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Patel V, Patel J, Gan J, Rahiminejad M, Preston R, Mak SM, Benedetti G. Reporting of coronary artery calcification on chest CT studies in patients with interstitial lung disease. Clin Radiol 2024; 79:e532-e538. [PMID: 38242805 DOI: 10.1016/j.crad.2023.11.028] [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: 04/26/2023] [Revised: 11/03/2023] [Accepted: 11/29/2023] [Indexed: 01/21/2024]
Abstract
AIM To evaluate the prevalence of coronary artery calcification (CAC) on non-contrast computed tomography (CT) of the thorax in patients with interstitial lung disease (ILD), assess consistency of CAC reporting and assess incidence of subsequent cardiac events. MATERIALS AND METHODS Patients with known interstitial lung disease who underwent a CT thorax over a 2-year period were retrospectively reviewed. Presence of CAC was assessed using a visual scale for CAC reporting and graded as mild, moderate, or severe by two cardiothoracic radiologists. CT reports were reviewed to determine if presence of CAC had been described. Electronic medical records were reviewed for any subsequent cardiothoracic events from the date of the CT thorax to present. RESULTS 254 patients were included in the analysis (54.7% men; mean age 59.9 yo). 43.7% had CAC on their CT thorax; however, in 87.3% of those, reports did not comment on its presence. 8 patients had cardiac events; 7 of them had CAC on CT although only in 1 case this was reported. Global CAC and LAD CAC Patients with cardiac events had a significantly higher global CAC (p=0.016) and LAD CAC (p=0.048) when compared to patients without. CONCLUSION We demonstrated a high prevalence of CAC in ILD patients and its significant association with adverse cardiac events. Unfortunately, CAC on CT thorax is still largely unreported. As per recent BSCI/BSCCT and BSTI guidelines, reporting of CAC should become part of routine practice, as may prompt prevention and impact on patients outcome.
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Affiliation(s)
- V Patel
- The Royal Marsden, Fulham Road, London, SW3 6JJ, UK
| | - J Patel
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - J Gan
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - M Rahiminejad
- National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - R Preston
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - S M Mak
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - G Benedetti
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
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Kim A, Kang D, Choi SC, Cho J, Sinn DH, Gwak GY. Steatotic liver disease and its newly proposed sub-classifications correlate with progression of the coronary artery calcium score. PLoS One 2024; 19:e0301126. [PMID: 38530817 DOI: 10.1371/journal.pone.0301126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND & AIMS A new nomenclature, Steatotic Liver Disease (SLD), has been proposed by consensus with sub-classifications and requires evidence-based validation. We assessed whether the presence and severity of SLD, as well as its sub-classifications, are associated with the progression of coronary atherosclerosis. METHODS This longitudinal cohort study included 13,811 adults who participated in repeated regular health screening examinations between January 1, 2004 and December 31, 2021 that included assessments of their coronary artery calcium (CAC) scores. SLD was defined using abdominal ultrasonography and classified as metabolic dysfunction associated steatotic liver disease (MASLD), MASLD with increased alcohol intake (MetALD), and cryptogenic SLD. SLD severity was assessed using fibrosis-4 (FIB-4) scores. The progression of CAC scores was measured using multidetector CT scans. RESULTS The average duration of follow-up was 5.8 years. During follow-up, the annual rate of CAC progression in participants with and without SLD was 18% (95% CI 17%-19%) and 14% (95% CI 13%-14%) (p < 0.01), respectively. The multivariable ratios of progression rates when we compared participants with cryptogenic SLD, MASLD, or MetALD with those without SLD were 0.98 (95% CI 0.95-1.01), 1.03 (95% CI 1.03-1.04), and 1.07 (95% CI 1.04-1.09), respectively. The multivariable ratios of progression rates when we compared participants with SLD with FIB-4 score <1.3 and SLD with FIB-4 score ≥1.3 with those without SLD were 1.03 (95% CI 1.02-1.04), and 1.05 (95% CI 1.04-1.06), respectively. CONCLUSIONS SLD was associated with a higher risk of coronary atherosclerosis, and the risk differed by sub-classifications and severity. These findings suggest that the newly proposed definition has clinical relevance in terms of stratifying cardiovascular disease risk.
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Affiliation(s)
- Aryoung Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Sung Chul Choi
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
- Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, United States of America
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Geum-Youn Gwak
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Ilgar M, Dağ N, Türkoğlu C. Importance of incidental coronary artery calcification in early diagnosis of obstructive coronary artery disease. Pol J Radiol 2023; 88:e338-e342. [PMID: 37576378 PMCID: PMC10415811 DOI: 10.5114/pjr.2023.130198] [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: 03/17/2023] [Accepted: 06/15/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose The early diagnosis of coronary artery disease (CAD) enables early intervention for the modifiable risk factors of the disease. Coronary artery calcification (CAC) detected incidentally on standard noncontrast chest computed tomography (CT) provides an opportunity for the early diagnosis of CAD. The purpose of this study was to demonstrate that CAC should be routinely reported when evaluating thoracic CT examinations. Routine reporting of CAC will contribute to the early diagnosis of CAD. Material and methods The present study included 279 patients who underwent conventional coronary angiography (CAG) and CT within one month before undergoing CAG. The CAG and CT images of the patients were evaluated retrospectively. The levels of coronary artery stenosis were determined in reference to the CAG images. The CAC scores of the patients were calculated using the Weston method based on their chest CT images. Results The mean age of the patients was 63.2 ± 11.5 (range, 41-93) years, and 172 (61.6%) of them were men. The Weston score (WS) was 0 in 18.9% of the patients with obstructive CAD (OCAD), whereas it was ≥ 7 in 27.9% of patients. All patients with a WS of ≥ 7 had OCAD. All patients without luminal stenosis or < 50% stenosis had a WS of < 7. Conclusions The CAC score is useful for the diagnosis of CAD and OCAD. If CAC is identified on standard noncontrast chest CT, it should be scored and reported accordingly. The WS can be used for CAC scoring.
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Affiliation(s)
- Mehtap Ilgar
- Malatya Training and Research Hospital, Malatya, Turkey
| | - Nurullah Dağ
- Malatya Training and Research Hospital, Malatya, Turkey
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Abedi F, Sadeghi M, Omidkhoda N, Kelesidis T, Ramezani J, Samadi S, Mohammadpour AH. HDL-cholesterol concentration and its association with coronary artery calcification: a systematic review and meta-analysis. Lipids Health Dis 2023; 22:60. [PMID: 37158895 PMCID: PMC10165789 DOI: 10.1186/s12944-023-01827-x] [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: 03/05/2023] [Accepted: 04/29/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Coronary artery calcification (CAC) is a potential risk marker of coronary atherosclerosis that has high specificity and sensitivity. However, the association between high-density lipoprotein cholesterol (HDL-C) concentration and CAC incidence and progression is controversial. METHODS PubMed, Embase, Web of Science, and Scopus were systematically searched to identify relevant observational studies up to March 2023 and assessed the methodological quality using Newcastle-Ottawa Scale (NOS) scale. Random-effects meta-analysis was used to estimate pooled odds ratios (OR) and 95% confidence interval considering heterogeneity across studies. RESULTS Of the 2,411 records, 25 cross-sectional (n = 71,190) and 13 cohort (n = 25,442) studies were included in the systematic review. Ten cross-sectional and eight cohort studies were not eligible and were omitted from the meta-analysis. A total of 15 eligible cross-sectional studies (n = 33,913) were included in the meta-analysis and pooled results revealed no significant association between HDL-C and CAC > 0, CAC > 10, or CAC > 100 [pooled OR: 0.99 (0.97, 1.01)]. Meta-analysis of the 5 eligible prospective cohort studies (n = 10,721) revealed no significant protective effect of high HDL-C against CAC > 0 [pooled OR: 1.02 (0.93, 1.13)]. CONCLUSIONS According to this analysis of observational studies, high HDL-C levels were not found to predict protection against CAC. These results suggest HDL quality rather than HDL quantity is important for certain aspects of atherogenesis and CAC. REGISTRATION NUMBER CRD42021292077.
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Affiliation(s)
- Farshad Abedi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Sadeghi
- Department of Epidemiology, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Navid Omidkhoda
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Theodoros Kelesidis
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Javad Ramezani
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Samadi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amir Hooshang Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
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Shlomai G, Shemesh J, Segev S, Koren-Morag N, Grossman E. The Multi-Ethnic Study of Atherosclerosis-Calcium Score Improves Statin Treatment Allocation in Asymptomatic Adults. Front Cardiovasc Med 2022; 9:855390. [PMID: 35911540 PMCID: PMC9334900 DOI: 10.3389/fcvm.2022.855390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background The current categorization of cardiovascular (CV) risk broadens the indications for statin therapy. Coronary artery calcium (CAC) identifies those who are most likely to benefit from primary prevention with statin therapy. The multi-ethnic study of atherosclerosis-calcium (MESA-C) includes CAC for CV risk stratification. Objective We aimed to establish whether the MESA-C score improves allocation to statin treatment in a cohort of asymptomatic adults. We also analyzed patient survival according to their risk score calculation. Design A retrospective analysis of asymptomatic adults. Participants A total of 632 consecutive subjects free of coronary artery disease (CAD) and/or stroke, mean age 56 ± 7 years, 84% male, underwent clinical evaluations and CAC measurements. Main Measures PCE and MESA-C risk scores were calculated for each subject. According to the 10-year risk for CV events, subjects were classified into moderate and high CV risk (≥7.5%) for whom a statin is clearly indicated, or borderline and low CV risk (<7.5%). Key Results During mean follow-up of 6.5 ± 3.3 years, 52 subjects experienced their first CV event. Those with a MESA-C risk score < 7.5% had favorable outcomes even when the PCE indicated a risk of ≥ 7.5%. The MESA-C score improved the discrimination of CV risk with the ROC curves C-statistics increasing from 0.653 for the PCE to 0.770 for the MESA-C. Of those, 84% (99/118) with borderline CV risk (5–7.5%) according to the PCE score, were reallocated by the MESA-C score into a higher (≥7.5%) or lower (<5%) CV risk category. Furthermore, subjects with low MESA-C scores had the highest survival rate regardless of the PCE risk, while those with high MESA-C risks had the lowest survival rate regardless of the PCE risk. Conclusion In asymptomatic subjects, the MESA-C score improves allocation to statin treatment and CV risk discrimination, while both scores are essential for more precise survival estimations.
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Affiliation(s)
- Gadi Shlomai
- Department of Internal Medicine D and Hypertension Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
- The Division of Endocrinology, Diabetes and Metabolism, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joseph Shemesh
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Grace Ballas Cardiac Research Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Shlomo Segev
- Periodic Examination Center, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Nira Koren-Morag
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Epidemiology and Preventive Medicine, Ramat Gan, Israel
| | - Ehud Grossman
- Department of Internal Medicine D and Hypertension Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
- Department of Epidemiology and Preventive Medicine, Ramat Gan, Israel
- *Correspondence: Ehud Grossman,
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McConachie P, McKay E, Crane A, Nguyen N, Quinn R, Butler SP. Accurate measurement of coronary artery calcium in cancer patients using the CT component of PET/CT scans. Nucl Med Commun 2022; 43:159-165. [PMID: 34711775 DOI: 10.1097/mnm.0000000000001503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study is to establish the correlation between a CAC score derived from the CT component of PET/CT scan (CAC-PET) using in-house software as compared to the conventional technique (CAC-Standard). In addition, the incidence of high CAC scores in asymptomatic cancer patients with low-to-intermediate cardiovascular risk will be determined. METHODS 100 patients referred for oncologic PET/CT were prospectively recruited to have a conventional CAC score after their PET/CT. Patients with a history of cardiac disease were excluded. The nongated CT images from the PET/CT (CAC-PET) were analysed using validated in-house software with the results compared to those from gated CT analysed using the standard technique (CAC-Standard). RESULTS The correlation of CAC scores between the two scan types was moderate [slope, 0.95; R2 = 0.91; limits of agreement (LOA) = 0.29-5.65]. Using a conventional categorical analysis, there was complete agreement in 73% of patients with one category difference in the remainder. [interclass correlation (ICC) = 0.90; Cohen's kappa = 0.63]. In total 28% of these asymptomatic low-to-intermediate-risk cancer patients had CAC scores over 300. CONCLUSION Estimation of CAC from the CT component of PET/CT scans is a reliable method for the detection of significant CAC in cancer patients and correlates well with the standard method. This technique should permit the calculation of cardiovascular risk in cancer patients undergoing PET/CT without any additional radiation exposure. A significant number of asymptomatic low-to-intermediate-risk cancer patients were found to have a high risk of cardiovascular disease.
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Affiliation(s)
- Peter McConachie
- Department of Nuclear Medicine, St George Hospital, Kogarah, Sydney, Australia
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Wang K, Malkin HE, Patchett ND, Pearlstein KA, Heiling HM, McCabe SD, Deal AM, Mavroidis P, Oakey M, Fenoli J, Lee CB, Klein JL, Jensen BC, Stinchcombe TE, Marks LB, Weiner AA. Coronary Artery Calcifications and Cardiac Risk After Radiation Therapy for Stage III Lung Cancer. Int J Radiat Oncol Biol Phys 2022; 112:188-196. [PMID: 34419565 PMCID: PMC8688314 DOI: 10.1016/j.ijrobp.2021.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/02/2021] [Accepted: 08/09/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Heart dose and heart disease increase the risk for cardiac toxicity associated with radiation therapy. We hypothesized that computed tomography (CT) coronary calcifications are associated with cardiac toxicity and may help ascertain baseline heart disease. METHODS AND MATERIALS We analyzed the cumulative incidence of cardiac events in patients with stage III non-small cell lung cancer receiving median 74 Gy on prospective dose-escalation trials. Events were defined as symptomatic effusion, pericarditis, unstable angina, infarction, significant arrhythmia, and/or heart failure. Coronary calcifications were delineated on simulation CTs using radiation software program (130 HU threshold). Calcifications were defined as "none," "low," and "high," with median volume dividing low and high. RESULTS Of 109 patients, 26 had cardiac events at median 26 months (range, 1-84 months) after radiation therapy. Median follow-up in surviving patients was 8.8 years (range, 2.3-17.3). On simulation CTs, 64 patients (59%) had coronary calcifications with median volume 0.2 cm3 (range, 0.01-8.3). Only 16 patients (15%) had baseline coronary artery disease. Cardiac events occurred in 7% (3 of 45), 29% (9 of 31), and 42% (14 of 33) of patients with no, low, and high calcifications, respectively. Calcification burden was associated with cardiac toxicity on univariate (low vs none: hazard ratio [HR] 5.0, P = .015; high vs none: HR 8.1, P < .001) and multivariate analyses (low vs none: HR 7.0, P = .005, high vs none: HR 10.6, P < .001, heart mean dose: HR 1.1/Gy, P < .001). Four-year competing risk-adjusted event rates for no, low, and high calcifications were 4%, 23%, and 34%, respectively. CONCLUSIONS The presence of coronary calcifications is a cardiac risk factor that can identify high-risk patients for medical referral and help guide clinicians before potentially cardiotoxic cancer treatments.
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Affiliation(s)
- Kyle Wang
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
| | - Hayley E. Malkin
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Nicholas D. Patchett
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Kevin A. Pearlstein
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Hillary M. Heiling
- Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina, Chapel Hill, NC
| | - Sean D. McCabe
- Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina, Chapel Hill, NC
| | - Allison M. Deal
- Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina, Chapel Hill, NC
| | | | - Mary Oakey
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Jeffrey Fenoli
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Carrie B. Lee
- Department of Internal Medicine, Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC
| | - J Larry Klein
- Department of Internal Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, NC,Department of Radiology, University of North Carolina, Chapel Hill, NC
| | - Brian C. Jensen
- Department of Internal Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, NC
| | | | - Lawrence B. Marks
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Ashley A. Weiner
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
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Hamilton MCK, Harries I, Lopez-Bernal T, Karteszi H, Redfern E, Lyen S, Manghat NE. Electrocardiography-gated CT for acute aortic syndrome: quantifying the potential impact of subspecialty national recommendations on emergency general radiology reporting. Clin Radiol 2021; 77:e27-e32. [PMID: 34579863 DOI: 10.1016/j.crad.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/09/2021] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the detection of acute aortic syndrome (AAS) and the prevalence of alternative diagnoses that may explain the presentation or require follow-up. MATERIALS AND METHODS This was a retrospective, blinded re-evaluation of consecutive electrocardiography (ECG)-gated computed tomography (CT) aortic studies by a cardiovascular radiologist performed between September 2019 and May 2020 in a tertiary-referral cardiothoracic centre. RESULTS There were 118 identified examinations, six examinations were excluded leaving 112 (mean age = 61 ± 17; 56% male). Three cases of AAS were present (prevalence 2.7%); only one was reported on initial review. There were no false-positive diagnoses of AAS. The heart was mentioned in 79 (70.5%) reports and 73 (65.2%) of reviews revealed a total of 114 new observations; 111 (97.4%) of these were cardiovascular with 44/112 (39.3%) patients potentially having a significant previously unsuspected cardiovascular diagnosis. CONCLUSION The implementation of national clinical guidance to increase testing and improve image quality led to a series of challenges. The real value of ECG-gated CT may lie in detecting other diseases that mimic AAS. With the additional workload, increased subspecialty expertise is required but there needs to be a willingness to learn with an adequate support infrastructure.
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Affiliation(s)
- M C K Hamilton
- Department of Clinical Radiology, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK; Department of Cardiology, Bristol Heart Institute, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - I Harries
- Department of Clinical Radiology, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK; Department of Cardiology, Bristol Heart Institute, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - T Lopez-Bernal
- Department of Clinical Radiology, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - H Karteszi
- Department of Clinical Radiology, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - E Redfern
- Department of Emergency Medicine, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - S Lyen
- Department of Clinical Radiology, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK; Department of Cardiology, Bristol Heart Institute, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - N E Manghat
- Department of Clinical Radiology, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK; Department of Cardiology, Bristol Heart Institute, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK.
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Koulaouzidis G, Charisopoulou D, Kukla M, Marlicz W, Rydzewska G, Koulaouzidis A, Skonieczna-Żydecka K. Association of non-alcoholic fatty liver disease with coronary artery calcification progression: a systematic review and meta-analysis. PRZEGLAD GASTROENTEROLOGICZNY 2021; 16:196-206. [PMID: 34584580 PMCID: PMC8456760 DOI: 10.5114/pg.2021.109063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, which is estimated to affect 20-30% of the adult population in Europe. Several studies have shown an association of NAFLD with multiple cardiovascular risk factors such as abdominal obesity, atherogenic dyslipidaemia, hypertension, insulin resistance, and impaired glucose tolerance. Atherosclerosis is a chronic, progressive, inflammatory disease, which begins early in life and follows a long asymptomatic phase. Coronary artery calcification (CAC) is the radiological confirmation of the presence of atherosclerotic coronary artery disease. The predictive value of CAC for future cardiac events is well established. Also, the progression of CAC is strongly associated with the development of cardiovascular events. AIM To assess the association of NAFLD with the progression of subclinical atherosclerotic activity, reflected as the dynamic changes in CAC score over time. MATERIAL AND METHODS The databases PubMed/Medline/Embase from inception until 31 December 2020 were searched for observational studies investigating NAFLD and CAC progression in adults. RESULTS In total, 5 studies were included, 4 of which, including 10,060 patients, provided data regarding the association of NAFLD with the progression of CAC. The analysis showed that NAFLD is associated with significant odds of progression of CAC; OR = 1.5, 95% CI: 1.34-1.68, p = 0.001. No publication bias was detected (Egger's test p = 0.6). Meta-regression analyses proved that OR toward CAC progression is not significantly influenced by the time of follow-up (coefficient = 0.0083, Z = 1.14, p = 0.25). CONCLUSIONS NAFLD increases the risk toward CAC progression over time.
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Affiliation(s)
- George Koulaouzidis
- Department of Biochemical Sciences, Pomeranian Medical University, Szczecin, Poland
| | - Dafni Charisopoulou
- Amalia Children’s Hospital, Radboud University Medical Centre, Nijmegen, Netherlands
- Academic Centre for Congenital Heart Disease, Netherlands
| | - Michał Kukla
- Department of Internal Medicine and Geriatrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
- Department of Endoscopy, University Hospital, Krakow, Poland
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
- Endoklinika, The Centre for Digestive Diseases, Szczecin, Poland
| | - Grażyna Rydzewska
- Clinical Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, Central Clinical Hospital of the Ministry of the Inferior and Administration, Warsaw, Poland
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Anastasios Koulaouzidis
- Department of Social Medicine and Public Health, Pomeranian Medical University, Szczecin, Poland
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10
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Deep learning method for aortic root detection. Comput Biol Med 2021; 135:104533. [PMID: 34139438 DOI: 10.1016/j.compbiomed.2021.104533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Computed tomography angiography (CTA) is a preferred imaging technique for a wide range of vascular diseases. However, extensive manual analysis is required to detect and identify several anatomical landmarks for clinical application. This study demonstrates the feasibility of a fully automatic method for detecting the aortic root, which is a key anatomical landmark in this type of procedure. The approach is based on the use of deep learning techniques that attempt to mimic expert behavior. METHODS A total of 69 CTA scans (39 for training and 30 for validation) with different pathology types were selected to train the network. Furthermore, a total of 71 CTA scans were selected independently and applied as the test set to assess their performance. RESULTS The accuracy was evaluated by comparing the locations marked by the method with benchmark locations (which were manually marked by two experts). The interobserver error was 4.6 ± 2.3 mm. On an average, the differences between the locations marked by the two experts and those detected by the computer were 6.6 ± 3.0 mm and 6.8 ± 3.3 mm, respectively, when calculated using the test set. CONCLUSIONS From an analysis of these results, we can conclude that the proposed method based on pre-trained CNN models can accurately detect the aortic root in CTA images without prior segmentation.
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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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12
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Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Nardi Agmon I, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M. ESR/ERS statement paper on lung cancer screening. Eur Respir J 2020; 55:13993003.00506-2019. [PMID: 32051182 DOI: 10.1183/13993003.00506-2019] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.
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Affiliation(s)
- Hans-Ulrich Kauczor
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - Anne-Marie Baird
- Central Pathology Laboratory, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Lorenzo Bonomo
- Dept of Radiology, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | | | | | | | - Sébastien Couraud
- Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, CH Lyon Sud, Pierre Bénite, France.,Faculté de Médecine et de Maïeutique Lyon Sud - Charles Mérieux, Université Claude Bernard Lyon I, Oullins, France
| | | | | | - Sergey Morozov
- Dept of Health Care of Moscow, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | | | - Nir Peled
- Thoracic Cancer Unit, Rabin Medical Center, Petach Tiqwa, Israel
| | | | - Helmut Prosch
- Dept of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sofia Ravara
- Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.,Tobacco Cessation Unit, CHCB University Hospital, Covilha, Portugal
| | | | | | - Mario Silva
- Section of Radiology, Dept of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - Bram van Ginneken
- Image Sciences Institute, University Medical Centre, Utrecht, The Netherlands.,Dept of Radiology, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Constantine Vardavas
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Oyunbileg von Stackelberg
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - Mina Gaga
- 7th Respiratory Medicine Dept, Athens Chest Hospital Sotiria, Athens, Greece
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13
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Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Agmon IN, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M. ESR/ERS statement paper on lung cancer screening. Eur Radiol 2020; 30:3277-3294. [PMID: 32052170 DOI: 10.1007/s00330-020-06727-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022]
Abstract
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.Key Points• Pulmonologists and radiologists both have key roles in the set up of multidisciplinary LCS teams with experts from many other fields.• Pulmonologists identify people eligible for LCS, reach out to family doctors, share the decision-making process and promote tobacco cessation.• Radiologists ensure appropriate image quality, minimum dose and a standardised reading/reporting algorithm, together with a clear definition of a "positive screen".• Strict algorithms define the exact management of screen-detected nodules and incidental findings.• For LCS to be (cost-)effective, it has to target a population defined by risk prediction models.
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Affiliation(s)
- Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, INF 110, 69120, Heidelberg, Germany.
| | - Anne-Marie Baird
- Central Pathology Laboratory, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Lorenzo Bonomo
- Department of Radiology, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | | | | | | | - Sébastien Couraud
- Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, Sud, Pierre Bénite, Lyon, CH, France.,Faculté de Médecine et de Maïeutique Lyon Sud - Charles Mérieux, Université Claude Bernard Lyon I, Oullins, France
| | | | | | - Sergey Morozov
- Department of Health Care of Moscow, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | | | - Nir Peled
- Thoracic Cancer Unit, Rabin Medical Center, Petach Tiqwa, Israel
| | | | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sofia Ravara
- Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.,Tobacco Cessation Unit, CHCB University Hospital, Covilha, Portugal
| | | | | | - Mario Silva
- Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - Bram van Ginneken
- Image Sciences Institute, University Medical Centre, Utrecht, The Netherlands.,Department of Radiology, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Constantine Vardavas
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Oyunbileg von Stackelberg
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, INF 110, 69120, Heidelberg, Germany
| | - Mina Gaga
- 7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece
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14
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Guo H, Kruger U, Wang G, Kalra MK, Yan P. Knowledge-Based Analysis for Mortality Prediction From CT Images. IEEE J Biomed Health Inform 2020; 24:457-464. [PMID: 31603807 PMCID: PMC7007835 DOI: 10.1109/jbhi.2019.2946066] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Low-Dose CT (LDCT) can significantly improve the accuracy of lung cancer diagnosis and thus reduce cancer deaths compared to chest X-ray. The lung cancer risk population is also at high risk of other deadly diseases, for instance, cardiovascular diseases. Therefore, predicting the all-cause mortality risks of this population is of great importance. This paper introduces a knowledge-based analytical method using deep convolutional neural network (CNN) for all-cause mortality prediction. The underlying approach combines structural image features extracted from CNNs, based on LDCT volume at different scales, and clinical knowledge obtained from quantitative measurements, to predict the mortality risk of lung cancer screening subjects. The proposed method is referred as Knowledge-based Analysis of Mortality Prediction Network (KAMP-Net). It constitutes a collaborative framework that utilizes both imaging features and anatomical information, instead of completely relying on automatic feature extraction. Our work demonstrates the feasibility of incorporating quantitative clinical measurements to assist CNNs in all-cause mortality prediction from chest LDCT images. The results of this study confirm that radiologist defined features can complement CNNs in performance improvement. The experiments demonstrate that KAMP-Net can achieve a superior performance when compared to other methods.
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Affiliation(s)
- Hengtao Guo
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Uwe Kruger
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Ge Wang
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Mannudeep K. Kalra
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Pingkun Yan
- Department of Biomedical Engineering and the Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
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15
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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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16
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Noncontrast Chest Computed Tomographic Imaging of Obesity and the Metabolic Syndrome. J Thorac Imaging 2019; 34:116-125. [DOI: 10.1097/rti.0000000000000391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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17
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Low-dose computed tomography screening reduces lung cancer mortality. Adv Med Sci 2018; 63:230-236. [PMID: 29425790 DOI: 10.1016/j.advms.2017.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/12/2017] [Accepted: 12/17/2017] [Indexed: 12/17/2022]
Abstract
Lung cancer causes an estimated 1.6 million deaths each year, being the leading cause of cancer-related deaths in the world. Late diagnosis and, in some cases, the high aggressiveness of the tumour result in low overall five-year survival rates of 12% among men and 7% among women. The cure is most likely in early-stage disease. The poor outcomes of treatment in lung cancer resulting from the fact that most cases are diagnosed in the advanced stage of the disease justify the implementation of an optimal lung cancer prevention in the form of smoking cessation and screening programmes that would offer a chance to detect early stages of the disease, while fitting within specific economic constraints. The National Lung Screening Trial (NLST) - the largest and most expensive randomised, clinical trial in the USA demonstrated a 20% mortality rate reduction in patients who had undergone chest low-dose computed tomography (LDCT) screening, as compared to patients screened with a conventional chest X-ray. Results of the NLST enabled the implementation of lung cancer screening programme among highrisk patients in the USA and parts of China. In 2017, recommendations of the European Society of Thoracic Surgeons also strongly recommend an implementation of a screening programme in the EU. Further studies of improved lung cancer risk assessment scores and of effective molecular markers should intensify in order to reduce all potential harms to the high-risk group and to increase cost-effectiveness of the screening.
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18
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Balata H, Blandin Knight S, Barber P, Colligan D, Crosbie EJ, Duerden R, Elton P, Evison M, Greaves M, Howells J, Irion K, Karunaratne D, Kirwan M, Macnab A, Mellor S, Miller C, Newton T, Novasio J, Sawyer R, Sharman A, Slevin K, Smith E, Taylor B, Taylor S, Tonge J, Walsham A, Waplington S, Whittaker J, Booton R, Crosbie PAJ. Targeted lung cancer screening selects individuals at high risk of cardiovascular disease. Lung Cancer 2018; 124:148-153. [PMID: 30268454 DOI: 10.1016/j.lungcan.2018.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is a major cause of morbidity and mortality in populations eligible for lung cancer screening. The aim of this study was to determine whether a brief CV risk assessment, delivered as part of a targeted community-based lung cancer screening programme, was effective in identifying individuals at high risk who might benefit from primary prevention. METHODS The Manchester Lung Screening Pilot consisted of annual low dose CT (LDCT) over 2 screening rounds, targeted at individuals in deprived areas at high risk of lung cancer (age 55-74 and 6-year risk ≥1.51%, using PLCOM2012 risk model). All participants of the second screening round were eligible to take part in the study. Ten-year CV risk was estimated using QRISK2 in participants without CVD and compared to age (±5 years) and sex matched Health Survey for England (HSE) controls; high risk was defined as QRISK2 score ≥10%. Coronary artery calcification (CAC) was assessed on LDCT scans and compared to QRISK2 score. RESULTS Seventy-seven percent (n=920/1,194) of screening attendees were included in the analysis; mean age 65.6 ± 5.4 and 50.4% female. QRISK2 and lung cancer risk (PLCOM2012) scores were correlated (r = 0.26, p < 0.001). Median QRISK2 score was 21.1% (IQR 14.9-29.6) in those without established CVD (77.6%, n = 714/920), double that of HSE controls (10.3%, IQR 6.6-16.2; n = 714) (p < 0.001). QRISK2 score was significantly higher in those with CAC (p < 0.001). Screening attendees were 10-fold more likely to be classified high risk (OR 10.2 [95% CI 7.3-14.0]). One third (33.7%, n = 310/920) of all study participants were high risk but not receiving statin therapy for primary CVD prevention. DISCUSSION Opportunistic CVD risk assessment within a targeted lung cancer screening programme is feasible and is likely to identify a very large number of individuals suitable for primary prevention.
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Affiliation(s)
- H Balata
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - S Blandin Knight
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - P Barber
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - D Colligan
- Manchester Health and Care Commissioning, Manchester, UK
| | - E J Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - R Duerden
- Department of Radiology, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - P Elton
- Greater Manchester Health & Social Care Partnership, Manchester, UK
| | - M Evison
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - M Greaves
- Department of Radiology, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - J Howells
- Department of Radiology, Royal Preston Hospital, Preston, UK
| | - K Irion
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - D Karunaratne
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Kirwan
- Thoracic Oncology Research Hub (TORCH), Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - A Macnab
- Department of Cardiology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - S Mellor
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | - C Miller
- Department of Cardiology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - T Newton
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | - J Novasio
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - R Sawyer
- Department of Radiology, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - A Sharman
- Department of Radiology, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - K Slevin
- Thoracic Oncology Research Hub (TORCH), Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - E Smith
- Department of Radiology, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - B Taylor
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - S Taylor
- Manchester Health and Care Commissioning, Manchester, UK
| | - J Tonge
- Manchester Health and Care Commissioning, Manchester, UK
| | - A Walsham
- Department of Radiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - S Waplington
- Manchester Health and Care Commissioning, Manchester, UK
| | - J Whittaker
- Department of Radiology, Stockport NHS Foundation Trust, Stockport, UK
| | - R Booton
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - P A J Crosbie
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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19
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Cappabianca S, Belfiore MP, Reginelli A, Capasso R, Del Prete A, Petrillo M, Mascia P, Rossi C, Romano F, De Filippo M, Scialpi M, Gragnano F, Calabrò P, Belfiore G, Brunese L, Grassi R, Rotondo A. Mandatory Reporting of Coronary Artery Calcifications Incidentally Noted on Chest Multi-Detector Computed Tomography: A Multicentre Experience. Curr Vasc Pharmacol 2018; 17:92-98. [PMID: 29345585 DOI: 10.2174/1570161116666180117111856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Coronary Artery Calcifications (CACs) are associated with coronary atherosclerosis and Cardiovascular (CV) events. In "non-cardiovascular" settings, CACs can be easily detected on chest Multi-Detector Computed Tomography (MDCT). Their evaluation may help to better stratify CV risk in the general population, especially for primary prevention. AIMS We retrospectively evaluated the relationship between CAC distribution and CV risk, determined by Framingham Risk Score (FRS), in a cohort of patients who underwent chest MDCT performed for several clinical indications. METHOD We retrospectively recruited 305 patients (194 men, 111 women; mean age 70.5 years) from 3 different Italian centres. Patients with coronary stent, pacemaker and/or CV devices were excluded from the study. Circumflex Artery (LCX), Left Main Coronary Artery (LMCA), left Anterior Descending artery (LAD) and right coronary artery (RCA) were analysed. RESULTS From a total population of 305 patients, 119 (39%) had low FRS (<10%), 115 (38%) had intermediate FRS (10-20%), and 71 (23%) had high FRS (>20%). The study identified 842 CACs located in decreasing order as follows: RCA (34.5%), LAD (32.3%), LCX (28%) and LMCA (13%). Statistical two-step analysis subdivided patients into two clusters according to FRS (risk threshold = 12.38%): cluster I (mean 9.34) and cluster II (mean 15.09). A significant association between CAC distribution and cluster II was demonstrated. CACs were mostly detected in patients with intermediate FRS. All patients (100%) with the highest CV risk showed intermediate RCA and LMCA involvement. CONCLUSION Radiologists can note the distribution of CACs on a chest MDCT and should mandatorily record them in their reports. Depending on CAC presence and location, these findings may have important clinical implications, mostly in asymptomatic patients with intermediate FRS. This information may reclassify a patients' CV risk and improve clinical management.
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Affiliation(s)
- Salvatore Cappabianca
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Maria Paola Belfiore
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Alfonso Reginelli
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Raffaella Capasso
- Department of Medicine and Health Sciences, University of Molise, 86100, Campobasso, Italy
| | - Alessandra Del Prete
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Mario Petrillo
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Paola Mascia
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Claudia Rossi
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Francesco Romano
- Department of Mental and Physical Health and University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Massimo De Filippo
- Department of Clinical Sciences, Section of Radiological Sciences, University Hospital of Parma, 43100, Parma, Italy
| | - Michele Scialpi
- Department of Surgical, Radiological and Odontostomatological Sciences, Division of Radiology 2, Perugia University, S. Maria della Misericordia Hospital, 06134, Perugia, Italy
| | - Felice Gragnano
- Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Calabrò
- Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Belfiore
- Department of Diagnostic Imaging, "Sant'Anna and San Sebastiano" Hospital, 81100, Caserta, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, 86100, Campobasso, Italy
| | - Roberto Grassi
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Antonio Rotondo
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
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Silveira de Souza VV, Soares Torres F, Hochhegger B, Watte G, Sartori G, Lucchese F, Azambuja Gonçalves B. Performance of ultra-low-dose CT for the evaluation of coronary calcification: a direct comparison with coronary calcium score. Clin Radiol 2017; 72:745-750. [PMID: 28413071 DOI: 10.1016/j.crad.2017.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/15/2017] [Accepted: 03/20/2017] [Indexed: 12/20/2022]
Abstract
AIM To evaluate the diagnostic performance of ultra-low-dose computed tomography (ULDCT) in comparison to standard coronary calcium score (CCS) acquisition for the evaluation of coronary artery calcification (CAC). MATERIALS AND METHODS Standard CCS acquisition and ULDCT were performed in patients referred for coronary CT angiography for the evaluation of coronary artery disease. CAC in ULDCT was graded subjectively using a four-point scale (from 0, no calcification, to 3, severe calcification) for the complete study and for each individual coronary segment. The summation of all individual coronary segment scores generated an ULDCT total CAC score. ULDCT results were compared to standard Agatston score and sensitivity and specificity of ULDCT were calculated. RESULTS CCS and ULDCT were performed in 74 patients, with a mean DLP of 77.7 mGy·cm (±12.1) and 9.3 mGy·cm (±0.6), respectively (p<0.001). Coronary calcification was detected in 47 patients (63.5%) in standard CCS acquisition (median Agatston score of 41; interquartile range [IQR]:0263), in comparison to 42 patients (56.8%) in ULDCT (p<0.001). The sensitivity and specificity of the ULDCT total CAC score ≥1 was 80.9% and 85.2%, respectively, with an accuracy of 82.4%. The area under the receiver operating characteristic curve for the presence of CAC was 0.87. CONCLUSION ULDCT shows good sensitivity, specificity, and overall accuracy for the detection of coronary calcification with a markedly lower radiation dose in comparison to CCS. ULDCT is unlikely to miss coronary calcification in individuals with at least moderate calcium load (Agatston score >100).
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Affiliation(s)
- V V Silveira de Souza
- Santa Casa de Misericórdia de Porto Alegre, Annes Dias St 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil.
| | - F Soares Torres
- Santa Casa de Misericórdia de Porto Alegre, Annes Dias St 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil
| | - B Hochhegger
- Santa Casa de Misericórdia de Porto Alegre, Annes Dias St 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil
| | - G Watte
- Santa Casa de Misericórdia de Porto Alegre, Annes Dias St 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil
| | - G Sartori
- Santa Casa de Misericórdia de Porto Alegre, Annes Dias St 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil
| | - F Lucchese
- Santa Casa de Misericórdia de Porto Alegre, Annes Dias St 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil
| | - B Azambuja Gonçalves
- Santa Casa de Misericórdia de Porto Alegre, Annes Dias St 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil
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