1
|
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.
Collapse
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
| |
Collapse
|
2
|
Saraf A, Tahir I, Hu B, Dietrich ASW, Tonnesen PE, Sharp GC, Tillman G, Roeland EJ, Nipp RD, Comander A, Peppercorn J, Fintelmann FJ, Jimenez RB. Association of Sarcopenia With Toxicity-Related Discontinuation of Adjuvant Endocrine Therapy in Women With Early-Stage Hormone Receptor-Positive Breast Cancer. Int J Radiat Oncol Biol Phys 2024; 118:94-103. [PMID: 37506979 DOI: 10.1016/j.ijrobp.2023.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/27/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE Sarcopenia, an age-related decline in muscle mass and physical function, is associated with increased toxicity and worse outcomes in women with breast cancer (BC). Sarcopenia may contribute to toxicity-related early discontinuation of adjuvant endocrine therapy (aET) in women with hormone receptor-positive (HR+) BC but remains poorly characterized. METHODS AND MATERIALS This multicenter, retrospective cohort study included consecutive women with stage 0-II HR+ BC who received breast conserving therapy (lumpectomy and radiation therapy) and aET from 2011 to 2017 with a 5-year follow-up. Skeletal muscle index (SMI, cm2/m2) was analyzed using a deep learning model on routine cross-sectional radiation simulation imaging; sarcopenia was dichotomized according to previously validated reports. The primary endpoint was toxicity-related aET discontinuation; logistic regression analysis evaluated associations between SMI/sarcopenia and aET discontinuation. Cox regression analysis evaluated associations with time to aET toxicity, ipsilateral breast tumor recurrence (IBTR), and disease-free survival (DFS). RESULTS A total of 305 women (median follow-up, 89 months) were included with a median age of 67 years and early-stage BC (12% stage 0, 65% stage I). A total of 60 (20%) women experienced toxicity-related aET discontinuation. Sarcopenia was associated with toxicity-related early discontinuation of aET (odds ratio, 2.18; P = .036) and shorter time to aET toxicity (hazard ratio [HR], 1.62; P = .031). SMI or sarcopenia were not independently associated with IBTR or DFS; toxicity-related aET discontinuation was associated with worse IBTR (HR, 9.47; P = .002) and worse DFS (HR, 4.53; P = .001). CONCLUSIONS Among women with early-stage HR+ BC who receive adjuvant radiation therapy and hormone therapy, sarcopenia is associated with toxicity-related early discontinuation of aET. Further studies should validate these findings in women who did not receive adjuvant radiation therapy. These high-risk patients may be candidates for aggressive symptom management and/or alternative treatment strategies to improve outcomes.
Collapse
Affiliation(s)
- Anurag Saraf
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Ismail Tahir
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Bonnie Hu
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - P Erik Tonnesen
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory C Sharp
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Gayle Tillman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric J Roeland
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Ryan D Nipp
- Department of Medical Oncology, University of Oklahoma Stephenson Cancer Center, Oklahoma City, Oklahoma
| | - Amy Comander
- Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffery Peppercorn
- Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
3
|
Tahir I, Cahalane AM, Saenger JA, Leppelmann KS, Abrishami Kashani M, Marquardt JP, Silverman SG, Shyn PB, Mercaldo ND, Fintelmann FJ. Factors Associated with Hospital Length of Stay and Adverse Events following Percutaneous Ablation of Lung Tumors. J Vasc Interv Radiol 2023; 34:759-767.e2. [PMID: 36521793 DOI: 10.1016/j.jvir.2022.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/12/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To explore the association between risk factors established in the surgical literature and hospital length of stay (HLOS), adverse events, and hospital readmission within 30 days after percutaneous image-guided thermal ablation of lung tumors. MATERIALS AND METHODS This bi-institutional retrospective cohort study included 131 consecutive adult patients (67 men [51%]; median age, 65 years) with 180 primary or metastatic lung tumors treated in 131 sessions (74 cryoablation and 57 microwave ablation) from 2006 to 2019. Age-adjusted Charlson Comorbidity Index, sex, performance status, smoking status, chronic obstructive pulmonary disease (COPD), primary lung cancer versus pulmonary metastases, number of tumors treated per session, maximum axial tumor diameter, ablation modality, number of pleural punctures, anesthesia type, pulmonary artery-to-aorta ratio, lung densitometry, sarcopenia, and adipopenia were evaluated. Associations between risk factors and outcomes were assessed using univariable and multivariable generalized linear models. RESULTS In univariable analysis, HLOS was associated with current smoking (incidence rate ratio [IRR], 4.54 [1.23-16.8]; P = .02), COPD (IRR, 3.56 [1.40-9.04]; P = .01), cryoablations with ≥3 pleural punctures (IRR, 3.13 [1.07-9.14]; P = .04), general anesthesia (IRR, 10.8 [4.18-27.8]; P < .001), and sarcopenia (IRR, 2.66 [1.10-6.44]; P = .03). After multivariable adjustment, COPD (IRR, 3.56 [1.57-8.11]; P = .003) and general anesthesia (IRR, 12.1 [4.39-33.5]; P < .001) were the only risk factors associated with longer HLOS. No associations were observed between risk factors and adverse events in multivariable analysis. Tumors treated per session were associated with risk of hospital readmission (P = .03). CONCLUSIONS Identified preprocedural risk factors from the surgical literature may aid in risk stratification for HLOS after percutaneous ablation of lung tumors, but were not associated with adverse events.
Collapse
Affiliation(s)
- Ismail Tahir
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexis M Cahalane
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan A Saenger
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Medical School, Sigmund Freud University, Vienna, Austria
| | - Konstantin S Leppelmann
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Maya Abrishami Kashani
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - J Peter Marquardt
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Florian J Fintelmann
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
| |
Collapse
|
4
|
Troschel FM, Troschel BO, Kloss M, Troschel AS, Pepper NB, Wiewrodt RG, Stummer W, Wiewrodt D, Theodor Eich H. Cervical body composition on radiotherapy planning computed tomography scans predicts overall survival in glioblastoma patients. Clin Transl Radiat Oncol 2023; 40:100621. [PMID: 37008514 PMCID: PMC10063381 DOI: 10.1016/j.ctro.2023.100621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Background and purpose Glioblastoma (GBM) patients face a strongly unfavorable prognosis despite multimodal therapy regimens. However, individualized mortality prediction remains imprecise. Harnessing routine radiation planning cranial computed tomography (CT) scans, we assessed cervical body composition measures as novel biomarkers for overall survival (OS) in GBM patients. Materials and methods We performed threshold-based semi-automated quantification of muscle and subcutaneous fat cross-sectional area (CSA) at the levels of the first and second cervical vertebral body. First, we tested this method's validity by correlating cervical measures to established abdominal body composition in an open-source whole-body CT cohort. We then identified consecutive patients undergoing radiation planning for recent GBM diagnosis at our institution from 2010 to 2020 and quantified cervical body composition on radiation planning CT scans. Finally, we performed univariable and multivariable time-to-event analyses, adjusting for age, sex, body mass index, comorbidities, performance status, extent of surgical resection, extent of tumor at diagnosis, and MGMT methylation. Results Cervical body composition measurements were well-correlated with established abdominal markers (Spearman's rho greater than 0.68 in all cases). Subsequently, we included 324 GBM patients in our study cohort (median age 63 years, 60.8% male). 293 (90.4%) patients died during follow-up. Median survival time was 13 months. Patients with below-average muscle CSA or above-average fat CSA demonstrated shorter survival. In multivariable analyses, continuous cervical muscle measurements remained independently associated with OS. Conclusion This exploratory study establishes novel cervical body composition measures routinely available on cranial radiation planning CT scans and confirms their association with OS in patients diagnosed with GBM.
Collapse
Affiliation(s)
- Fabian M. Troschel
- Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
- Corresponding author at: Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Benjamin O. Troschel
- Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Maren Kloss
- Department of Neurosurgery, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Amelie S. Troschel
- Department of Medicine II, Klinikum Wolfsburg, Sauerbruchstraße 7, 38440 Wolfsburg, Germany
| | - Niklas B. Pepper
- Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Rainer G. Wiewrodt
- Pulmonary Research Division, Münster University, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
- Department of Pulmonary Medicine, Mathias Foundation, Hospitals Rheine and Ibbenbueren, Frankenburgsstrasse 31, 48431 Rheine, Germany
| | - Walter Stummer
- Department of Neurosurgery, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Dorothee Wiewrodt
- Department of Neurosurgery, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| |
Collapse
|
5
|
Editor's Notebook: October 2022. AJR Am J Roentgenol 2022; 219:531-532. [PMID: 36135969 DOI: 10.2214/ajr.22.28227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|