Frequency of unrecognized, unreported, or underreported coronary artery and cardiovascular calcification on noncardiac chest CT

BackgroundCoronary 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.MethodsTo 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.ResultsCAC 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%.ConclusionsIn 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.