Visual CAC scores from pre-op PET scans provide valuable post-op risk assessments
Cardiovascular data acquired from pre-operative PET/CT scans used in cancer care could help providers more effectively manage patient risk.
Oncology patients routinely complete PET/CT scans prior to surgery, the findings of which are used to guide operations specific to their condition. These scans, however, provide valuable health information that extends beyond planned cancer treatments, especially with respect to an individual’s cardiovascular risk. Researchers believe applying a visual ordinal CAC scoring system to PET/CT exams could serve as a form of risk stratification for noncardiac surgery.
“PET/CT is commonly performed during oncologic workup and provides an opportunity for coronary artery calcification evaluation,” corresponding author Suk Hyun Lee, MD, PhD, with the department of radiology at Hallym University Kangnam Sacred Heart Hospital, in the Republic of Korea, and colleagues noted in the American Journal of Roentgenology. “However, technical constraints typically preclude standard Agatston scoring using the attenuation-correction CT images obtained during PET/CT examinations.”
To test the prognostic utility of visual CAC scoring of PET scans, researchers retrospectively analyzed the cases of 972 patients who underwent 18F-FDG PET/CT with a nongated low-dose CT acquisition followed by intermediate- or high-risk noncardiac surgery within 12 months. Radiologists visually assessed the four major coronary arteries, assigning a score between 0 and 3 for each. The scores were used to derive a visual CAC grade (none, mild, moderate, severe) for each patient and then compared to patients’ health records to determine their risk of 30-day perioperative major clinical events (MCEs, defined as all-cause mortality or in-hospital troponin I elevation).
Mild and moderate to severe CAC were present in 46.3% and 16% of patients. MCEs occurred in 1.9%, 3.1%, 5.8% and 11.3% of patients with no, mild, moderate, and severe CAC, with moderate and severe CAC being an independent predictor. Individuals who had risk scores of 1 combined with moderate or severe CAC were more likely to endure an event compared to those with no or mild CAC, suggesting that the visual assessments have prognostic utility.
The authors suggested that including standardized reporting on preoperative PET/CT could help providers to better manage their patients’ care.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.