The performance of non-ECG gated chest CT for cardiac assessment: The cardiac pathologies in chest CT (CaPaCT) study

N. G. Eijsvoogel; B. M. F. Hendriks; B. Martens; S. C. Gerretsen; S. Gommers; S. M. J. van Kuijk; C. Mihl; J. E. Wildberger; M. Das

doi:10.1016/j.ejrad.2020.109151

The performance of non-ECG gated chest CT for cardiac assessment: The cardiac pathologies in chest CT (CaPaCT) study

N. G. Eijsvoogel^*, B. M. F. Hendriks, B. Martens, S. C. Gerretsen, S. Gommers, S. M. J. van Kuijk, C. Mihl, J. E. Wildberger, M. Das

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Purpose: Evaluating the prevalence of CAD on non-ECG gated chest CTs, image quality (IQ) and the clinical performance of the CAD-RADS classification for predicting cardiovascular events (CVE).

Methods: 215 consecutive patients referred for chest CTs between May 2016 and March 2018 were included (3rd-generation DSCT) using non-ECG gated acquisitions with automated tube voltage selection (110kV(qual.ref)/40mAs(qual.ref)), pitch 2.65-3.0 and individualized contrast media injection protocols. Dedicated cardiac post-processing reconstructions (0.6 mm/0.4 mm/Kernel Bv36) were added to standard chest reconstructions.

Two independent cardiac radiologists performed a 3-step analysis. In case of discrepancy, a third reader gave the final decision. Step 1: visual presence of calcifications; 2: scans with calcifications assessed for IQ using a 5-point Likert scale (poor/sufficient/moderate/good/excellent); 3: stenosis severity was analysed in detail (if Likert sufficient-excellent using CAD-RADS). Electronic patient files were checked to see if pathology was previously mentioned (incidental) and whether patients developed an CVE during follow-up.

Results: 1: Calcifications were present in 156/215 cases (72.6 %), 74 of these were incidental. 2: In 68/156 (43.6 %) patients with calcifications IQ was rated sufficient-excellent. 3: CAD-RADS >= 3 was seen in 39/68 patients (57.4 %), 12 times (30.8 %) findings were incidental. During follow-up (median 16 [0-35] months), 7/39 (18 %) patients with CAD-RADS >= 3 developed a CVE. 17 patients died during follow-up.

Conclusion: Coronary calcification on non ECG-gated chest CTs was detected in 72.6 % of patients, cardiac assessment was feasible in nearly half of these patients. Only patients with a CAD-RADS >= 3 developed CVE, therefore the CAD-RADS may help identify and guide patients at risk of future CVE.

Original language	English
Article number	109151
Number of pages	8
Journal	European Journal of Radiology
Volume	130
DOIs	https://doi.org/10.1016/j.ejrad.2020.109151
Publication status	Published - Sept 2020

Keywords

Computed tomography angiography
Atherosclerosis
Coronary
Cardiac diseases
Incidental findings
CORONARY-ARTERY CALCIUM
CARDIOVASCULAR COMPUTED-TOMOGRAPHY
RISK-FACTORS
GUIDELINES
MORTALITY
SOCIETY

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@article{8c9ced365f404374b894e43829cb4c0f,

title = "The performance of non-ECG gated chest CT for cardiac assessment: The cardiac pathologies in chest CT (CaPaCT) study",

abstract = "Purpose: Evaluating the prevalence of CAD on non-ECG gated chest CTs, image quality (IQ) and the clinical performance of the CAD-RADS classification for predicting cardiovascular events (CVE).Methods: 215 consecutive patients referred for chest CTs between May 2016 and March 2018 were included (3rd-generation DSCT) using non-ECG gated acquisitions with automated tube voltage selection (110kV(qual.ref)/40mAs(qual.ref)), pitch 2.65-3.0 and individualized contrast media injection protocols. Dedicated cardiac post-processing reconstructions (0.6 mm/0.4 mm/Kernel Bv36) were added to standard chest reconstructions.Two independent cardiac radiologists performed a 3-step analysis. In case of discrepancy, a third reader gave the final decision. Step 1: visual presence of calcifications; 2: scans with calcifications assessed for IQ using a 5-point Likert scale (poor/sufficient/moderate/good/excellent); 3: stenosis severity was analysed in detail (if Likert sufficient-excellent using CAD-RADS). Electronic patient files were checked to see if pathology was previously mentioned (incidental) and whether patients developed an CVE during follow-up.Results: 1: Calcifications were present in 156/215 cases (72.6 %), 74 of these were incidental. 2: In 68/156 (43.6 %) patients with calcifications IQ was rated sufficient-excellent. 3: CAD-RADS >= 3 was seen in 39/68 patients (57.4 %), 12 times (30.8 %) findings were incidental. During follow-up (median 16 [0-35] months), 7/39 (18 %) patients with CAD-RADS >= 3 developed a CVE. 17 patients died during follow-up.Conclusion: Coronary calcification on non ECG-gated chest CTs was detected in 72.6 % of patients, cardiac assessment was feasible in nearly half of these patients. Only patients with a CAD-RADS >= 3 developed CVE, therefore the CAD-RADS may help identify and guide patients at risk of future CVE.",

keywords = "Computed tomography angiography, Atherosclerosis, Coronary, Cardiac diseases, Incidental findings, CORONARY-ARTERY CALCIUM, CARDIOVASCULAR COMPUTED-TOMOGRAPHY, RISK-FACTORS, GUIDELINES, MORTALITY, SOCIETY",

author = "Eijsvoogel, {N. G.} and Hendriks, {B. M. F.} and B. Martens and Gerretsen, {S. C.} and S. Gommers and {van Kuijk}, {S. M. J.} and C. Mihl and Wildberger, {J. E.} and M. Das",

note = "Funding Information: The scientific guarantor of this publication is MD. The authors of this manuscript declare relationships with the following companies: JEW receives institutional grants from AGFA, Bard, Bayer, GE, Optimed, Philips and Siemens and personal fees (speakers bureau) from Bayer and Siemens. MD receives institutional grants from Philips, Siemens and Bayer and personal fees (speakers bureau) from Cook, Siemens and Bayer. CM receives institutional grants from Bayer and Siemens and personal fees (speakers bureau) from Bayer. Publisher Copyright: {\textcopyright} 2020 The Authors",

year = "2020",

month = sep,

doi = "10.1016/j.ejrad.2020.109151",

language = "English",

volume = "130",

journal = "European Journal of Radiology",

issn = "0720-048X",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - The performance of non-ECG gated chest CT for cardiac assessment

T2 - The cardiac pathologies in chest CT (CaPaCT) study

AU - Eijsvoogel, N. G.

AU - Hendriks, B. M. F.

AU - Martens, B.

AU - Gerretsen, S. C.

AU - Gommers, S.

AU - van Kuijk, S. M. J.

AU - Mihl, C.

AU - Wildberger, J. E.

AU - Das, M.

N1 - Funding Information: The scientific guarantor of this publication is MD. The authors of this manuscript declare relationships with the following companies: JEW receives institutional grants from AGFA, Bard, Bayer, GE, Optimed, Philips and Siemens and personal fees (speakers bureau) from Bayer and Siemens. MD receives institutional grants from Philips, Siemens and Bayer and personal fees (speakers bureau) from Cook, Siemens and Bayer. CM receives institutional grants from Bayer and Siemens and personal fees (speakers bureau) from Bayer. Publisher Copyright: © 2020 The Authors

PY - 2020/9

Y1 - 2020/9

N2 - Purpose: Evaluating the prevalence of CAD on non-ECG gated chest CTs, image quality (IQ) and the clinical performance of the CAD-RADS classification for predicting cardiovascular events (CVE).Methods: 215 consecutive patients referred for chest CTs between May 2016 and March 2018 were included (3rd-generation DSCT) using non-ECG gated acquisitions with automated tube voltage selection (110kV(qual.ref)/40mAs(qual.ref)), pitch 2.65-3.0 and individualized contrast media injection protocols. Dedicated cardiac post-processing reconstructions (0.6 mm/0.4 mm/Kernel Bv36) were added to standard chest reconstructions.Two independent cardiac radiologists performed a 3-step analysis. In case of discrepancy, a third reader gave the final decision. Step 1: visual presence of calcifications; 2: scans with calcifications assessed for IQ using a 5-point Likert scale (poor/sufficient/moderate/good/excellent); 3: stenosis severity was analysed in detail (if Likert sufficient-excellent using CAD-RADS). Electronic patient files were checked to see if pathology was previously mentioned (incidental) and whether patients developed an CVE during follow-up.Results: 1: Calcifications were present in 156/215 cases (72.6 %), 74 of these were incidental. 2: In 68/156 (43.6 %) patients with calcifications IQ was rated sufficient-excellent. 3: CAD-RADS >= 3 was seen in 39/68 patients (57.4 %), 12 times (30.8 %) findings were incidental. During follow-up (median 16 [0-35] months), 7/39 (18 %) patients with CAD-RADS >= 3 developed a CVE. 17 patients died during follow-up.Conclusion: Coronary calcification on non ECG-gated chest CTs was detected in 72.6 % of patients, cardiac assessment was feasible in nearly half of these patients. Only patients with a CAD-RADS >= 3 developed CVE, therefore the CAD-RADS may help identify and guide patients at risk of future CVE.

AB - Purpose: Evaluating the prevalence of CAD on non-ECG gated chest CTs, image quality (IQ) and the clinical performance of the CAD-RADS classification for predicting cardiovascular events (CVE).Methods: 215 consecutive patients referred for chest CTs between May 2016 and March 2018 were included (3rd-generation DSCT) using non-ECG gated acquisitions with automated tube voltage selection (110kV(qual.ref)/40mAs(qual.ref)), pitch 2.65-3.0 and individualized contrast media injection protocols. Dedicated cardiac post-processing reconstructions (0.6 mm/0.4 mm/Kernel Bv36) were added to standard chest reconstructions.Two independent cardiac radiologists performed a 3-step analysis. In case of discrepancy, a third reader gave the final decision. Step 1: visual presence of calcifications; 2: scans with calcifications assessed for IQ using a 5-point Likert scale (poor/sufficient/moderate/good/excellent); 3: stenosis severity was analysed in detail (if Likert sufficient-excellent using CAD-RADS). Electronic patient files were checked to see if pathology was previously mentioned (incidental) and whether patients developed an CVE during follow-up.Results: 1: Calcifications were present in 156/215 cases (72.6 %), 74 of these were incidental. 2: In 68/156 (43.6 %) patients with calcifications IQ was rated sufficient-excellent. 3: CAD-RADS >= 3 was seen in 39/68 patients (57.4 %), 12 times (30.8 %) findings were incidental. During follow-up (median 16 [0-35] months), 7/39 (18 %) patients with CAD-RADS >= 3 developed a CVE. 17 patients died during follow-up.Conclusion: Coronary calcification on non ECG-gated chest CTs was detected in 72.6 % of patients, cardiac assessment was feasible in nearly half of these patients. Only patients with a CAD-RADS >= 3 developed CVE, therefore the CAD-RADS may help identify and guide patients at risk of future CVE.

KW - Computed tomography angiography

KW - Atherosclerosis

KW - Coronary

KW - Cardiac diseases

KW - Incidental findings

KW - CORONARY-ARTERY CALCIUM

KW - CARDIOVASCULAR COMPUTED-TOMOGRAPHY

KW - RISK-FACTORS

KW - GUIDELINES

KW - MORTALITY

KW - SOCIETY

U2 - 10.1016/j.ejrad.2020.109151

DO - 10.1016/j.ejrad.2020.109151

M3 - Article

C2 - 32650129

SN - 0720-048X

VL - 130

JO - European Journal of Radiology

JF - European Journal of Radiology

M1 - 109151

ER -

The performance of non-ECG gated chest CT for cardiac assessment: The cardiac pathologies in chest CT (CaPaCT) study

Abstract

Keywords

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