Early Detection of Cardiovascular Disease in Chest Population Screening: Challenges for a Rapidly Emerging Cardiac CT Application.
Authors
Affiliations (6)
Affiliations (6)
- Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.
- Research Institute for Diagnostic Accuracy, Groningen, 9713 GH, The Netherlands.
- Department of Radiology and Nuclear Medicine, Gelre Ziekenhuizen, 7334 DZ, Apeldoorn, The Netherlands.
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, 9713 GZ, the Netherlands.
- Department of Respiratory Medicine, Amsterdam University Medical Center, Amsterdam, 1105 AZ, The Netherlands.
- Faculty of Medical Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9713 GZ, the Netherlands.
Abstract
While lung cancer screening (LCS) reduces lung cancer-related mortality in high-risk individuals, cardiovascular disease (CVD) remains a leading cause of death due to shared risk factors such as smoking and age. Coronary artery calcium (CAC) assessment offers an opportunity for concurrent cardiovascular screening, with higher CAC scores indicating increased CVD risk and mortality. Despite guidelines recommending CAC-scoring on all non-contrast chest CT scans, a lack of standardization leads to underreporting and missed opportunities for preventive care. Routine CAC-scoring in LCS can enable personalized CVD management and reduce unnecessary treatments. However, challenges persist in achieving adequate diagnostic quality with one combined image acquisition for both lung and cardiovascular assessment. Advancements in CT technology have improved CAC quantification on low-dose CT scans. Electron-beam tomography, valued for superior temporal resolution, was replaced by multi-detector CT for better spatial resolution and general usability. Dual-source CT further improved temporal resolution and reduced motion artifacts, making non-gated CT protocols for CAC-assessment possible. Additionally, artificial intelligence-based CAC quantification can reduce the added workload of cardiovascular screening within LCS programs. This review explores recent advancements in cardiac CT technologies that address prior challenges in opportunistic CVD screening and considers key factors for integrating CVD screening into LCS programs, aiming for high-quality standardization in CAC reporting.