Reporting and Outcomes of Coronary Calcification on Lung Cancer Screening CT

  • Mark M. Hammer
    Address correspondence to: M.H.
    Department of Radiology, Brigham and Women's Hospital, Boston, 75 Francis St, Boston, 02115, Massachusetts

    Harvard Medical School, Boston, Massachusetts
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  • Suzanne C. Byrne
    Department of Radiology, Brigham and Women's Hospital, Boston, 75 Francis St, Boston, 02115, Massachusetts

    Harvard Medical School, Boston, Massachusetts
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  • Ron Blankstein
    Department of Radiology, Brigham and Women's Hospital, Boston, 75 Francis St, Boston, 02115, Massachusetts

    Harvard Medical School, Boston, Massachusetts

    Cardiovascular Imaging Program, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Published:November 30, 2022DOI:

      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.


      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.


      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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