Visual scoring of aortic valve calcifications on low-dose CT in lung cancer screening

• Published in: European radiology Vol. 30; no. 5; pp. 2658 - 2668
• Main Authors: Zhu, Yeqing, Wang, Yong, Gioia, William E., Yip, Rowena, Jirapatnakul, Artit C., Chung, Michael S., Yankelevitz, David F., Henschke, Claudia I.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2020; Springer Nature B.V
• Subjects: Age Factors; Aged; Agreements; Aorta; Aortic stenosis; Aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - pathology; Aortic Valve Stenosis - diagnostic imaging; Calcification; Calcification (ectopic); Calcinosis - diagnostic imaging; Cancer screening; Cardiac; Cardiovascular diseases; Coronary artery; Coronary Artery Disease - epidemiology; Diagnostic Radiology; Early Detection of Cancer; Echocardiography; EKG; Electrocardiography; Evaluation; Female; Health risks; Heart valves; Humans; Imaging; Internal Medicine; Interventional Radiology; Lung cancer; Lung diseases; Lung Neoplasms - diagnostic imaging; Male; Mass Screening; Medical screening; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Proportional Hazards Models; Radiology; Regression analysis; Reliability analysis; Reproducibility of Results; Risk analysis; Risk assessment; Risk Factors; Sensitivity analysis; Sensitivity and Specificity; Severity of Illness Index; Sex; Sex Factors; Smoking; Stenosis; Tomography; Tomography, X-Ray Computed - methods; Ultrasonic imaging; Ultrasound; Vascular Calcification - diagnostic imaging; Visual observation; Echocardiography; Aortic valve calcification; Cardiovascular diseases; Aortic valve stenosis
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-019-06614-w

Objectives To evaluate risk factors for prevalence and progression of aortic valve calcification (AVC) in lung cancer screening participants and also to assess the sensitivity and reliability of visual AVCs on low-dose CT (LDCT) for predicting aortic stenosis (AS) in high-risk smokers. Methods We reviewed 1225 consecutive participants in annual LDCT screening for lung cancer at the Mount Sinai Hospital between 2010 and 2017. Sensitivity and specificity of moderate/severe AVC score on LDCT to identify AS on echocardiogram were calculated for 126 participants who had both within 12 months. Using regression analyses, risk factors for AVC at baseline, for progression, and for new AVC on annual rounds of screening were identified. Reliability of AVC assessment on LDCT was assessed by comparing visual AVC scores (1) with standard-dose, electrocardiography (ECG)-gated CT for 31 participants who had both within 12 months and (2) with Agatston scores of 1225 participants and by determining (3) the intra-reader agreement of 1225 participants. Results Visual AVC scores on LDCT had substantial agreement with the severity of AS on echocardiography and substantial inter-observer and excellent intra-observer agreement. Sensitivity and specificity of moderate/severe visual AVC scores for moderate/severe AS on echocardiogram were 100% and 94%, respectively. Significant predictors for baseline AVC were male sex (OR = 2.52), age (OR 10 years  = 2.87), and coronary artery calcification score (OR = 1.18), the significant predictor for AVC progression after baseline was pack-years of smoking (HR 10 packyears  = 1.14), and significant predictors for new AVC on annual LDCT were male sex (HR = 1.51), age (HR 10 years  = 2.17), CAC (HR = 1.09)  and BMI (HR = 1.06). Conclusions AVC scores on LDCT should be documented, especially in lung cancer screening program. Key Points • LDCT screening for lung cancer provides an opportunity to identify lung cancer and cardiovascular disease in asymptomatic smokers. • Visual aortic valve calcification scores could be reliably evaluated on LDCT and had substantial agreement with the severity of aortic valve stenosis on echocardiography. • Sensitivity and specificity of moderate/severe visual AVC scores on LDCT for moderate/severe AS on echocardiogram were 100% and 94%, respectively.