Characteristics of non-cancerous chest CT scan to predict

image: (A) Axial CT image shows coronary artery calcium (red square). (B) Axial CT image shows the pulmonary artery and the diameter of the ascending aorta at the level of the main pulmonary artery (red arrows). Coronal CT images (C) without and (D) with segmentation label map for lung densitometry to assess emphysema; the label map shows the lung parenchyma in blue and the major airways in red. Axial CT images (E) without and (F) segmentation label map at fifth thoracic vertebral body, (G) without and (H) with segmentation label map at eighth thoracic vertebral body, and ( I) without and (J) with segmentation label map at the tenth vertebral body level, for body composition analysis. Skeletal muscle in red; adipose tissue in green. Axial CT images (K) without and (L) with measurement of bone mineral density, represented by a yellow ROI at the level of the first lumbar vertebral body.
to see After

Credit: American Roentgen Ray Society (ARRS), American Journal of Roentgenology (AJR)

Leesburg, Virginia, April 13, 2022—According to the ARRS’ American Journal of Radiology (RDA), non-cancerous imaging markers on chest CT scan performed before stereotactic body radiation therapy (SBRT) improve the prediction of survival, compared to clinical characteristics alone.

“In patients undergoing SBRT for stage I lung cancer,” explained Florian J. Fintelmann, corresponding author and 2019 ARRS Fellow, “a higher coronary artery calcium (CAC) score, arterial lung (PA) on higher aorta and lower thoracic skeleton muscle index independently predicted worse overall survival.

The retrospective study by Fintelmann and his team included 282 patients (168 women, 114 men; median age: 75 years) with stage I lung cancer and treated with SBRT between January 2009 and June 2017. To quantify CAC score and AP/aorta ratio, as well as emphysema and body composition, a pretreatment chest CT scan was used. Associations of clinical and imaging features with the whole were quantified using a multivariate Cox proportional hazards (PH) model.

For stage I lung cancer patients treated with SBRT, CAC score, AP/aorta ratio, and skeletal muscle index showed significant independent associations with overall survival. (p<.05 the model including clinical and imaging characteristics demonstrated better discriminatory capacity for overall survival than alone versus p>

“The AP-aorta ratio, which is easily quantified with electronic calipers during routine image review, was the strongest predictor of overall survival,” the authors of this paper said. RDA article concluded.

An electronic supplement to this RDA the item is available here.


North America’s premier radiology society, the American Roentgen Ray Society (ARRS) remains dedicated to the advancement of medicine through the profession of medical imaging and its related sciences. An international forum for advancements in radiology since the discovery of x-rays, ARRS upholds its mission to improve health through a community committed to advancing knowledge and skills with the world’s longest continuously published radiology journal —American Journal of Radiology—the annual meeting of the ARRS, In practice magazine, thematic symposia, a myriad of multimedia educational materials, as well as the allocation of scholarships through the Roentgen Fund®.

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