Experts involved in new research are encouraging radiologists to always report on coronary calcifications visualized during CT lung cancer screenings (LCS), as doing so frequently leads to additional exams and/or treatment when necessary.
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the United States. Patients of a certain ago and those deemed to be at risk of ASCVD commonly undergo calcium scoring CT scans to evaluate (score) disease severity, but calcium can also be visualized during routine chest CTs. However, despite this, experts recently found that coronary calcium incidentally detected during LCS is either not reported on or underestimated up to 34% of the time [1].
“Coronary artery calcification can be seen and qualitatively graded on nongated chest CTs, including lung cancer screening (LCS) CTs. Patients in LCS programs either currently smoke or have quit within the last 15 years and thus represent an important population for ASCVD since smoking is one of the major risk factors,” corresponding author of the new paper Suzanne C. Byrne, MD, of the Department of Radiology at Brigham and Women's Hospital, and co-authors explained.
Byrne and colleagues conducted a retrospective review of LCS CTs completed at their institution from January 2015 to November 2021 in search of interpretations containing the reporting of coronary calcification. Those patients were further narrowed down based on whether those patients also underwent a calcium scoring CT within one year of their LCS CT, resulting in a total of 117 patients with paired scans out of 8,987.
Coronary calcium was said to be underestimated in 28% of patients and was not mentioned during the initial LCS scan in 13%. When calcium was reported, it led to new statin prescriptions, with OR of 1.8, and when findings contained an “S” modifier (significant incidental finding), this figure increased to 4.4. The S modifier also led to stress testing in 9% of patients.
Reporting of calcium was found to be limited to only moderate to severe cases.
“The reporting of coronary calcification on LCS CT represents an example of opportunistic screening, i.e., using already-acquired images to screen for a separate disease (in this case ASCVD),” the authors explained. “Whenever a screening test is considered, opportunistic or not, the sensitivity and downstream implications of the test should be evaluated.”
The authors suggested that radiologists and clinicians must have a thorough understanding of these implications, as reporting on incidentally detected coronary calcium can lead to early initiation of management in patients found to be at high risk of ASCVD. They stated that radiologists should report on all patients with coronary calcium, not just those with moderate to severe findings, as this would allow an informed discussion between patients and referring providers regarding the risks and benefits.
The study abstract is available in Academic Radiology.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.