Coronary Artery Calcification Identified on Lung Cancer Screening CT Scans: A Scoping Review

Abstract

Background: Coronary artery calcification (CAC) can be a significant incidental finding on low-dose CT scans performed for lung cancer screening (LCS). CAC presence and grade hold important diagnostic and preventive value, particularly in patients without previously recognized coronary artery disease.

Research question: What is the prevalence of CAC as an incidental finding on LCS CT scans across prior studies?

Study design and methods: A literature review was conducted using the PubMed database to identify studies investigating CAC identified on LCS CT scans. The review included articles published in English from January 2012 through March 2024. The search query used 3 main keywords: CAC, LCS, and incidental finding.

Results: The initial search resulted in 256 abstracts screened for eligibility, resulting in 32 articles included in the final review. CAC presence across included studies varied from 14.8% to 98%. CAC most commonly was reported as mild in grade, among 46.9% of studies. Most studies were conducted among predominantly White male participants. Finally, only 6 articles provided information on downstream interventions for patients with newly detected CAC.

Interpretation: CAC, a predictive risk factor for cardiovascular events and mortality, is a frequently detected incidental finding on LCS CT scans, with substantial variation in presence across studies. Identification of CAC on LCS CT scans could inform clinical decisions to reduce patients' overall cardiovascular risk. These findings underscore the significance of standardizing the documentation and management of CAC in LCS. Finally, future studies should include greater race diversity.

Keywords: CT incidental finding; coronary artery calcification; coronary artery calcification grade; coronary artery calcification prevalence; lung cancer screening.