Related Experiment Video
Updated: Apr 16, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Association of Coronary Artery Calcification and Mortality in the National Lung Screening Trial: A Comparison of
Caroline Chiles1, Fenghai Duan1, Gregory W Gladish1
1From the Department of Radiology, Wake Forest University Health Sciences Center, Medical Center Boulevard, Winston-Salem, NC 27157 (C.C.); Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI (F.D., B.S.S., S.D.); Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.W.G.); Department of Radiology, Medical University of South Carolina, Charleston, SC (J.G.R.); Summit Radiology LLC, Oconomowoc, Wis (S.G.B.); American College of Radiology Imaging Network, Philadelphia, Pa (S.S.D.); and Department of Radiology, Houston Methodist Hospital and Research Institute, Houston, Tex (R.F.M.).
Insights
Simple visual assessment of coronary artery calcification (CAC) on low-dose CT scans effectively predicts coronary heart disease (CHD) death and all-cause mortality. This method offers comparable risk assessment to Agatston scoring in older, heavy smokers.
Area of Science:
- Cardiovascular imaging and risk stratification
- Public health and preventative medicine
Background:
- Coronary heart disease (CHD) remains a leading cause of mortality worldwide.
- Accurate risk assessment is crucial for preventative strategies.
- Low-dose computed tomography (CT) for lung cancer screening may offer opportunities for incidental cardiovascular risk assessment.
Purpose of the Study:
- To evaluate three coronary artery calcification (CAC) scoring methods for predicting CHD death and all-cause mortality.
- To assess the utility of CAC scoring in participants of the National Lung Screening Trial (NLST).
Main Methods:
- Analysis of 1575 low-dose CT scans from NLST participants (210 CHD deaths, 315 non-CHD deaths, 1050 survivors).
- Evaluation of three CAC scoring methods: Agatston scoring, segmented vessel-specific scoring, and overall visual assessment.
- Weighted Cox proportional hazards models were used to determine the association between CAC scores and mortality outcomes.
Main Results:
- All three CAC scoring methods demonstrated a significant association with CHD death and all-cause mortality.
- Agatston scores, summed segmented vessel-specific scores, and visual assessment categories showed increasing hazard ratios with higher CAC levels.
- Visual assessment of CAC provided risk stratification comparable to Agatston scoring.
Conclusions:
- Simple visual assessment of CAC on low-dose CT scans, acquired during lung cancer screening, is a valuable tool for risk stratification of CHD death and all-cause mortality.
- This accessible method can be integrated into routine screening protocols for older, heavy smokers to identify individuals at high cardiovascular risk.
Purpose:
To evaluate three coronary artery calcification (CAC) scoring methods to assess risk of coronary heart disease (CHD) death and all-cause mortality in National Lung Screening Trial (NLST) participants across levels of CAC scores.
Materials And Methods:
The NLST was approved by the institutional review board at each participating institution, and informed consent was obtained from all participants. Image review was HIPAA compliant. Five cardiothoracic radiologists evaluated 1575 low-dose computed tomographic (CT) scans from three groups: 210 CHD deaths, 315 deaths not from CHD, and 1050 participants who were alive at conclusion of the trial. Radiologists used three scoring methods: overall visual assessment, segmented vessel-specific scoring, and Agatston scoring. Weighted Cox proportional hazards models were fit to evaluate the association between scoring methods and outcomes.
Results:
In multivariate analysis of time to CHD death, Agatston scores of 1-100, 101-1000, and greater than 1000 (reference category 0) were associated with hazard ratios of 1.27 (95% confidence interval: 0.69, 2.53), 3.57 (95% confidence interval: 2.14, 7.48), and 6.63 (95% confidence interval: 3.57, 14.97), respectively; hazard ratios for summed segmented vessel-specific scores of 1-5, 6-11, and 12-30 (reference category 0) were 1.72 (95% confidence interval: 1.05, 3.34), 5.11 (95% confidence interval: 2.92, 10.94), and 6.10 (95% confidence interval: 3.19, 14.05), respectively; and hazard ratios for overall visual assessment of mild, moderate, or heavy (reference category none) were 2.09 (95% confidence interval: 1.30, 4.16), 3.86 (95% confidence interval: 2.02, 8.20), and 6.95 (95% confidence interval: 3.73, 15.67), respectively.
Conclusion:
By using low-dose CT performed for lung cancer screening in older, heavy smokers, a simple visual assessment of CAC can be generated for risk assessment of CHD death and all-cause mortality, which is comparable to Agatston scoring and strongly associated with outcome.
More Related Videos
06:57Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
11:30A Semi-Automated and Reproducible Biological-Based Method to Quantify Calcium Deposition In Vitro
Published on: June 2, 2022
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease IV: Preventive Measures
01:28Imaging Studies for Cardiovascular System V: CT
01:30Acute Coronary Syndrome III: Diagnostic Studies