What should we do about Coronary Calcification on Thoracic CT?

Abstract

Purpose Coronary artery calcification is a frequent incidental finding on thoracic computed tomography (CT) performed for non-cardiac indications. On electrocardiogram-gated cardiac CT, it is an established marker of coronary artery disease and is associated with increased risk of subsequent cardiac events.

Materials and Methods This review discusses the current evidence and guidelines regarding the reporting of coronary artery calcification on non-electrocardiogram-gated thoracic CT performed for non-cardiac indications.

Results For patients undergoing routine thoracic CT, coronary artery calcification is associated with an increased risk of myocardial infarction and mortality. Coronary artery calcification can be accurately assessed on non-gated thoracic CT compared to gated CT. Guidelines support the reporting of coronary artery calcification on thoracic CT. However, radiologist opinions vary. The identification of coronary artery calcification on thoracic CT may identify patients with previously unknown coronary artery disease. For asymptomatic patients this may trigger an assessment of modifiable cardiovascular risk factors and guide the appropriate use of preventative medications.

Conclusion Future research will address whether changing management based on calcification on thoracic CT will improve outcomes and automated assessment of calcification using machine learning techniques.

Key Points:

• Coronary artery calcification is a frequent incidental finding on thoracic CT.

• The presence and severity of coronary artery calcification is associated with cardiac outcomes and mortality.

• Reporting coronary artery calcification on thoracic CT is supported by national and international guidelines.

Citation Format

• Williams MC, Llewellyn O, . What Should We Do About Coronary Calcification on Thoracic CT?. Fortschr Röntgenstr 2022; 194: 833 – 840

Zusammenfassung

Hintergrund Die Verkalkung der Koronararterien ist ein häufiger Zufallsbefund der Thorax-Computertomografie (CT) bei nicht-kardialen Indikationen. In der EKG-getriggerten Herz-CT ist sie ein bekannter Marker für eine koronare Herzkrankheit und mit einem erhöhten Risiko für nachfolgende kardiale Ereignisse verbunden.

Materialien und Methoden Diese Übersichtsarbeit diskutiert die aktuelle Evidenz und die Leitlinien in Bezug auf den Nachweis einer Koronararterienverkalkung bei nicht EKG-gesteuerten Thorax-CT-Untersuchungen bei nicht-kardialen Indikationen.

Ergebnisse Bei Patienten, die sich einer routinemäßigen Thorax-CT unterziehen, ist eine Koronararterienverkalkung mit einem erhöhten Myokardinfarkt- und Mortalitätsrisiko verbunden. Koronararterienverkalkung kann bei der Thorax-CT ohne Gating im Vergleich zur Gating-CT genau beurteilt werden. Die Leitlinien unterstützen den Nachweis einer Koronararterienverkalkung in der Thorax-CT. Die Meinungen der Radiologen gehen jedoch auseinander. Der Nachweis einer Koronararterienverkalkung in der Thorax-CT kann Patienten mit zuvor unbekannter Koronararterienerkrankung erkennen. Bei asymptomatischen Patienten kann dies der Auslöser für die Beurteilung modifizierbarer kardiovaskulären Risikofaktoren sein und zum angemessenen Einsatz von Präventivmedikamenten führen.

Schlussfolgerung Zukünftige Forschungsarbeiten werden sich mit der Frage befassen, ob eine Veränderung der Behandlung auf Grundlage von Verkalkungen in der Thorax-CT zu einem besseren Outcome und zu einer Verbesserung der automatischen Bewertung von Verkalkungen durch maschinelles Lernen führt.

Kernaussagen:

• Koronararterienverkalkung ist ein häufiger Zufallsbefund in der Thorax-CT.

• Vorhandensein und Schweregrad einer Koronararterienverkalkung sind mit kardialen Folgen und Mortalität assoziiert.

• Nationale und internationale Leitlinien unterstützen, dass eine Koronararterienverkalkung in der Thorax-CT in den Arztbericht aufgenommen wird.

Key words

cardiac - CT - outcomes analysis

Publikationsverlauf

Eingereicht: 06. September 2021

Angenommen: 05. Januar 2022

Artikel online veröffentlicht:
10. März 2022

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