From the Guidelines
The next step for incidental vascular calcifications found on abdominal CT scan should be a comprehensive cardiovascular risk assessment, as recommended by the American College of Cardiology Foundation/American Heart Association Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults 1. This assessment should include a detailed medical history, physical examination, blood pressure measurement, and laboratory tests including lipid profile, blood glucose, and kidney function tests.
- Patients should be evaluated for traditional cardiovascular risk factors such as hypertension, diabetes, smoking, and family history of cardiovascular disease.
- Depending on the location and extent of calcifications, additional imaging studies may be warranted, such as a dedicated CT calcium scoring for coronary arteries or duplex ultrasound for peripheral vascular disease.
- Management typically involves aggressive risk factor modification including lifestyle changes (smoking cessation, regular exercise, healthy diet) and pharmacological therapy as indicated (statins, antihypertensives, antiplatelet agents). Vascular calcifications are associated with increased cardiovascular morbidity and mortality as they represent atherosclerotic disease, which may be systemic.
- The Agatston scoring system or the visual method of none, mild, moderate, or heavy or severe can be used to report and assess the extent of calcifications 1.
- The finding should not be dismissed as merely incidental, as it provides an opportunity for early intervention to prevent future cardiovascular events, and the Society of Cardiovascular Computed Tomography and the Society of Thoracic Radiology recommend reporting CAC in all patients irrespective of the scan indication or the patient risk status 1.
From the Research
Next Steps for Vascular Calcifications Incidental Finding on Abd CT Scan
- The next step for vascular calcifications incidental finding on abdominal CT scan should be to evaluate the patient's risk factors for cardiovascular disease, as vascular calcifications are a marker of atherosclerosis and an independent risk factor for cardiac-related mortality 2.
- The patient's lipid profile, including triglycerides and high-density lipoprotein, should be assessed, as elevated triglycerides and decreased high-density lipoprotein have been correlated with incidental atherosclerotic calcification on abdominopelvic CT 3.
- Ankle-brachial index (ABI) may be a useful noninvasive method to evaluate peripheral artery disease (PAD) and predict cardiovascular risk, as ABI <0.9 and ABI >1.3 have been associated with increased risk of cardiovascular mortality 4.
- Consideration should be given to reporting incidental coronary calcification found on non-gated chest CT, as it may have a significant impact on management and mortality 2.
- The combination of coronary artery calcification (CAC), carotid intima-media thickness (CIMT), and ABI may provide complementary information about stroke risk, and CAC may be a useful predictor of cardiovascular events, particularly in the intermediate risk group 5, 6.