Reporting and Outcomes of Coronary Calcification on Lung Cancer Screening CT

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 calcifica-tion; 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 cal-cifications 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.(c) 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Automated summary

This study retrospectively evaluated the accuracy of reporting coronary calcification on lung cancer screening CTs in real-world scenarios, as well as the subsequent testing and prescribing of statins. The results showed that 65% of patients had concordant coronary calcification scores in paired cardiac CTs, while in 34% of patients, the calcifications were not mentioned or underestimated. Reporting coronary artery calcification led to new statin prescriptions, with a higher odds ratio for calcifications with significant incidental findings. Radiologists should consider reporting coronary calcifications to facilitate risk-benefit discussions with physicians.