Rationale and Objectives
To evaluate the accuracy and downstream testing and statin prescribing of real-world
reporting of coronary calcification on lung cancer screening (LCS) CT.
Materials and Methods
We retrospectively reviewed LCS CTs from January 2015 to November 2021 for reporting
of coronary calcification; reports that denoted coronary calcification as a significant
incidental finding (“S” modifier) were also noted. We evaluated calcium scoring accuracy
in patients in whom a cardiac or calcium scoring CT was performed within 1 year of
the LCS CT. For the first LCS CT in all patients, we evaluated whether a stress test
was performed within 6 months and whether a new statin prescription was written within
90 days of the LCS CT. Patients were stratified by atherosclerotic cardiovascular
disease (ASCVD) risk group, used in a multivariable regression analysis for new statin
prescriptions.
Results
Eight thousand nine hundred eighty-seven patients underwent screening. In 117 patients
who had a paired cardiac CT, scores were concordant in 65 (56%), and LCS CTs did not
mention or underestimated calcifications in 40 (34%). Reporting of coronary artery
calcifications led to new statin prescriptions, with OR of 1.8 for calcifications
without S modifier and 4.4 for calcifications with S modifier. Reporting of coronary
artery calcification with S modifier led to subsequent stress testing in 141/1582
(9%) of patients.
Conclusion
Coronary calcifications are frequently not mentioned or underestimated at LCS CT.
Reporting of coronary calcifications leads to new statin prescriptions, and radiologists
should consider reporting these to allow for a risk-benefit discussion with the patient's
physician.
Key Words
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Article info
Publication history
Published online: November 30, 2022
Accepted:
November 11,
2022
Received in revised form:
October 27,
2022
Received:
September 14,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
