What should we do about coronary calcification on thoracic CT?

Purpose
Coronary artery calcification is a frequent incidental finding on thoracic computed tomography (CT) performed for non-cardiac indications. On electrocardiogram gated cardiac CT it is an established marker of coronary artery disease and is associated with increased risk of subsequent cardiac events.
Materials and Methods
This review discusses the current evidence and guidelines regarding the reporting of coronary artery calcification on non-electrocardiogram gated thoracic CT performed for non-cardiac indications.
Results
For patients undergoing routine thoracic CT, coronary artery calcification is associated with an increased risk of myocardial infarction and mortality. Coronary artery calcification can be accurately assessed on non-gated thoracic CT compared to gated CT. Guidelines support the reporting of coronary artery calcification on thoracic CT, however radiologist opinions vary. The identification of coronary artery calcification on thoracic CT may identify patients with previously unknown coronary artery disease. For asymptomatic patients this may trigger an assessment of modifiable cardiovascular risk factors and guide the appropriate use of preventative medications.
Conclusions
Future research will address whether changing management based on calcification on thoracic CT will improve outcomes and automated assessment of calcification using machine learning techniques.