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Updated: May 9, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Frequency of unrecognized, unreported, or underreported coronary artery and cardiovascular calcification on
Kim Allan Williams1, James T Kim, Kathleen M Holohan
1Division of Cardiology, Wayne State University School of Medicine, Harper University Hospital, 3990 John R, 4 Hudson, Detroit, MI 48201, USA. kawilliams@med.wayne.edu
Insights
Coronary artery calcification (CAC) is often missed on noncardiac chest CT (NCCT) scans, even in high-risk patients. Routine reporting of CAC on NCCT is recommended due to its prognostic importance.
Area of Science:
- Radiology
- Cardiology
- Medical Imaging
Background:
- Coronary artery calcification (CAC) is linked to cardiovascular outcomes and influences patient management.
- Noncardiac chest CT (NCCT) can detect CAC, but standardized interpretation protocols are lacking.
- There is limited data on the reporting frequency of incidental CAC findings on NCCT.
Purpose of the Study:
- To determine the frequency of unreported coronary artery calcification (CAC) findings on noncardiac chest CT (NCCT).
- To assess the discrepancy between the presence of CAC on NCCT and its documentation in radiology reports.
Main Methods:
- A cohort of 355 patients with known or suspected coronary artery disease underwent both single-photon emission CT myocardial perfusion imaging and NCCT.
- Investigators independently reviewed NCCT reports and performed retrospective image interpretations.
- Data on CAC presence, location, and reporting were collected and analyzed.
Main Results:
- Coronary artery calcification (CAC) was identified in 58% of patients on NCCT review.
- Only 44% of these CAC findings were documented in the final radiology reports.
- Critical findings like left main CAC were reported in only 1 patient, and left anterior descending CAC in just 3% of cases.
Conclusions:
- Coronary artery calcification (CAC) on noncardiac chest CT (NCCT) is frequently underreported, even in high-risk individuals.
- Despite its prognostic significance, CAC detection and reporting on NCCT are inconsistent.
- Routine evaluation and reporting of CAC during NCCT interpretation are recommended to improve patient care.
Background:
Coronary artery calcification (CAC) is correlated with cardiovascular outcomes and, therefore, can change management. Such calcifications are identifiable on noncardiac chest CT (NCCT), although there is no standard for interpretation. However, no data are published on the frequency of these findings being reported during NCCT interpretation.
Methods:
To obtain population with a high likelihood of CAC, we identified 355 patients with known (n = 136) or suspected (n = 219) coronary artery disease in whom single-photon emission CT myocardial perfusion imaging and NCCT were ordered within 1 month of each other; their mean age was 63 years, and 204 were women. Single-photon emission CT reports, NCCT reports, and retrospective NCCT image interpretations were performed by the investigators independently.
Results:
CAC was present in 207 of the 355 patients (58% of the group) but was recorded in the final radiology report as present in only 44% of these subjects. CAC in the left main coronary artery was evident on review in 139 patients but was specified in the final report in only 1 patient. Left anterior descending CAC was evident in 188 patients but reported in only 3%.
Conclusions:
In this observational study, CAC on NCCT in this enriched population was often unreported. Although NCCT can indicate presence and location of CAC, these features are rarely reported, even when involving locations such as the left main coronary artery or left anterior descending artery. In view of its diagnostic and prognostic importance, evaluation of CAC should become a routine part of the interpretation of NCCT.
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