Coronary Artery Calcification on Low-Dose Lung Cancer Screening CT in South Korea: Visual and Artificial Intelligence-Based Assessment and Association With Cardiovascular Events.

Journal: AJR. American journal of roentgenology
Published Date:

Abstract

Coronary artery calcification (CAC) on lung cancer screening low-dose chest CT (LDCT) is a cardiovascular risk marker. South Korea was the first Asian country to initiate a national LDCT lung cancer screening program, although CAC-related outcomes are poorly explored. The purpose of this article is to evaluate CAC prevalence and severity using visual analysis and artificial intelligence (AI) methods and to characterize CAC's association with major adverse cardiovascular events (MACEs) in patients undergoing LDCT in Korea's national lung cancer screening program. This retrospective study included 1002 patients (mean age, 62.4 ± 5.4 [SD] years; 994 men, eight women) who underwent LDCT at two Korean medical centers between April 2017 and May 2023 as part of Korea's national lung cancer screening program. Two radiologists independently assessed CAC presence and severity using visual analysis, consulting a third radiologist to resolve differences. Two AI software applications were also used to assess CAC presence and severity. MACE occurrences were identified by EMR review. Interreader agreement for CAC presence and severity, expressed as kappa, was 0.793 and 0.671, respectively. CAC prevalence was 53.4% by consensus visual assessment, 60.1% by AI software I, and 56.6% by AI software II. CAC severity was mild, moderate, and severe by consensus visual analysis in 28.0%, 10.3%, and 15.1%; by AI software I in 39.9%, 14.0%, and 6.2%; and by AI software II in 34.9%, 14.3%, and 7.3%. MACEs occurred in 36 of 625 (5.6%) patients with follow-up after LDCT (median, 1108 days). MACE incidence in patients with no, mild, moderate, and severe CAC for consensus visual analysis was 1.1%, 5.0%, 2.9%, and 8.6%, respectively ( < .001); for AI software I, it was 1.3%, 3.0%, 7.9%, and 11.3% ( < .001); and for AI software II, it was 1.2%, 3.4%, 7.7%, and 9.6% ( < .001). For Korea's national lung cancer screening program, MACE occurrence increased significantly with increasing CAC severity, whether assessed by visual analysis or AI software. The study is limited by the large sex imbalance for Korea's national lung cancer screening program. The findings provide reference data for health care practitioners engaged in developing and overseeing national lung cancer screening programs, highlighting the importance of routine CAC evaluation.

Authors

  • Chan Park
    Department of Radiology, Chonnam National University Hospital and Chonnam National University Medical School, Gwangju, Republic of Korea.
  • Byung Chan Lee
    Department of Radiology, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea 58128.
  • Won Gi Jeong
    From the Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., S.H.Y.); Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea (W.G.J.); Faculty of Pharmacy, University of Montréal, Montréal, Canada (P.M.D.); OBVIA-Observatoire sur les Impacts Sociétaux de l'IA et du Numérique, Québec, Canada (P.M.D.); and FIND-The Global Alliance for Diagnostics, Geneva, Switzerland (M.A., M.R.).
  • Won-Ju Park
    Department of Occupational and Environmental Medicine, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea.
  • Gong Yong Jin
    Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju City, Jeollabuk-Do, South Korea.
  • Yun-Hyeon Kim
    Department of Radiology, Seoul National College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (H.C., S.H.Y., S.J.P., C.M.P., J.H.L., H. Kim, E.J.H., S.J.Y., J.G.N., C.H.L., J.M.G.); CHESS Center, The First Hospital of Lanzhou University, Lanzhou, China (Q.X., J.L.); Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (K.H.L.); Department of Internal Medicine, Incheon Medical Center, Incheon, Korea (J.Y.K.); Department of Radiology, Seoul Medical Center, Seoul, Korea (Y.K.L.); Department of Radiology, National Medical Center, Seoul, Korea (H. Ko); Department of Radiology, Myongji Hospital, Gyeonggi-do, Korea (K.H.K.); and Department of Radiology, Chonnam National University Hospital, Gwanju, Korea (Y.H.K.).