Department of Radiology, Massachusetts General Hospital, Boston, MA.
J Thorac Imaging. 2020 Mar;35(2):129-135. doi: 10.1097/RTI.0000000000000458.
Coronary artery calcification (CAC) is a common and important incidental finding in low-dose computed tomography (LDCT) performed for lung cancer screening (LCS). The impact of these incidental findings on patient management is unclear.
The goals of our study were to determine the impact of reporting CAC on patient management and to determine whether standardized reporting of CAC affects the likelihood of future interventions.
In this IRB-approved retrospective study, we queried our LCS database for reports of LDCT performed between January 2016 and September 2018. All reports with significant findings of CAC designated with the letter "S" for any Lung-RADS category were selected. The grading of CAC was extracted from the reports. Medical records were reviewed for each patient to determine demographics, clinical history, medications, and cardiac-related diagnostic and interventional procedures. The changes in management after the report of significant CAC on LDCT were documented. Statistical analysis with Student t test and Pearson χ test was performed.
A total of 756/3110 patients (mean age: 67±6.4 y; M=466, 61.6%: F=290, 38.4%) were reported to have significant CAC on LDCT for LCS. Of them, 236/756 patients (31.2%) had established coronary artery disease (CAD) at baseline, before the initial LDCT. A change in management was observed in 155/756 patients (20.5%). The most common changes in management included the following: alteration in medication regimen (n=114/155, 73.5%), stress testing (n=65/155, 41.9%), and referral to a cardiologist (36/155, 23.2%). Percutaneous coronary intervention (4, 2.6%) and surgery (3, 1.9%) were uncommon. Changes in management were more common in those without established CAD and in those whose CAC was semiquantitatively graded (35% vs. 25%, P=0.02).
CAC is a common significant finding in LDCT for LCS. Reporting of CAC in patients with nonestablished CAD and semiquantitative assessment resulted in changes in management.
在肺癌筛查（LCS）中进行的低剂量计算机断层扫描（LDCT）中，冠状动脉钙化（CAC）是一种常见且重要的偶然发现。这些偶然发现对患者管理的影响尚不清楚。
我们研究的目的是确定报告 CAC 对患者管理的影响，并确定 CAC 的标准化报告是否会影响未来干预的可能性。
在这项经 IRB 批准的回顾性研究中，我们从 2016 年 1 月至 2018 年 9 月的 LCS 数据库中查询了 LDCT 报告。选择了任何 Lung-RADS 类别中带有字母“S”表示 CAC 有显著发现的所有报告。从报告中提取 CAC 的分级。对每位患者的病历进行了审查，以确定人口统计学、临床病史、药物和心脏相关的诊断和介入程序。记录了 LDCT 报告有显著 CAC 后管理的变化。进行了学生 t 检验和 Pearson χ 检验的统计分析。
共有 756/3110 例（平均年龄：67±6.4 岁；男性=466 例，占 61.6%；女性=290 例，占 38.4%）因 LCS 行 LDCT 时报告有显著 CAC。其中，236/756 例（31.2%）患者在初始 LDCT 前已经患有冠状动脉疾病（CAD）。756 例患者中有 155 例（20.5%）患者的管理发生了变化。最常见的管理变化包括以下内容：改变药物治疗方案（n=114/155，73.5%）、应激测试（n=65/155，41.9%）和转介给心脏病专家（n=36/155，23.2%）。经皮冠状动脉介入治疗（4 例，2.6%）和手术（3 例，1.9%）很少见。在无 CAD 且 CAC 半定量分级的患者中，管理变化更为常见（35%比 25%，P=0.02）。
在 LCS 的 LDCT 中，CAC 是一种常见的显著发现。在无 CAD 和半定量评估的患者中报告 CAC 会导致管理方式发生变化。
