As the popularity of using biological age rather than chronological age as a measure of health continues to grow, interest in using CT to assess a variety of cardiometabolic conditions is also rising, according to a presentation delivered September 4 at the International Society for Computed Tomography (ISCT) meeting in Brussels.
CT is an ideal imaging modality for evaluating everything from visceral and subcutaneous fat, muscle density, and calcium (both aortic and coronary) to organ volumes and bone marrow density, according to presenter Perry Pickhardt, MD, of the University of Wisconsin in Madison.
“We’re already using CT opportunistically [for these indications], but we could use it for cardiometabolic screening — especially with the increasing emphasis on precision medicine and personalized care,” he said.
In his talk, Pickhardt focused on using CT to assess biological age, noting that although chronological age drives many healthcare decisions, it isn’t an infallible measure.
“There’s growing awareness that one’s effective biological age would better reflect state of health than their chronological age,” he said. “Ideally, biological age could account for the cumulative physiologic effects of lifestyle habits, genetic predisposition, and superimposed diseases.”
Traditionally, a person’s health has been assessed at a subcellular level using “frailomics” methodologies such as epigenetics, transcriptomics (the study of a set of RNA transcripts in a cell, tissue, or organism), proteomics (the study of proteins in an organism or sample), and metabolomics (the study and measurement of metabolites within a biological sample). In this effort to determine biological age, however, there has been “zero mention of imaging biomarkers,” according to Pickhardt.
“At the end of the day, we can do better than all this epigenomic clock and subcellular mechanism [assessment] by using CT,” he said.
Many CT scans are performed each year, and each offers “robust” objective data embedded in both chest and abdominal scans, Pickhardt noted. He listed the following clinical scenarios for which CT could offer key data:
- Osteoporosis
- Cardiovascular disease
- Sarcopenia
- Frailty assessment
- Cancer cachexia
- Metabolic syndrome and diabetes mellitus
- Hepatic stenosis and fibrosis
- Biological aging
Tracking biomarkers on CT could help clinicians better predict patient outcomes, according to Pickhardt, who noted that CT does “quite well” when biomarker data are combined, demonstrating an area under the curve (AUC) of 0.79.
“If we look at clinical biomarkers, things like cholesterol, hemoglobin A1C, blood pressure, nothing really gets anywhere near what the CT biomarkers [can tell us],” he said.
Check out AuntMinnie’s recent interview with Pickhardt on why CT colonography is the “best kept secret in medicine.”