Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA.
Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
Eur Radiol. 2020 May;30(5):2658-2668. doi: 10.1007/s00330-019-06614-w. Epub 2020 Feb 10.
To evaluate risk factors for prevalence and progression of aortic valve calcification (AVC) in lung cancer screening participants and also to assess the sensitivity and reliability of visual AVCs on low-dose CT (LDCT) for predicting aortic stenosis (AS) in high-risk smokers.
We reviewed 1225 consecutive participants in annual LDCT screening for lung cancer at the Mount Sinai Hospital between 2010 and 2017. Sensitivity and specificity of moderate/severe AVC score on LDCT to identify AS on echocardiogram were calculated for 126 participants who had both within 12 months. Using regression analyses, risk factors for AVC at baseline, for progression, and for new AVC on annual rounds of screening were identified. Reliability of AVC assessment on LDCT was assessed by comparing visual AVC scores (1) with standard-dose, electrocardiography (ECG)-gated CT for 31 participants who had both within 12 months and (2) with Agatston scores of 1225 participants and by determining (3) the intra-reader agreement of 1225 participants.
Visual AVC scores on LDCT had substantial agreement with the severity of AS on echocardiography and substantial inter-observer and excellent intra-observer agreement. Sensitivity and specificity of moderate/severe visual AVC scores for moderate/severe AS on echocardiogram were 100% and 94%, respectively. Significant predictors for baseline AVC were male sex (OR = 2.52), age (OR = 2.87), and coronary artery calcification score (OR = 1.18), the significant predictor for AVC progression after baseline was pack-years of smoking (HR = 1.14), and significant predictors for new AVC on annual LDCT were male sex (HR = 1.51), age (HR = 2.17), CAC (HR = 1.09) and BMI (HR = 1.06).
AVC scores on LDCT should be documented, especially in lung cancer screening program.
• LDCT screening for lung cancer provides an opportunity to identify lung cancer and cardiovascular disease in asymptomatic smokers. • Visual aortic valve calcification scores could be reliably evaluated on LDCT and had substantial agreement with the severity of aortic valve stenosis on echocardiography. • Sensitivity and specificity of moderate/severe visual AVC scores on LDCT for moderate/severe AS on echocardiogram were 100% and 94%, respectively.
评估肺癌筛查参与者主动脉瓣钙化（AVC）的流行率和进展的危险因素，并评估低剂量 CT（LDCT）上的视觉 AVC 对预测高危吸烟者主动脉瓣狭窄（AS）的敏感性和可靠性。
我们回顾了 2010 年至 2017 年间在西奈山医院进行年度 LDCT 筛查的 1225 例连续肺癌筛查参与者。对 126 例在 12 个月内均接受 LDCT 和超声心动图检查的患者，计算 LDCT 上中度/重度 AVC 评分预测超声心动图上 AS 的敏感性和特异性。使用回归分析确定基线时、进展时和年度筛查时新 AVC 的危险因素。通过比较（1）31 例在 12 个月内均接受 LDCT 和标准剂量、心电图（ECG）门控 CT 的视觉 AVC 评分，（2）1225 例参与者的 Agatston 评分，（3）1225 例参与者的观察者内一致性，评估 LDCT 上 AVC 评估的可靠性。
LDCT 上的视觉 AVC 评分与超声心动图上 AS 的严重程度具有显著相关性，观察者间和观察者内具有高度一致性。中度/重度视觉 AVC 评分预测超声心动图上中度/重度 AS 的敏感性和特异性分别为 100%和 94%。基线 AVC 的显著预测因素为男性（OR=2.52）、年龄（OR=2.87）和冠状动脉钙化评分（OR=1.18），基线后 AVC 进展的显著预测因素为吸烟包年数（HR=1.14），年度 LDCT 上新 AVC 的显著预测因素为男性（HR=1.51）、年龄（HR=2.17）、CAC（HR=1.09）和 BMI（HR=1.06）。
LDCT 上的 AVC 评分应予以记录，尤其是在肺癌筛查项目中。
