Caroline Chiles MD, Presenter: Nothing to Disclose

Fenghai Duan PhD, Abstract Co-Author: Consultant, WorldCare Clinical, LLC

Gregory W. Gladish MD, Abstract Co-Author: Nothing to Disclose

James G. Ravenel MD, Abstract Co-Author: Nothing to Disclose

Scott Baginski MD, Abstract Co-Author: Nothing to Disclose

Bradley Jay Snyder MD, Abstract Co-Author: Nothing to Disclose

Sarah Baum MS, Abstract Co-Author: Nothing to Disclose

Stephanie M. Smith BA, Abstract Co-Author: Nothing to Disclose

Reginald F. Munden MD, DMD, Abstract Co-Author: Spouse, Research Grant, Toshiba Coporation

Low dose CT (LDCT) screening for lung cancer offers an opportunity to evaluate coronary artery calcification (CAC), a predictor of cardiovascular events strongly associated with age and smoking history. This study examines mortality in NLST participants with quantitative and qualitative CAC scores.

We conducted a retrospective, randomly selected, case-control study to analyze the relationship between baseline LDCT CAC, coronary heart disease (CHD) and all-cause (AC) mortality . Five cardiothoracic radiologists evaluated a total of 1,570 LDCTs from 3 groups: group 1 included 210 CHD deaths; group 2 included 314 AC deaths (excluding CHD); a control group included 1046 participants alive at conclusion of the trial. Of these, 133 were excluded for clinical/technical reasons. Readers performed quantitative analysis of CAC (Agatston scoring), as well as qualitative analysis, based on both an overall and a per-vessel visual assessment (none/0, mild/1, moderate/2, heavy/3), using a set of standard reference CT images.

A CAC Agatston score of 0 was present in 34% of controls, 12% of patients with CHD death and 18% of patients with ACM (p<0.001). In predicting time to CHD death, total Agatston scores of 1-100, 101-1,000, and >1,000 (reference 0) were associated with hazard ratios (HRs) of 1.3 (p=.40), 3.5 (p<.001), 6.0 (p<.001); the visual assessments of 1-9, 10-19, and 20-30 (summing the ordinal scores of 10 vessel segments, reference 0) were associated with HRs of 2.4 (p=.001), 4.5 (p<.001), 6.6 (p<.001); the overall visual assessments were associated with HRs of 2.1 (p=.008), 3.7 (p<.001), 5.9 (p<.001). In predicting time to AC death (including CHD death), corresponding HRs for total Agatston scores were 1.2 (p=.25), 2.4(p<.001), 3.5 (p<.001); corresponding HRs for the summed visual assessment were 1.8 (p<.001), 3.1 (p<.001), 3.6 (p<.001); corresponding HRs for the overall visual assessments were 1.6 (p=.006), 2.4 (p<.001), 3.4 (p<.001), respectively.

A visual assessment of CAC can be used for risk prediction of CHD death and ACM using non-gated LDCT for lung cancer screening, and is comparable to Agatston scoring. ACRIN receives funding from the National Cancer Institute through the grants U01 CA079778 and U01CA 080098.

CAC, a significant cause of mortality in the lung cancer screening population, can be evaluated by a simple visual assessment.

Chiles, C, Duan, F, Gladish, G, Ravenel, J, Baginski, S, Snyder, B, Baum, S, Smith, S, Munden, R, Coronary Artery Calcification as a Predictor of Mortality in the National Lung Screening Trial – American College of Radiology Imaging Network.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13016702.html