: 06/27/2016] [Indexed: 01/16/2023]
Abstract
A shift in mortality and morbidity has been observed in people living with human immunodeficiency virus (PLWHIV) from acquired immunodeficiency syndrome (AIDS) to non-AIDS diseases. Lung cancer has the highest incidence rates among all the non-AIDS-defining malignancies and is associated with mortality rates that exceed those of other cancers. Strategies to increase lung cancer survival in PLWHIV are needed. Lung cancer screening with chest LDCT has been shown to be efficient in the general population at risk. The objective of this review is to discuss lung cancer screening with chest computed tomography in PLWHIV. Lung cancer screening in PLWHIV is feasible. Whether PLWHIV could benefit from an age threshold for screening that is earlier than the minimum age of 55 years usually required in the general population still needs further investigation. Studies evaluating smoking cessation programs and how they could be articulated with lung cancer screening programs are also needed in PLWHIV.
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Affiliation(s)
- Alain Makinson
- Department of Infectious and Tropical Diseases, U1175-National Institute of Health and Medical Research/Mixt International Department 233, Development Research Institute, University Montpellier, Montpellier, France.
| | - Vincent Le Moing
- Department of Infectious and Tropical Diseases, U1175-National Institute of Health and Medical Research/Mixt International Department 233, Development Research Institute, University Montpellier, Montpellier, France
| | - Jacques Reynes
- Department of Infectious and Tropical Diseases, U1175-National Institute of Health and Medical Research/Mixt International Department 233, Development Research Institute, University Montpellier, Montpellier, France
| | - Tristan Ferry
- Infectious and Tropical Disease Unit, University Hospital de la Croix Rousse, Lyon, France
| | - Armelle Lavole
- Department of Pneumology and Reanimation, Hôpital Tenon, Public Assistance-Parisian Hospitals, and Faculté de Médecine Pierre and Marie Curie, University Paris VI, Paris, France
| | - Isabelle Poizot-Martin
- Clinical Immunohaematology Service, University Aix-Marseille, Public Assistance-Hospitals of Marseille Sainte-Marguerite, National Institute of Health and Medical Research, U912 (Economical and Social Sciences of Health and Treatment of Medical Information), Marseille, France
| | - Jean-Louis Pujol
- Thoracic Oncology Unit, University Hospital Montpellier, Montpellier, French Cooperative Thoracic Intergroup, Paris, France
| | - Jean-Philippe Spano
- Department of Medical Oncology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Public Assistance-Parisian Hospitals, National Institute of Health and Medical Research, Mixt Research Department_S 1136, Institute Pierre Louis Epidemiology and of Public Health, Sorbonne University, University Pierre Marie Curie University Paris 06, Paris, France
| | - Bernard Milleron
- Respiratory Disease Department, Tenon Hospital APHP, Paris VI University, French Cooperative Thoracic Intergroup, Paris, France
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Pelandre G, Marchiori E, Nacif MS. Do we have sufficient data to use nongated CT for cardiovascular risk stratification? J Cardiovasc Comput Tomogr 2015; 9:e5. [PMID: 26679549 DOI: 10.1016/j.jcct.2015.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/15/2015] [Accepted: 07/07/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Gustavo Pelandre
- Department of Radiology, Faculty of Medicine, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil.
| | - Edson Marchiori
- Department of Radiology, Faculty of Medicine, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil
| | - Marcelo Souto Nacif
- Department of Radiology, Faculty of Medicine, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil; Department of Radiology, Faculty of Medicine, Fluminense Federal University, Niterói, RJ, Brazil
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