低剂量计算机断层扫描筛查肺癌时冠状动脉钙化的发生率

Frequency of coronary artery calcification on low-dose computed tomography screening for lung cancer.

作者信息

Shemesh Joseph, Henschke Claudia I, Farooqi Ali, Yip Rowena, Yankelevitz David F, Shaham Dorith, Miettinen Olli S

机构信息

Department of Cardiology, The Grace Ballas Cardiac Research Unit, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.

出版信息

Clin Imaging. 2006 May-Jun;30(3):181-5. doi: 10.1016/j.clinimag.2005.11.002.

DOI:10.1016/j.clinimag.2005.11.002

PMID:16632153

Abstract

PURPOSE

The purpose of this study was to determine the frequency of coronary artery calcification (CAC) in high-risk people undergoing computed tomography (CT) screening for lung cancer.

METHODS

Between 1999 and 2004, we performed CT screening for lung cancer on 4250 participants, all without documented prior cardiovascular disease, using multidetector-row (MD) CT. Of the patients, 1102 underwent imaging with a four-detector-row CT at 120 kVp and 40 mA, with pitch 1.5 and collimation of 2.5 mm in a single breath hold of 15-20 seconds, and 3148 did with an eight-detector-row CT at the same kVp, mA, and pitch settings but with collimation of 1.25 mm. Visualized CACs in each coronary artery (main, left anterior descending, circumflex, and right) were scored separately as 0 (absent), 1 (mild), 2 (moderate), or 3 (severe), yielding a possible score of 0-12 for each person. Frequency distributions by gender, age, and pack-years of smoking were determined. Odds ratios (ORs) were calculated using logistic regression analysis of the prevalence of CAC as a joint function of gender, age, pack-years of smoking, and presence of diabetes.

RESULTS

Among the subjects younger than 50 years, positive CAC scores were three times more frequent for men than for women (22% vs. 7%); among those older than 50 years, the frequency increased for both men and women but the increase for women was greater than that for men. The frequency of positive CAC scores increased with increasing pack-years of smoking; it was always higher for men than for women. The ORs were 2.6 for male gender (P<.0001), 3.7 and 9.6 for ages 60-69 years and 70 years or older, respectively, for increasing age (P<.0001 for both), 1.6 and 2.3 for 30-59 pack-years and 60 pack-years or longer, respectively, for increasing pack-years of smoking (P<.0001 for both), and 1.6 for having diabetes (P=.016).

CONCLUSION

The CAC score can be derived from ungated low-dose MDCT images. This information can contribute to risk stratification and management of coronary artery disease.

摘要

目的

本研究旨在确定接受计算机断层扫描（CT）肺癌筛查的高危人群中冠状动脉钙化（CAC）的发生率。

方法

1999年至2004年间，我们使用多排探测器（MD）CT对4250名参与者进行了肺癌CT筛查，所有参与者均无心血管疾病病史。其中，1102例患者采用四排探测器CT在120 kVp和40 mA条件下成像，螺距为1.5，准直为2.5 mm，单次屏气15 - 20秒；3148例患者采用八排探测器CT在相同的kVp、mA和螺距设置下成像，但准直为1.25 mm。分别对每条冠状动脉（主冠状动脉、左前降支、回旋支和右冠状动脉）中可视化的CAC进行评分，分为0（无）、1（轻度）、2（中度）或3（重度），每个人的可能评分为0 - 12分。确定了按性别、年龄和吸烟包年数的频率分布。使用逻辑回归分析计算CAC患病率作为性别、年龄、吸烟包年数和糖尿病存在情况的联合函数的比值比（OR）。

结果

在50岁以下的受试者中，男性CAC阳性评分的频率是女性的三倍（22%对7%）；在50岁以上的受试者中，男性和女性的频率均增加，但女性的增加幅度大于男性。CAC阳性评分的频率随吸烟包年数的增加而增加；男性的频率始终高于女性。男性的OR为2.6（P <.0001），60 - 69岁和70岁及以上年龄组随年龄增加的OR分别为3.7和9.6（两者P均<.0001），30 - 59包年和60包年及以上随吸烟包年数增加的OR分别为1.6和2.3（两者P均<.0001），患有糖尿病的OR为1.6（P =.016）。