Comparability of coronary risk assessment methods with chest ultra-LDCT and CT coronography with ECG synchronization

Purpose. To assess the comparability of coronary calcium values measured on ultralow-dose computed tomography studies without ECG-synchronization versus a) non-contrast computed tomography with ECG synchronization, b) CT coronography with ECG synchronization.Materials and methods. The study comprised 283 studies: 68 patients who underwent contrast-free ultra-LDCT without ECG synchronization and contrast-free CT with ECG synchronization performed in a single visit, and 49 patients with contrast-free ultra-LDCT without ECG synchronization, non-contrast CT with ECG synchronization, and CT coronography with ECG synchronization and intravenous injection of contrast agent, also carried out in one visit, meeting all inclusion and exclusion criteria of the study.Quantitative coronary calcium values were calculated with the Agatston score and the CAC-DRS scale (score of calcification degree from 0 to 3 and the number of affected arteries from 0 to 4 points). The degree of coronary artery stenosis was analyzed with CAD-RADS scale (0-5).The above parameters were compared using visual/quantitative assessment of coronary calcium on ultra-LDCT without ECG synchronization and visual/quantitative assessment for CT with ECG synchronization, as well as the degree of stenosis on CT coronography in the same patients.Results. Based on the results of accuracy indices comparison, the possibility to use quantitative scale (Agatston score, CAC-DRS quantitative scale) to assess coronary calcification in the lung cancer screening in comparison with ECG-synchronized CT was determined during interpretation of ultra-LDCT without ECG synchronization. The correlation matrix to assess correlation between visual, quantitative scales of coronary artery changes and calcification at ultra-LDCT without ECG synchronization and quantitative scale at CT with ECG synchronization vs. CT coronography identifies very strong positive statistically significant correlations.Conclusion. Methods of coronary calcinosis assessment with chest ultra-LDCT and CT with ECG synchronization are comparable, therefore it is possible to assess coronary calcium in lung cancer screening by ultra-LDCT data at a reliable-high level using both quantitative and visual CAC-DRS scales.

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Ability of Evaluation Coronary Calcium Index Based on Ultra-Low-Dose Computed Tomography Used in Moscow Lung Cancer Screening Project

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2021-06-18 ◽

2021 ◽

Vol 17 (3) ◽

pp. 414-422

Author(s):

A. E. Nikolaev ◽

A. N. Shapiev ◽

O. A. Korkunova ◽

G. Z. Mukhutdinova ◽

P. V. Tkacheva ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Coronary Artery ◽

Cancer Screening ◽

Low Dose ◽

Lung Cancer Screening ◽

Coronary Calcium ◽

Slice Thickness ◽

Diagnostic Significance ◽

Low Dose Computed Tomography

Aim. Determination of the possibility of reliable quantitative assessment of the coronary calcium index based on ultra-low-dose computed tomography (ultra-LDCT) which used in Moscow Lung Cancer Screening project.Material and methods. The study included the results of 254 ultra-LDCT studies conducted as part of the Moscow lung cancer screening project. For compare the parameters of coronary calcium on different images used 16 pairs of ultra-LDCT images with a slice thickness of 1 mm and CT images with a slice thickness of 3 mm, performed without ECG synchronization, performed with an interval of less than 10 days, as well as 18 pairs of ultra-LDCT with a slice thickness of 1 mm and CT with ECG synchronization with a slice thickness of 3 mm, performed on the same day after execution. Analysis of DICOM 3.0 standard images was performed. Quantitative indicators of coronary calcium in patients from lung cancer screening were analyzed, a comparative analysis of the calcium index for Agatstone, Volume, Mass, and using the CAC-DRS scale (assessment of the degree of calcification by scores from 0 to 3 and the number of affected arteries from 0 to 4 points) was performed.Results. Evaluation ultra-LDCT with a slice thickness in 1 mm and with a CT scan with slice thickness in 3 mm with and without ECG-synchronization for the presence of coronary calcium, and subsequent rating according to the index Agatston, Volume, Mass, as the total coronary calcium and for each coronary artery (right, left, left descending, left circumflex) received the complete data correlation (Pearson's - 1), with full correlation (Spearman's >0.9), with good rank correlations (>0,9). Compare qualitative (CAC-DRS V) and quantitative (CAC-DRS A) estimates on ultra-LDCT with CT with ECG synchronization in the same patients show a complete correlation of data was obtained (Pearson's formula - 1), with a complete correlation (Spearman's formula - 1).Conclusion. Coronary calcium which detected in lung cancer screening subjects should be included in the overall decision-making process for further routing of patients (cardiologist, interventional surgeon, pulmonologist, therapist). Ultra-LDCT is a method that has high diagnostic accuracy in detecting and evaluating the prevalence of coronary calcium in comparison with standard CT with and without ECG synchronization, as demonstrated in our study. Evaluation of coronary calcium according to ultra-LDCT without ECG synchronization used in screening, preferably with a 1 mm slice thickness. Despite the fact that the gold standard is CT with ECG synchronization with a 3 mm slice thickness, the diagnostic significance of ultra-LDCT which used in lung cancer screening is high in relation to detecting coronary artery calcification.

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Impact of Slice Thickness on the Predictive Value of Lung Cancer Screening Computed Tomography in the Evaluation of Coronary Artery Calcification

Journal of the American Heart Association ◽

10.1161/jaha.118.010110 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 7

Author(s):

Jared L. Christensen ◽

Esseim Sharma ◽

Anastassia Y. Gorvitovskaia ◽

Jerome P. Watts ◽

Maen Assali ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Coronary Artery ◽

Cancer Screening ◽

Predictive Value ◽

Coronary Artery Calcification ◽

Lung Cancer Screening ◽

Slice Thickness

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Impact of Significant Coronary Artery Calcification Reported on Low-Dose Computed Tomography Lung Cancer Screening

Journal of Thoracic Imaging ◽

10.1097/rti.0000000000000458 ◽

2020 ◽

Vol 35 (2) ◽

pp. 129-135 ◽

Cited By ~ 3

Author(s):

Dexter P. Mendoza ◽

Bashar Kako ◽

Subba R. Digumarthy ◽

Jo-Anne O. Shepard ◽

Brent P. Little

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Coronary Artery ◽

Cancer Screening ◽

Coronary Artery Calcification ◽

Low Dose ◽

Lung Cancer Screening ◽

Low Dose Computed Tomography

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Prevalence and distribution of coronary calcium in asymptomatic Japanese subjects in lung cancer screening computed tomography

Journal of Cardiology ◽

10.1016/j.jjcc.2015.06.010 ◽

2016 ◽

Vol 67 (5) ◽

pp. 449-454 ◽

Cited By ~ 4

Author(s):

Yuki Ohmoto-Sekine ◽

Ryoko Yanagibori ◽

Kazuhisa Amakawa ◽

Makiko Ishihara ◽

Hiroshi Tsuji ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Cancer Screening ◽

Lung Cancer Screening ◽

Coronary Calcium ◽

Japanese Subjects

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Impact on All-Cause and Cardiovascular Mortality Rates of Coronary Artery Calcifications Detected during Organized, Low-Dose, Computed-Tomography Screening for Lung Cancer: Systematic Literature Review and Meta-Analysis

Cancers ◽

10.3390/cancers13071553 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1553

Author(s):

Sébastien Gendarme ◽

Helene Goussault ◽

Jean-Baptiste Assié ◽

Cherifa Taleb ◽

Christos Chouaïd ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Coronary Artery ◽

Cancer Screening ◽

Low Dose ◽

Meta Analysis ◽

Lung Cancer Screening ◽

Mortality Rates ◽

All Cause Mortality ◽

Low Dose Computed Tomography

Although organized, low-dose, computed-tomography (CT) scan lung-cancer screening has been shown to lower all-cause and lung-cancer-specific mortality, the primary cause of death for subjects eligible for such screening remains cardiovascular (CV) mortality. This meta-analysis study was undertaken to evaluate the impact of screening-scan-detected coronary artery calcifications (CACs) on CV and all-cause mortality. We conducted a systematic review and meta-analysis of studies reporting CV mortality according to the Agatson CAC score for participants in a lung-cancer screening program of randomized clinical or cohort studies. PubMed, Embase, and Cochrane databases were screened in June 2020. Two authors independently selected articles and extracted data. Six studies, including 20,175 subjects, were retained. CV and all-cause mortality rates were higher for subjects with CAC scores >0, with respective relative risks of 2.02 [95% CI 1.23–3.32] and 2.29 [95% CI 1.00–5.21]. Both mortality rates were even higher for those with high CAC scores (>400 or >1000). CACs are more common in men than in women, with an odds ratio of 1.49 [95% CI 1.40–1.59]. The presence of CAC is associated with CV mortality with an RR of 2.05 [95% CI 1.20–3.57] in men and 2.37 [CI 95% 1.29–5.09] in women, respectively. Analysis of lung-cancer-screening scans for CACs is a tool able to predict CV mortality. Prospective studies within those programs are needed to assess the benefit of primary CV prevention based on CAC detection.

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Cardiac visceral fat volume estimation from low-dose chest computed tomography: a study with a designed beating heart phantom

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2021-49-006 ◽

2021 ◽

Vol 49 (1) ◽

pp. 61-71

Author(s):

V. Yu. Chernina ◽

N. S. Kulberg ◽

O. O. Aleshina ◽

T. A. Korb ◽

I. A. Blokhin ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Adipose Tissue ◽

Cancer Screening ◽

Low Dose ◽

Lung Cancer Screening ◽

Coronary Calcium ◽

Stage I ◽

Stage Ii ◽

Contracting Heart

Background: Since 2017, a pilot project for lung cancer screening by chest low dose computed tomography (LDCT) has been implemented in Moscow. Patients to be included into the screening have risk factors for ischemic heart disease (IHD). The association between epicardial adipose tissue (EAT) volume and coronary artery atherosclerosis, IHD, and atrial fibrillation has been demonstrated previously.Aim: To demonstrate the feasibility of LDCTbased EAT volumetry using a dynamic (contracting) heart phantom.Materials and methods: The study was performed with the designed dynamic heart phantom and chest phantom in two stages. At stage I, two adipose tissue pieces were scanned inside and outside the chest phantom using CT and LDCT. At stage II, the dynamic heart phantom was scanned outside and inside the chest phantom. In addition, we scanned the heart phantom with a coronary calcium phantom. The contracting heart phantom was developed within three months. All scans of the phantom were performed within one day. We determined the adipose tissue thresholds in LDCT and the EAT volumetric error with both chest CT and LDCT. Measurements of the adipose tissue volumes were performed by the radiologist twice with semi-automatic software.Results: The results of stage I helped to identify optimal density thresholds for LDCT-based adipose tissue volumetry in lung cancer screening, ranging from -250 HU to -30 HU. The stage II results showed that for all heart phantom scanning variants, the average EAT volumetry error did not exceed 5%, except for the case of contracting heart phantom with added coronary calcium in a chest phantom with body mass index (BMI) 29 (-5.92%). Adding the coronary calcium phantom to the heart phantom in LDCT increased the error by an average of 4% in BMI 23 and BMI 29 chest phantoms.Conclusion: LDCT-based EAT volumetry with fat density threshold from -250 HU to -30 HU is feasible in lung cancer screening, including patients with coronary calcium. However, considering the phantom design, further patient studies, and correlation of EAT volumes between LDCT for lung cancer screening and сoronary CT angiography are required.

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