Missed Cardiovascular Risk on Chest Computed Tomography: Opportunistic Detection and Reporting of Coronary Artery Calcification on Non-Contrast, Non-Gated Chest Computed Tomography

Abstract

Introduction: Coronary artery calcification (CAC) is an imaging marker of coronary atherosclerosis that can be identified on non-contrast, non-gated chest computed tomography (CT). However, it may not be documented when imaging is performed for non-cardiac indications.

Objective: To determine the prevalence and visual severity of CAC on non-contrast, non-gated chest CT and the proportion of detected cases documented in the original radiology reports.

Methods: This single-centre retrospective observational study included 300 adult patients who underwent non-contrast, non-gated chest CT at Peshawar Institute of Cardiology, Pakistan, between January 2023 and June 2026. CAC was assessed visually and classified as absent, mild, moderate, or severe. Findings were compared with the original radiology reports to determine reporting proportions. Demographic and clinical comparisons were descriptive.

Results: CAC was identified in 112 of 300 examinations (37.3%). Among these 112 examinations, 61 (54.5%) had mild, 35 (31.3%) moderate, and 16 (14.3%) severe CAC. CAC was documented in 61 (54.5%) of the original reports and was unreported in 51 (45.5%). The reporting proportion increased from 41.0% for mild CAC to 68.6% for moderate and 75.0% for severe CAC. CAC prevalence was higher among patients aged ≥55 years and those with hypertension, diabetes, or a current or former smoking history.

Conclusion: CAC was present in more than one-third of the included chest CT examinations, and almost half of detected cases were not documented in the original reports. Systematic visual assessment and severity-based reporting may improve communication of coronary atherosclerotic findings for clinical cardiovascular risk assessment.