CORONARY CALCIUM REPORTING TRENDS IN THE US

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1 CORONARY CALCIUM REPORTING TRENDS IN THE US Jacobo Kirsch, MD 1 Felipe Martinez, MD 1 Craig Asher, MD 2 1 Division of Radiology 2 Department of Cardiology Cleveland Clinic Florida

2 No relevant financial disclosure.

3 Introduction Risk stratification is the cornerstone of preventive cardiology. Calcium scoring has abundant supporting data from large prospective studies that show its association with the risk of future cardiovascular events.

4 Introduction Agatston scoring and ordinal scoring methods are predictive of cardiovascular death and major adverse cardiac events. Additionally, several studies have demonstrated that a simpler so-called Gestalt method of visual analysis of calcium burden correlates well with dedicated calcium scoring methods. Furthermore, that these Gestalt method may also be sufficient for risk classification.

5 Purpose To determine the trends in reporting coronary calcium during non-cardiac CT examinations in the US.

6 Methods/Materials Survey Monkey surveys were sent to all ACR members self-described in their profiles as radiologists trained in the US. Questionnaire items included questions regarding their preferences/structure for reporting the presence/absence of coronary calcifications on standard CT exams of the chest.

7 Survey Questions 1. In your practice, do you interpret CT scans of the chest (adults)? 2. You are a radiologist in practice for how long? 3. Do you consider yourself a cardiac imager (ie. subspecialty training, advance proficiency certification, etc)? 4. On your non-gated chest CT interpretations, do you routinely report the presence of coronary calcifications? 5. Does your institution perform coronary artery calcium score studies? 6. Do you interpret coronary calcium scoring? 7. On your non-gated chest CT interpretations, when reporting the presence of coronary calcifications, do you mention only the presence of calcium or do you qualify the amount of calcified plaque? 8. On your non-gated chest CT reports, when coronary calcified plaque is present, do you include recommendations for further imaging? 9. Do you use a reporting template for non-contrast CT reporting? 10.Is coronary calcium presence a part of the template? 11.Are you aware of published data correlating qualitative and quantitative calcium scores on non-gated chest CT examinations?

8 Results 634 responses were received of which 541 (85%) included radiologists that interpret CT exams of the chest; of these, only 24% considered themselves cardiac imagers. 474 radiologists routinely reported the coronary calcifications on their reports (88%). However, only 52% reported an assessment of the atherosclerotic burden.

9 Results Of those that consider themselves cardiac imagers, 91% reported the calcifications. However, only 57% of them reported a subjective assessment (any grading system such as mild, moderate, severe) of the plaque burden.

10 Results Are you aware of published data correlating qualitative and quantitative calcium scores on non-gated chest CT examinations? No 58% Yes 42%

11 Conclusions While most radiologists interpreting CT exams of the thorax do report the presence/absence of coronary calcium, only approximately half of them provide a subjective assessment of the plaque burden. Only a minority of radiologists are aware of published data supporting the good correlation between subjective assessment and quantitative measurements.

12 References Wilson PWF, D Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97: Budoff MJ, Shaw LJ, Liu ST, et al. Long-term prog- nosis associated with coronary calcification: observa- tions from a registry of patients. J Am Coll Cardiol. 2007;49(18): The detection of any coronary calcium outperforms Framingham risk score as a first step in screening for coronary atherosclerosis. Johnson KM, Dowe DA. AJR Am J Roentgenol May;194(5): Budoff MJ, Nasir K, Kinney GL, et al. Coronary artery and thoracic calcium on noncontrast thoracic CT scans: comparison of ungated and gated examinations in patients from the COPD Gene cohort. J Cardiovasc Comput Tomogr 2011;5(2): CrossRef, Medline Kirsch J, Buitrago I, Mohammed TL, Gao T, Asher CR, Novaro GM. Detection of coronary calcium during standard chest computed tomography correlates with multi-detector computed tomography coronary artery calcium score. Int J Cardiovasc Imaging 2012;28(5): Einstein AJ, Johnson LL, Bokhari S, et al. Agreement of visual estimation of coronary artery calcium from low-dose CT attenuation correction scans in hybrid PET/CT and SPECT/CT with standard Agatston score. J Am Coll Cardiol 2010;56(23): Shemesh J, Henschke CI, Shaham D, et al. Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease. Radiology 2010;257(2): C Chiles, F Duan, GW Gladish, JG Ravenel, SG Baginski, BS Snyder, S DeMello, SS Desjardins, RF Munden, For of the NLST Study Team. Association of Coronary Artery Calcification and Mortality in the National Lung Screening Trial: A Comparison of Three Scoring Methods. Radiology. DOI: Huang YL, Wu FZ, Wang YC, et al. Reliable categorisation of visual scoring of coronary artery calcification on lowdose CT for lung cancer screening: validation with the standard Agatston score. Eur Radiol 2013;23(5): Shemesh J, Henschke CI, Farooqi A, et al. Frequency of coronary artery calcification on low-dose computed tomography screening for lung cancer. Clin Imaging 2006;30(3):

Corporate Medical Policy

Corporate Medical Policy Computed Tomography to Detect Coronary Artery Calcification File Name: computed_tomography_to_detect_coronary_artery_calcification Origination: 3/1994 Last CAP Review 11/2014 Next