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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
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Coronary artery calcium score - emerging role for opportunistic screening and novel applications

Ryan Patel1, Michelle C Williams MBChB1

  • 1British Heart Foundation Centre of Research Excellence, University of Edinburgh, Edinburgh, United Kingdom.

The British Journal of Radiology
|April 25, 2026
PubMed

Insights

Opportunistic screening for coronary artery calcium (CAC) using thoracic CT improves cardiovascular risk assessment. Artificial intelligence/machine learning (AI/ML) and photon-counting CT enhance CAC detection and integration into clinical practice.

Area of Science:

  • Cardiovascular Imaging
  • Radiology
  • Artificial Intelligence in Medicine

Background:

  • Coronary artery calcium (CAC) is detectable on thoracic CT scans.
  • Opportunistic screening for CAC can aid in cardiovascular risk assessment and early coronary artery disease detection.
  • Current evidence lacks randomized trials on the clinical impact of opportunistic CAC screening.

Purpose of the Study:

  • To review the evidence supporting opportunistic CAC screening on thoracic CT.
  • To highlight novel applications of CAC assessment, including AI/ML and photon-counting CT.
  • To discuss CAC as a multi-system biomarker and its future potential.

Main Methods:

  • Review of existing literature on opportunistic CAC screening.
  • Discussion of AI/ML models for automated CAC identification and quantification.
  • Exploration of photon-counting CT for enhanced CAC detection and risk stratification.

Main Results:

  • Opportunistic CAC screening integrates cardiovascular risk assessment into existing thoracic CT workflows.
  • AI/ML models offer rapid, reproducible, and automated CAC assessments, potentially reducing radiologist workload.
  • Photon-counting CT presents new possibilities for CAC detection and risk stratification via high-resolution and spectral imaging.

Conclusions:

  • Opportunistic CAC screening via thoracic CT is a valuable tool for cardiovascular risk stratification.
  • AI/ML and advanced CT technologies like photon-counting CT show significant promise for improving CAC detection and clinical integration.
  • Further research, including randomized trials, is needed to fully establish the clinical impact of opportunistic CAC screening.

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