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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Shall we report cardiomegaly at routine computed tomography of the chest?
Marc J Gollub1, Neety Panu, Holly Delaney
1Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. gollubm@mskcc.org
Insights
The cardiothoracic ratio (CTR) on CT scans correlates with chest X-rays and can help detect left ventricular hypertrophy (LVH). A CTR below 0.49 suggests a low likelihood of LVH in cancer patients.
Area of Science:
- Radiology
- Cardiology
- Oncology
Background:
- Cardiomegaly and left ventricular hypertrophy (LVH) are common cardiac conditions.
- Echocardiography (ECHO) is the gold standard for diagnosing cardiac abnormalities.
- Routine chest computed tomography (CT) may offer insights into cardiac health.
Purpose of the Study:
- To assess the accuracy of the cardiothoracic ratio (CTR) on routine chest CT for diagnosing cardiomegaly, using ECHO as the gold standard.
- To identify CT-derived cardiac measurements that correlate with LVH detected by ECHO.
Main Methods:
- A retrospective analysis of 101 cancer patients who underwent both chest CT and ECHO.
- Cardiothoracic ratio (CTR) measured on CT and chest radiography (CXR).
- Correlation and receiver operating characteristic (ROC) curve analyses were performed.
Main Results:
- CTR on CT and CXR were highly correlated (r = 0.802).
- CT CTR showed moderate ability to identify LVH (AUC = 0.70).
- CT left ventricular diameter moderately correlated with ECHO measurements (r = 0.49 for internal diameter, r = 0.37 for mass).
Conclusions:
- Cardiothoracic ratio (CTR) on routine CT scans is highly correlated with CTR on chest X-rays (CXR).
- Preliminary findings suggest a CTR < 0.49 on CT may indicate a low likelihood of left ventricular hypertrophy (LVH).
- Further research is needed to validate these findings in larger cohorts.
Purpose:
To examine the accuracy of the cardiothoracic ratio (CTR) at routine computed tomography (CT) of the chest to diagnose cardiomegaly by using echocardiography (ECHO) as a criterion standard, and secondarily, to search for CT cardiac measurements correlating with left ventricular hypertrophy (LVH) at ECHO.
Materials And Methods:
We searched 2 databases: cancer patients who had chest CT who also underwent routine ECHO by one experienced cardiologist, from January to March 2008. Consecutive patients were enrolled who had chest radiography (CXR) within 1 month and ECHO within 6 months of CT. Cardiothoracic ratio was defined as the transverse greatest cardiac diameter from outer to outer myocardium on axial images divided by the transverse greatest thoracic diameter from inner to inner chest wall on axial images, as measured by 2 board-certified radiologists. Left ventricular short diameter on CT was measured from inner to inner myocardium. Left ventricular hypertrophy at ECHO was defined using the standard American Society of Echocardiography criteria. Other data captured included cardiac and chemotherapy history, and secondary signs of heart failure. The Pearson correlation coefficient (r) and Wilcoxon rank sum tests and receiver operating characteristic (ROC) curves were used for statistical analysis.
Results:
101 patients, 52 men and 49 women, with a mean age of 58 years met the entry criteria. Cardiothoracic ratio at CXR and CT were highly correlated (r = 0.802) (P < 0.001). There was moderate ability of CT CTR to identify LVH (area under the receiver operating characteristic curve AUC = 0.70; 95% CI, 0.51-0.90). The CT left ventricular short diameter showed moderate correlation with the ECHO left ventricular internal diameter (r = 0.49) and left ventricular mass (r = 0.37).
Conclusion:
In patients with cancer undergoing routine ECHO, the cardiothoracic ratio at routine CT scans was highly correlated with that at CXR. Preliminary estimates in this small study indicate a low likelihood of LVH when the CTR is less than 0.49.
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