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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Computed Tomography-Derived Abdominal Aortic Calcification Independently Predicts Survival in Rectal Cancer Surgery:
Michael Rouse1,2, Arwa Hadi1, Yumna Kaleem1,2
1Department of Surgery, University of Melbourne, Melbourne, Australia.
Background:
Contemporary rectal cancer treatment pathways remain predominantly guided by tumour-related characteristics, including stage and histopathology, with comparatively limited objective assessment of physiological reserve for treatment planning. Aortic calcification represents a potential imaging biomarker reflecting systemic vascular disease, chronic inflammation and physiological reserve. We evaluated computed tomography (CT)-derived abdominal aortic calcification as a prognostic imaging biomarker for postoperative outcomes and long-term survival.
Methods:
A retrospective cohort study was conducted using the prospectively maintained Australian Comprehensive Cancer Outcomes and Research Database (ACCORD) of rectal cancer patients treated between 2013 and 2022. Pre-treatment staging CT was subjected to semi-automated volumetric quantification of calcium using 3D Slicer software. Calcification volume was assessed segmentally at vertebral levels L1-L4 and at the iliac vessels. Primary outcomes were major postoperative complications (Clavien-Dindo ≥ III) and overall survival. Cox proportional hazards modelling was performed using a prespecified parsimonious multivariable model.
Results:
A total of 174 patients were included in the analysis. Increasing calcification burden demonstrated no statistically significant association with major postoperative complications (OR 1.09 per 1000-unit increase; 95% CI 0.99-1.19; p = 0.07). Increasing calcification independently predicted worse 5-year survival after multivariable adjustment (HR 1.17 per 1000-unit increase ([CI 1.08-1.28, p = 0.001]). Kaplan-Meier analyses showed separation between calcification groups, although dichotomised analyses did not reach statistical significance.
Conclusion:
Aortic calcification independently predicts long-term survival following rectal cancer surgery but not short-term postoperative complications. Quantitative CT-derived calcification assessment may provide a rapid, objective imaging biomarker that reflects physiological reserve and represents a potential adjunct to future risk stratification pathways.
