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Coronary Computed Tomography Angiography Results in More Computed Tomography Chest Follow-up for Incidental Findings at 1 Year Relative to Stress-perfusion Cardiac Magnetic Resonance Imaging. J Thorac Imaging 2022; 37:292-299. [DOI: 10.1097/rti.0000000000000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nordjoe YE, Aubin Igombe SR, Chat L. Non-cardiovascular findings on chest CT angiography in children with congenital heart disease: How important are they? BMC Med Imaging 2022; 22:13. [PMID: 35065612 PMCID: PMC8783999 DOI: 10.1186/s12880-022-00739-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background There are only a few publications about the non-cardiovascular findings in children with congenital heart diseases explored by chest CT angiography. The purpose of our study is to evaluate the prevalence of non-cardiovascular findings on chest CT angiographies in children with congenital heart disease and to raise awareness about their importance among the radiologists. Methods We retrospectively reviewed the 272 chest CT angiographies performed in our pediatric radiology department between January 2017 and march 2021 and extracted the data of the 180 patients positive for a congenital heart disease. Then from that pool, we sorted out the non-cardiovascular findings into significant and non-significant in regard of their relevance or not in the patient’s management. Results Non-cardiovascular lesions were found in 58% (105/180) of our patients, and 49% (88/180) of them presented at least one significant non-cardiac lesion. Lung and airways abnormalities were found in 41% (74/180) of the cases, representing the majority of the non-cardiovascular findings. Syndromic associations were found in 17% (28/180) of our patients, including 14 cases of heterotaxic syndrome. Conclusion Non-cardiovascular findings are common in children with congenital heart disease. Reporting these associated lesions is a requisite for an optimal therapeutic management of these children. Radiologists should never forget that a Chest CT angiography in children is first and foremost a chest CT.
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Laskowski D, Feger S, Bosserdt M, Zimmermann E, Mohamed M, Kendziora B, Rief M, Dreger H, Estrella M, Dewey M. Detection of relevant extracardiac findings on coronary computed tomography angiography vs. invasive coronary angiography. Eur Radiol 2021; 32:122-131. [PMID: 34129067 PMCID: PMC8660731 DOI: 10.1007/s00330-021-07967-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/11/2021] [Accepted: 03/31/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To compare the detection of relevant extracardiac findings (ECFs) on coronary computed tomography angiography (CTA) and invasive coronary angiography (ICA) and evaluate the potential clinical benefit of their detection. METHODS This is the prespecified subanalysis of ECFs in patients presenting with a clinical indication for ICA based on atypical angina and suspected coronary artery disease (CAD) included in the prospective single-center randomized controlled Coronary Artery Disease Management (CAD-Man) study. ECFs requiring immediate therapy and/or further workup including additional imaging were defined as clinically relevant. We evaluated the scope of ECFs in 329 patients and analyzed the potential clinical benefit of their detection. RESULTS ECFs were detected in 107 of 329 patients (32.5%; CTA: 101/167, 60.5%; ICA: 6/162, 3.7%; p < .001). Fifty-nine patients had clinically relevant ECFs (17.9%; CTA: 55/167, 32.9%; ICA: 4/162, 2.5%; p < .001). In the CTA group, ECFs potentially explained atypical chest pain in 13 of 101 patients with ECFs (12.9%). After initiation of therapy, chest pain improved in 4 (4.0%) and resolved in 7 patients (6.9%). Follow-up imaging was recommended in 33 (10.0%; CTA: 30/167, 18.0%; ICA: 3/162, 1.9%) and additional clinic consultation in 26 patients (7.9%; CTA: 25/167, 15.0%; ICA: 1/162, 0.6%). Malignancy was newly diagnosed in one patient (0.3%; CTA: 1/167, 0.6%; ICA: 0). CONCLUSIONS In this randomized study, CTA but not ICA detected clinically relevant ECFs that may point to possible other causes of chest pain in patients without CAD. Thus, CTA might preclude the need for ICA in those patients. TRIAL REGISTRATION NCT Unique ID: 00844220 KEY POINTS: • CTA detects ten times more clinically relevant ECFs than ICA. • Actionable clinically relevant ECFs affect patient management and therapy and may thus improve chest pain. • Detection of ECFs explaining chest pain on CTA might preclude the need for performing ICA.
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Affiliation(s)
- Dominik Laskowski
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Feger
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maria Bosserdt
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Elke Zimmermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Mahmoud Mohamed
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Benjamin Kendziora
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Rief
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Henryk Dreger
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Melanie Estrella
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,Berlin Institute of Health and DZHK (German Centre for Cardiovascular Research) Partner Site, Berlin, Germany.
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Kay FU, Canan A, Abbara S. Common Incidental Findings on Cardiac CT: a Systematic Review. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9494-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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5
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Prevalence and Clinical Relevance of Extracardiac Findings in Cardiovascular Magnetic Resonance Imaging. J Thorac Imaging 2019; 34:48-55. [PMID: 30142138 DOI: 10.1097/rti.0000000000000360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess the prevalence of extracardiac findings (ECF) during cardiovascular magnetic resonance (CMR) examinations and their downstream effect on clinical management. MATERIALS AND METHODS We retrospectively identified 500 consecutive patients. Trans-axial balanced steady-state free precession nongated images acquired from the upper thorax to the upper abdomen were evaluated independently by 2 radiologists. ECF were classified as nonsignificant (benign, with no need for further investigation), significant (mandatory to be reported/monitored), and major (clinically remarkable pathology, mandatory to be reported/investigated/treated). Fifteen-month clinical follow-up information was collected through hospital records. RESULTS Of 500 patients, 108 (21.6%) showed a total of 153 ECF: 59 (11.8% of the entire study population; 38.5% of all ECF) nonsignificant, 76 (15.2%; 49.7%) significant, and 18 (3.6%; 11.8%) major ECF. The most frequent ECF were pleural effusion, hepatic cyst, renal cyst, and ascending aorta dilatation. Of 94 significant and major ECF, 46 were previously unknown and more common in older patients. Newly diagnosed major ECF (n=11, 2.2% of the entire study population, and 7.2% of all ECF)-including 5 tumors (1% of study population)-were confirmed by downstream evaluations and required specific treatment. Patients with major ECF were significantly older than patients without with major ECF. Newly diagnosed clinically significant and major ECF prompted downstream diagnostic tests in 44% and 100% of cases, respectively. CONCLUSIONS The detection of significant and major ECF is common during CMR reporting. The knowledge and the correct identification of most frequent ECF enable earlier diagnoses and faster treatment initiation of unknown extracardiac pathologies in patients referred to CMR imaging.
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Prevalence of extramedullary hematopoiesis, renal cysts, splenic and hepatic lesions, and vertebral hemangiomas among thalassemic patients: a retrospective study from the Myocardial Iron Overload in Thalassemia (MIOT) network. Ann Hematol 2019; 98:1333-1339. [PMID: 30891614 DOI: 10.1007/s00277-019-03659-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/04/2019] [Indexed: 12/21/2022]
Abstract
We determined the prevalence of incidental extracardiac findings (IEF) at Magnetic Resonance Imaging (MRI) potentially related to anemia and hypoxia in age- and sex-matched populations (N = 318) with thalassemia major (TM) and thalassemia intermedia (TI) enrolled in the Myocardial Iron Overload in Thalassemia network. Overall, IEFs were detected in 33.3% and 25.8% of patients with TI and TM, respectively (P = 0.114). TI and TM patients had elevated but comparable prevalence of renal, splenic and liver cysts, and vertebral hemangiomas while TI patients had a significant higher frequency of extramedullary hematopoiesis (EMH) (15.1% vs 4.4%; P = 0.002). The prevalence of total IEFs increased with advancing age. TI non-transfusion-dependent patients had a significantly lower frequency of renal cysts than TI transfusion-dependent patients (8.8% vs 26.4%; P = 0.005). The prevalence of renal cysts in the thalassemic population was significantly higher than that in the general population (19.2% vs 1.9%; P < 0.0001). Our data on renal cysts indicate a significant higher prevalence of these IEFs compared to the general population, suggesting the role of the inappropriate activation of the hypoxia-inducible factor system linked to the chronic hypoxia. The significant prevalence of IEF in thalassemia patients undergoing MRI for iron quantification should prompt the discussion of the inclusion of IEF in the MRI report.
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Computed tomography coronary angiography in patients without known coronary artery disease can demonstrate possible non-cardiovascular causes of non-acute retrosternal chest pain. Insights Imaging 2018; 9:687-694. [PMID: 30276668 PMCID: PMC6206382 DOI: 10.1007/s13244-018-0654-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/21/2018] [Accepted: 08/07/2018] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES To assess the computed tomography coronary angiography (CTCA) accuracy for demonstrating possible non-cardiovascular causes of non-acute retrosternal chest pain in patients without known coronary artery disease (CAD) and to correlate CTCA results with the patient management and relief from pain. METHODS This prospective observational study was approved by the ethical committee. Consecutive patients suffering non-acute chest pain who underwent CTCA and with not known CAD were enrolled and classified as having coronary diseases (CD) or extracardiac diseases (ECD). Association between age, sex, body mass index (BMI), cardiovascular risk factors, and type of chest pain with CD or ECD was estimated. Correlation between BMI classes and each risk factor was also calculated. RESULTS A total of 106 patients (60 males; age 62 ± 14 years [mean ± standard deviation]; mean BMI 27) were enrolled. Hypertension was found in 71/106 (67%); smoking was significantly more frequent among males (p = 0.003) and hypercholesterolemia among females (p = 0.017); hypertension and hypercholesterolemia significantly correlated with age, and hypertension also with BMI. Pain was atypical in 70/106 (66%) patients. The kind of pain did not correlate with disease or gender. CTCA showed possible causes of chest pain in 69/106 (65%) patients; 32/69 (47%) having only CD, 23/69 (33%) only ECD, and 14/69 (20%) both CD and ECD. Prevalence was: hiatal hernia 35/106 (33%); significant CAD 24/106 (23%); myocardial bridging 22/106 (21%). At follow-up of 94/106 (89%) patients, 71/94 (76%) were pain-free, 14/17 (82%) significant CAD had been treated, and only one patient with non-significant CAD was treated after CTCA. CONCLUSION CTCA suggested possible causes of non-acute pain in 65% of patients. MAIN MESSAGES • CTCA can either rule in or rule out possible causes of chest pain alternative to CAD. • Clinically relevant findings were detected in 65% of patients with non-acute chest pain. • Non-cardiovascular diseases potentially explained symptoms in 35% of patients.
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Extracardiac findings on coronary computed tomography angiography in patients without significant coronary artery disease. Eur Radiol 2018; 29:1714-1723. [PMID: 30255246 DOI: 10.1007/s00330-018-5688-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/09/2018] [Accepted: 07/30/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To analyse extracardiac findings in patients without significant coronary artery disease (CAD) in general and in symptomatic patients in particular. METHODS We searched the Radiology Information System database for coronary computed tomography angiographies (CTA) performed from 2000-2014 and retrospectively enrolled 3,898 patients without significant CAD (coronary stenosis < 50%) in CTA. In 2,330 symptomatic patients, we analysed the spectrum of extracardiac findings and identified pathologies potentially explaining chest pain. Finally, we investigated variables affecting the number of extracardiac findings detected in CTA. RESULTS Overall extracardiac findings were found in 1,177 patients (30.2%; 95%CI, 28.8-31.7%). 94 patients (2.4%; 95%CI, 2.0-2.9%) had extracardiac findings with a recommendation for follow-up, sixteen patients (0.4%; 95%CI, 0.3-0.7%) had incidental urgent, and another three patients (0.1%; 95%CI, 0.1-0.2%) had incidental malignant extracardiac findings. 185 of 2,330 symptomatic patients (7.9%; 95%CI, 6.9-9.1%) revealed extracardiac findings potentially explaining chest pain after exclusion of significant CAD. The number of extracardiac findings increased significantly with patient age (p < 0.001) and the cumulative experience of the CT reader (p < 0.001). CONCLUSION 30.2% of patients undergoing CTA for exclusion of CAD had ECF, and 7.9% of symptomatic patients without significant CAD on their examination had findings that could potentially explain their symptoms. KEY POINTS • Of patients undergoing CTA, 2.8% have relevant incidental extracardiac findings. • CTA could identify the differential diagnosis of chest pain when excluding significant CAD. • Patient age and reader's professional experience influence the number of detected ECFs.
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Sokolowski FC, Karius P, Rodríguez A, Lembcke A, Wagner M, Hamm B, Dewey M. Extracardiac findings at cardiac MR imaging: a single-centre retrospective study over 14 years. Eur Radiol 2018; 28:4102-4110. [PMID: 29713779 DOI: 10.1007/s00330-018-5432-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/05/2018] [Accepted: 03/16/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To determine the prevalence and significance of extracardiac findings (ECF) in a large set of cardiac magnetic resonance (MR) imaging examinations. METHODS The institutional review board (IRB) of the Charité approved this retrospective, single-centre study. A total of 4376 cardiac MR imaging reports of 3553 patients (age 37.4 ± 20 years, 60.8 % male) examined from 2000 to 2014 were included. Findings with a recommendation for follow-up were considered "major ECF". To analyse the association of indication, age and gender with ECF, Poisson regression and computed incidence rate ratios (IRR) were evaluated. RESULTS The overall prevalence of ECF was 34% (95% confidence interval [CI] 32.5-35.6%). Major ECF were present in 3.4% (95% CI 2.9-4.1%) while findings that changed patient management were found in 0.9% (95% CI 0.7-1.3%). In the cases of congenital heart disease, ECF prevalence was higher compared to myocarditis (IRR, 6.0; 95% CI 5.1-7.1%; p < 0.001), while the prevalence of major ECF was lower (IRR, 0.2; 95% CI 0.02-0.51%; p < 0.05). Older patient age was associated with more nonvascular ECF (p < 0.001). Female patients had the same probability of having an ECF as male patients (IRR, 1.04; 95% CI 0.95-1.1%; p = 0.43). CONCLUSION ECF in cardiac MR imaging are present in about every third patient while relevant ECF that change patient management can be found in about one out of 100 patients. Our data suggest that it is important to involve well-trained radiologists in reading cardiac MR images, which often reveal ECF if congenital heart disease is the clinical indication. KEY POINTS • Extracardiac findings are present in about every third patient. • Relevant ECF changing patient management are found in one out of 100 findings. • Chance of ECF is high in patients with CHD and vascular indications.
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Affiliation(s)
- Felix C Sokolowski
- Department of Radiology, Charite Medical School, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Philipp Karius
- Department of Radiology, Charite Medical School, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Alejandra Rodríguez
- Department of Radiology, Charite Medical School, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Alexander Lembcke
- Department of Radiology, Charite Medical School, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Moritz Wagner
- Department of Radiology, Charite Medical School, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charite Medical School, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charite Medical School, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Chariteplatz 1, 10117, Berlin, Germany.
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10
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Andrews JPM, McKillop G, Dweck MR. Incidental finding of large pneumothorax on Cardiac MR scan. BMC Med Imaging 2018; 18:3. [PMID: 29433494 PMCID: PMC5810119 DOI: 10.1186/s12880-017-0240-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We believe this is the first case report of a pneumothorax being identified using cardiac magnetic resonance imaging. This case also illustrates the haemodynamic effect a large pneumothorax can have on right ventricular filling in diastole. CASE PRESENTATION A 26-year-old attended for an interval follow up Cardiac Magnetic Resonance (CMR) of his thoracic aorta after a thoracic co-arctation repair aged 3. He was found to have an incidental large pneumothorax by the reporting cardiology fellow which was confirmed by the on-call radiologist. The pneumothorax was most notable for its compression of the right ventricle in diastole. Although the patient had worrying features on CMR imaging, he remained clinically stable and a conservative approach to management saw the pneumothorax resolve after a 3 week period. CONCLUSIONS Pneumothoraces are important, potentially life threatening conditions. Although very rarely identified on MR imaging, radiographers and reporting doctors should be aware of their key features. This case serves to identify not only the abnormal lung parenchymal features but also the striking compressional effect of the pneumothorax on the right ventricle in diastole. Indeed we believe this is the first case report of a pneumothorax identified on CMR imaging.
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Affiliation(s)
- J P M Andrews
- Centre for Cardiovascular Sciences, Chancellors Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK. .,Edinburgh Heart Centre, Royal infirmary of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SA, UK.
| | - G McKillop
- Department of Radiology, Royal Infirmary of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - M R Dweck
- Centre for Cardiovascular Sciences, Chancellors Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.,Edinburgh Heart Centre, Royal infirmary of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SA, UK
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Boldeanu I, Perreault Bishop J, Nepveu S, Stevens LM, Soulez G, Kieser TM, Lamy A, Noiseux N, Chartrand-Lefebvre C. Incidental findings in CT imaging of coronary artery bypass grafts: results from a Canadian multicenter prospective cohort. BMC Res Notes 2018; 11:72. [PMID: 29368660 PMCID: PMC5784672 DOI: 10.1186/s13104-018-3168-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/12/2018] [Indexed: 12/18/2022] Open
Abstract
Objective To assess the prevalence and clinical significance of incidental findings identified during computed tomography imaging of coronary artery bypass grafts. Results This prospective study includes 144 patients undergoing coronary graft patency assessment using computed tomography. Incidental findings were classified as significant if they were considered to need an immediate action or treatment, short-term work-up or follow-up, or minor. A total of 211 incidental findings were present in 109 (75.7%) patients. Seventy-one incidental findings (33.6%) were cardiac and 140 (66.4%) were extracardiac. Most common cardiac incidental findings were atrial dilatation [39 patients, 48 incidental findings (67.6%)] and aortic valve calcifications (7 patients, 9.9%). Among the 140 extracardiac incidental findings, the most common were lung nodules (51 patients, 54 nodules, 38.6%), and emphysema (21 patients, 15%). Thirty-six (25.7%) extracardiac incidental findings were significant and notably, 23 (63.9%) were lung nodules. Follow-up was recommended in 37 cases, among which all patients with significant lung nodules (23 patients, 62.2%). In conclusion, most common computed tomography incidental findings in patients with coronary grafts were lung nodules and emphysema. Electronic supplementary material The online version of this article (10.1186/s13104-018-3168-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- I Boldeanu
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet Street, Montreal, QC, H2X 0C1, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - J Perreault Bishop
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet Street, Montreal, QC, H2X 0C1, Canada
| | - S Nepveu
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet Street, Montreal, QC, H2X 0C1, Canada
| | - L-M Stevens
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Division of Cardiac Surgery, CHUM, Montreal, Canada
| | - G Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet Street, Montreal, QC, H2X 0C1, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - T M Kieser
- Division of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, Foothills Medical Centre, University of Calgary, Calgary, Canada
| | - A Lamy
- Division of Cardiac Surgery, McMaster University and Population Health Research Institute, Hamilton, ON, Canada
| | - N Noiseux
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Division of Cardiac Surgery, CHUM, Montreal, Canada
| | - C Chartrand-Lefebvre
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet Street, Montreal, QC, H2X 0C1, Canada. .,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.
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12
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Beganu E, Rodean I, Bordi L, Cernica D, Benedek I. The Role of Coronary Computed Tomography Angiography and Cardiac Magnetic Resonance in STEMI Patients with Normal Coronary Angiography. JOURNAL OF INTERDISCIPLINARY MEDICINE 2017. [DOI: 10.1515/jim-2017-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Usually, the diagnosis of myocardial infarction based on patient symptoms, electrocardiogram (ECG) changes, and cardiac enzymes, is not a challenge for cardiologists. The correlation between coronary anatomy and the ECG territories that present ischemic changes can help the clinician to estimate which coronary artery presents lesions upon performing a coronary angiogram. In certain situations, the diagnosis of myocardial infarction can be difficult due to the lack of correlations between the clinical and paraclinical examinations and the coronary angiogram. In some cases, patients with chest pain and ST-segment elevation on the ECG tracing present with a normal coronary angiography. In other cases, patients without important changes on the ECG can present critical lesions or even occlusions upon angiographic examination. The aim of this article is to highlight the role of noninvasive coronary magnetic resonance and multi-slice computed tomography in patients with ST-segment elevation myocardial infarction and normal coronary angiography.
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Affiliation(s)
- Elena Beganu
- Center of Advanced Research in Multimodality Cardiac Imaging , Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Ioana Rodean
- Center of Advanced Research in Multimodality Cardiac Imaging , Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Lehel Bordi
- Center of Advanced Research in Multimodality Cardiac Imaging , Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Daniel Cernica
- Center of Advanced Research in Multimodality Cardiac Imaging , Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Imre Benedek
- Center of Advanced Research in Multimodality Cardiac Imaging , Cardio Med Medical Center , Tîrgu Mureș , Romania
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
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13
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Sohns JM, Menke J, Schwarz A, Bergau L, Kowallick JT, Schuster A, Konietschke F, Placzek M, Weiberg D, Nordlohne S, Schmuck S, Schulz S, Derlin T, Staab W. Incidental findings in cardiac magnetic resonance imaging: superiority of bSSFP over T1w-HASTE for extra-cardiac findings assessment. Int J Cardiovasc Imaging 2017; 33:1581-1587. [PMID: 28451954 DOI: 10.1007/s10554-017-1145-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/20/2017] [Indexed: 12/21/2022]
Abstract
Incidental findings are frequent in radiological examinations and may have an impact on further patient management. The aim of this retrospective study was to analyze, which of two thoracic scout sequences is more suitable for detecting incidental extra-cardiac findings at cardiac magnetic resonance imaging (CMRI) with stress perfusion. During a 14-month period clinically indicated stress perfusion CMRI was performed in 97 consecutive patients. For anatomical orientation ECG-triggered (electrocardiography) T1w-Half-fourier acquisition single-shot turbo spin-echo (HASTE) and balanced steady state free precession (bSSFP) sequences were performed for planning the standard cardiac sequences. Two radiologists independently studied incidental extra-cardiac findings with both sequences and rated the diagnostic confidence of the sequences for this assessment using a multinomial model. Furthermore, the interobserver agreement between the observers was assessed by weighted kappa statistics. Eight patients without incidental findings were excluded. In the other 89 patients a total of 153 incidental extra-cardiac findings were observed. Overall, 47.1% of findings were seen with better diagnostic confidence at bSSFP as opposed to 20.6% at T1w-HASTE. 32.4% of findings were equally well seen with both sequences. Consequently the bSSFP sequence was significantly better in terms of diagnostic confidence for detecting the majority of extra-cardiac incidental findings (P < 0.01), whereas a minority of findings was better visible by the HASTE sequence. The weighted kappa statistics was 0.85, indicating good interobserver agreement. Compared with T1w-HASTE, the bSSFP sequence improved the visibility of incidental extra-cardiac findings at stress perfusion CMRI. While all findings were seen on both sequences, bSSFP resulted in improved diagnostic confidence, and the T1w-HASTE sequence provided complementary diagnostic information in only a minority of patients.
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Affiliation(s)
- Jan M Sohns
- Department of Nuclear Medicine, Center of Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. .,German Centre for Cardiovascular Research, DZHK, Berlin, Germany.
| | - Jan Menke
- Institute for Diagnostic and Interventional Radiology, Georg-August-University, UMG, Göttingen, Germany
| | - Alexander Schwarz
- Institute for Diagnostic and Interventional Radiology, Georg-August-University, UMG, Göttingen, Germany
| | - Leonard Bergau
- German Centre for Cardiovascular Research, DZHK, Berlin, Germany.,Department of Cardiology and Pneumology, Georg-August-University, UMG, Göttingen, Germany
| | - Johannes T Kowallick
- German Centre for Cardiovascular Research, DZHK, Berlin, Germany.,Institute for Diagnostic and Interventional Radiology, Georg-August-University, UMG, Göttingen, Germany
| | - Andreas Schuster
- German Centre for Cardiovascular Research, DZHK, Berlin, Germany.,Department of Cardiology and Pneumology, Georg-August-University, UMG, Göttingen, Germany
| | - Frank Konietschke
- Department of Mathematical Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Marius Placzek
- Department of Medical Statistics, Georg-August-University, UMG, Göttingen, Germany
| | - Desiree Weiberg
- Department of Nuclear Medicine, Center of Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefan Nordlohne
- Department of Nuclear Medicine, Center of Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sebastian Schmuck
- Department of Nuclear Medicine, Center of Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sebastian Schulz
- Department of Nuclear Medicine, Center of Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Center of Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Wieland Staab
- German Centre for Cardiovascular Research, DZHK, Berlin, Germany.,Institute for Diagnostic and Interventional Radiology, Georg-August-University, UMG, Göttingen, Germany
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14
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Malik A, Hellinger JC, Servaes S, Schwartz MC, Keller MS, Epelman M. Prevalence of non-cardiovascular findings on CT angiography in children with congenital heart disease. Pediatr Radiol 2017; 47:267-279. [PMID: 27924361 DOI: 10.1007/s00247-016-3742-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/30/2016] [Accepted: 10/27/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND CT angiography is gaining broader acceptance in the evaluation of children with known or suspected congenital heart disease. These studies include non-cardiovascular structures such as the mediastinum, lung parenchyma and upper abdominal organs. It is important to inspect all these structures for potential abnormalities that might be clinically important and, in some cases, may impact care plans. OBJECTIVE To determine the prevalence of non-cardiovascular findings in CT angiography of children with congenital heart disease. MATERIALS AND METHODS During 28 months, 300 consecutive children (170 males; mean age: 7.1 years, age range: 6 h-26 years), referred from a tertiary pediatric cardiology center, underwent clinically indicated CT angiography to evaluate known or suspected congenital heart disease. Slightly more than half (n = 169) of the patients were postoperative or post-intervention. Examinations were retrospectively reviewed, and non-cardiovascular findings were recorded and tabulated by organ system, congenital heart disease and operative procedure in conjunction with outcomes from medical charts. RESULTS Non-cardiovascular findings were identified in 83% (n = 250 / 300) of the studies for a total of 857 findings. In 221 patients (n = 73.7% of 300) a total of 813 non-cardiovascular findings were clinically significant, while in 9.7% (n = 29 / 300) of patients, 5.1% (n = 44 / 857) of the findings were nonsignificant. In 38.3% (n = 115 / 300) of patients with significant non-cardiovascular pathology, the findings were unexpected and directly impacted patient care plans. Commonly involved organs with non-cardiovascular findings were the lungs with 280 non-cardiovascular findings in 176 / 300 (58.7%) of patients, the airway with 139 non-cardiovascular findings in 103 / 300 (34.3%) of patients and the liver with 108 non-cardiovascular findings in 72 / 300 (24.0%) of patients. Syndromic associations were noted in 22% (n = 66 / 300) of the patients. CONCLUSION Non-cardiovascular findings are common in children with congenital heart disease who undergo CT angiography. Based upon our study population, if a child with congenital heart disease has a CT angiography, five out of six will have non-cardiovascular findings, while nearly three out of four (73.7%; 221 / 300) will have significant non-cardiovascular findings. Close attention to the non-cardiovascular structures in children with congenital heart disease presenting for a CT angiography is recommended as in nearly 40% of these children, findings were unexpected and directly altered patient care.
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Affiliation(s)
- Archana Malik
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Radiology, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Jeffrey C Hellinger
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,New York Cardiovascular Institute at Lenox Hill Radiology, New York, NY, USA
| | - Sabah Servaes
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mathew C Schwartz
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Sanger Heart and Vascular Institute, Levine Children's Hospital, Charlotte, NC, USA
| | - Marc S Keller
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Monica Epelman
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Medical Imaging/Radiology, Nemours Children's Health System/Nemours Children's Hospital, 13535 Nemours Parkway, Orlando, FL, 32827, USA.
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15
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Mahdavi A, Mohammadzadeh A, Joodi G, Tabatabaei MR, Sheikholeslami F, Motevalli M. Diagnostic Accuracy of Dual-Source Computerized Tomography Coronary Angiography in Symptomatic Patients Presenting to a Referral Cardiovascular Center During Daily Clinical Practice. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e24350. [PMID: 27679698 PMCID: PMC5035936 DOI: 10.5812/iranjradiol.24350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 10/21/2014] [Accepted: 11/11/2014] [Indexed: 12/21/2022]
Abstract
Background There are numerous studies that address the diagnostic value of dual-source computed tomography (DSCT) as an alternative to conventional coronary angiography (CCA). However, the benefit of application of DSCT in a real world clinical setting should be evaluated. Objectives To determine the diagnostic accuracy of DSCT technique compared with CCA as the gold standard method in detection of coronary artery stenosis among symptomatic patients who are presented to a referral cardiovascular center during daily clinical practice. Patients and Methods Evaluating the medical records of a tertiary care referral cardiovascular center, 47 patients who had undergone DSCT and CCA, and also met the inclusion and exclusion criteria of the study were selected. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) of the DSCT imaging technique were calculated. Results In total, 97.8% of the segments (628/642) could be visualized with diagnostic image quality via DSCT coronary angiography. The mean heart rate during DSCT was 69.2 ± 12.2 bpm (range: 39 - 83 bpm), and the mean Agatston score was 507.7 ± 590.5 (range: 0 - 2328). Per segment analysis of the findings revealed that the sensitivity, specificity, PPV, NPV, positive LR (PLR) and negative LR (NLR) of DSCT technique for evaluation of patients with coronary artery disease were 93.7%, 96.8%, 92.7%, 97.2%, 29.4, and 0.066, respectively. Also per vessel, analysis of the findings showed a sensitivity of 97.1%, a specificity of 94.0%, PPV of 95.3%, NPV of 96.3%, PLR of 16.1, and NLR of 0.030. Conclusion Our results indicate that DSCT coronary angiography provides high diagnostic accuracy for the evaluation of CAD patients during daily routine practice of a referral cardiovascular setting.
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Affiliation(s)
- Arash Mahdavi
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Mohammadzadeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Golsa Joodi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farhad Sheikholeslami
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Motevalli
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author: Marzieh Motevalli, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Tel: +98-2122042026, Fax: +98-21-22042026, E-mail:
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16
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Bignotti B, Succio G, Nosenzo F, Perinetti M, Gristina L, Barbagallo S, Secondini L, Calabrese M, Tagliafico A. Breast findings incidentally detected on body MRI. SPRINGERPLUS 2016; 5:781. [PMID: 27386267 PMCID: PMC4912526 DOI: 10.1186/s40064-016-2343-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 12/21/2022]
Abstract
Objectives To evaluate breast findings incidentally detected on body MRI. Methods A retrospective review of the institutional database identified 1752 body MRI performed between January 2015 and September 2015. MRI of women with breast tissue visible in the field-of-view were reviewed for breast findings. Breast findings were classified with the breast imaging reporting and data system (BI-RADS) lexicon. The standard statistic, costs of additional work-up, and the clinical relevance were used to describe breast findings, and we calculated 95 % exact confidence intervals (CIs). Results 440 body MRI of 440 women (mean age: 57 ± 20 years) included breast tissue in the field-of-view. A total of 41 breast findings were identified in 41 patients. Breast findings were classified BI-RADS 2 N = 25, BI-RADS 3 N = 13, BI-RADS 4 N = 3. A total of 3.6 % [95 % CI 1.6 %, 5.6 %] women with breast tissue visible on MRI had a recommendation for further imaging work-up for a breast finding. The 18.7 % (3 of 16) of these patients had a clinically important finding (breast cancer). Further imaging evaluation increased costs of €108.3 per patient with a breast finding. Conclusions Clinically important breast findings could be detected on body MRI in up to 0.7 % (3 of 440) of women.
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Affiliation(s)
- Bianca Bignotti
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Giulia Succio
- Department of Diagnostic Senology, IRCCS Azienda Ospedaliera Universitaria San Martino IST-Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Francesca Nosenzo
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Michela Perinetti
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Licia Gristina
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Stella Barbagallo
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Lucia Secondini
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Massimo Calabrese
- Department of Diagnostic Senology, IRCCS Azienda Ospedaliera Universitaria San Martino IST-Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Alberto Tagliafico
- Institute of Anatomy, Department of Experimental Medicine, University of Genova, Via Leon Battista Alberti, 2, 16132 Genoa, Italy
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17
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Karkhanis S, Patil S, Hoey ET, Ganeshan A. The prevalence and significance of thoracic findings in patients undergoing extended coverage computed tomography for assessment of abdominal aortic aneurysms. Br J Radiol 2016; 89:20150723. [PMID: 26987373 DOI: 10.1259/bjr.20150723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Many major vascular centres, including ours, incorporate coverage of the thoracic aorta in CT scans evaluating abdominal aortic aneurysms (AAAs) (extended coverage contrast-enhanced CT (EC-CECT) scan]. We sought to determine the prevalence of thoracic pathology in a large consecutive series of patients with AAA undergoing EC-CECT. METHODS All patients who underwent EC-CECT for AAA between April 2013 and 2014 were identified from our radiology information system. Reports were retrospectively reviewed and for each study, sex, age and reported thoracic aortic and other non-vascular findings were extracted. Findings were initially categorized into "major" or "minor" depending on if they were mentioned in the report impression/conclusion. Any major thoracic pathology was termed "significant" if there was a new diagnosis/patient intervention/investigation and a change in patient management. RESULTS Of the 150 scans included in the study, 97 (65%) had at least one thoracic finding. These findings included 24 scans (16%) with major findings and 73 scans (48%) with minor findings. In 13 scans (9%), the findings were significant and resulted in a delay (n = 11) or cancellation (n = 2) of AAA repair. CONCLUSION Pre-procedural EC-CECT helps to identify significant intrathoracic findings in patients with AAA, which can have a major impact on AAA repair. This study supports the routine use of pre-procedural EC-CECT in planning AAA repair. ADVANCES IN KNOWLEDGE This study describes the prevalence of significant thoracic pathology, which can impact on AAA repair. This information could potentially change the pre-procedure imaging protocol for patients with AAA.
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Affiliation(s)
- Salil Karkhanis
- 1 Radiology Department, New Queen Elizabeth Hospital, Birmingham, UK
| | - Shahbaz Patil
- 1 Radiology Department, New Queen Elizabeth Hospital, Birmingham, UK
| | - Edward Td Hoey
- 2 Radiology Department, Birmingham Heartland Hospital, Birmingham, UK
| | - Arul Ganeshan
- 2 Radiology Department, Birmingham Heartland Hospital, Birmingham, UK
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18
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Sconfienza LM, Mauri G, Muzzupappa C, Poloni A, Bandirali M, Esseridou A, Tritella S, Secchi F, Di Leo G, Sardanelli F. Relevant incidental findings at abdominal multi-detector contrast-enhanced computed tomography: A collateral screening? World J Radiol 2015; 7:350-356. [PMID: 26516432 PMCID: PMC4620116 DOI: 10.4329/wjr.v7.i10.350] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 07/31/2015] [Accepted: 08/21/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the prevalence of relevant incidental findings (RIFs) detected during routine abdominal contrast-enhanced computed tomography (CeCT).
METHODS: We retrospectively evaluated the reports of a consecutive series of abdominal CeCT studies performed between January and May 2013. For each report, patients’ age and sex, admission as inpatient or outpatient, clinical suspicion as indicated by the requesting physician, availability of a previous abdominal examination, and name of the reporting radiologist were recorded. Based on the clinical suspicion, the presence and features of any RIFs (if needing additional workup) was noted.
RESULTS: One thousand forty abdominal CeCT were performed in 949 patients (528 males, mean age 66 ± 14 years). No significant difference was found between inpatients and outpatients age and sex distribution (P > 0.472). RIFs were found in 195/1040 (18.8%) CeCT [inpatients = 108/470 (23.0%); outpatients = 87/570 (15.2%); P = 0.002]. RIFs were found in 30/440 (6.8%) CeCT with a previous exam and in 165/600 (27.5%) without a previous exam (P < 0.001). Radiologists’ distribution between inpatients or outpatients was significantly different (P < 0.001). RIFs prevalence increased with aging, except for a peak in 40-49 year group. Most involved organs were kidneys, gallbladder, and lungs.
CONCLUSION: A RIF is detected in 1/5 patients undergoing abdominal CeCT. Risk of overdiagnosis should be taken into account.
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19
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Dunet V, Schwitter J, Meuli R, Beigelman-Aubry C. Incidental extracardiac findings on cardiac MR: Systematic review and meta-analysis. J Magn Reson Imaging 2015; 43:929-39. [PMID: 26397378 DOI: 10.1002/jmri.25053] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To perform a systematic review and meta-analysis to calculate the pooled prevalence of incidental extracardiac findings (IEFs) on cardiac magnetic resonance (MR) and to determine factors influencing reported prevalences. MATERIALS AND METHODS We examined studies published in the literature using the MEDLINE database. Studies reporting IEFs on cardiac MR were included. Meta-analysis provided pooled prevalences of total, minor, major IEFs, and major IEFs with patient management changes using a random-effects model. Heterogeneity and inconsistency (I-squared) between studies as well as publication bias were assessed. RESULTS Twelve studies including 7062 patients (mean age: 52 years, range: 0.5-93 years, 4476 male/2586 female) and 7122 cardiac MR examinations were considered in the meta-analysis. Overall, the pooled prevalence of total IEFs was 35% (95% confidence interval [CI]: 23-47%). The pooled prevalence of minor and major IEFs were 17% (95% CI: 9-26%) and 12% (95% CI: 7-18%), respectively. Newly diagnosed major IEFs changed patient management in 1% (95% CI: 1-2%) of the study population. A high heterogeneity and inconsistency (I-squared >74%) between studies without publication bias were observed, notably due to IEFs recording method (P < 0.002) and formal training of cardiac MR readers (P < 0.006). CONCLUSION Major IEFs may be found in 12% of patients undergoing cardiac MR examination and change the management in 1% of patients. Readers' training for the evaluation of noncardiac structures increases reported prevalence.
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Affiliation(s)
- Vincent Dunet
- Department of Radiodiagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Juerg Schwitter
- Cardiac MR Center, Lausanne University Hospital, Lausanne, Switzerland.,Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Reto Meuli
- Department of Radiodiagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland.,Cardiac MR Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Catherine Beigelman-Aubry
- Department of Radiodiagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland.,Cardiac MR Center, Lausanne University Hospital, Lausanne, Switzerland
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20
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Value of “large FOV” calcium score as a screening method for detection of extracardiac incidental findings. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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21
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CT before transcatheter aortic valve replacement: Value of venous phase imaging for detection and interpretation of findings with impact on the TAVR procedure. J Cardiovasc Comput Tomogr 2015; 9:422-7. [DOI: 10.1016/j.jcct.2015.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 03/08/2015] [Accepted: 03/17/2015] [Indexed: 12/21/2022]
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22
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Shahir K, McCrea JM, Lozano LAS, Goodman LR. Reduced z-axis technique for CT Pulmonary angiography in pregnancy—validation for practical use and dose reduction. Emerg Radiol 2015; 22:651-6. [DOI: 10.1007/s10140-015-1340-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/13/2015] [Indexed: 12/21/2022]
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23
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The lack of obstructive coronary artery disease on coronary CT angiography safely reduces downstream cost and resource utilization during subsequent chest pain presentations. J Cardiovasc Comput Tomogr 2015; 9:329-36. [DOI: 10.1016/j.jcct.2015.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/09/2015] [Accepted: 03/30/2015] [Indexed: 12/21/2022]
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24
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Dunet V, Barras H, Boulanger X, Monney P, Qanadli SD, Meuli R, Schwitter J, Beigelman-Aubry C. Impact of extracardiac findings during cardiac MR on patient management and outcome. Med Sci Monit 2015; 21:1288-96. [PMID: 25943552 PMCID: PMC4548703 DOI: 10.12659/msm.893599] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Cardiac magnetic resonance (CMR) is increasingly used to assess heart diseases. Relevant non-cardiac diseases may also be incidentally found on CMR images. The aim of this study was to determine the prevalence and nature of incidental extra-cardiac findings (IEF) and their clinical impact in non-selected patients referred for CMR. Material/Methods MR images of 762 consecutive patients (515 men, age: 56±18 years) referred for CMR were prospectively interpreted by 2 radiologists blinded for any previous imaging study. IEFs were classified as major when requiring treatment, follow-up, or further investigation. Clinical follow-up was performed by checking hospital information records and by calling referring physicians. The 2 endpoints were: 1) non-cardiac death and new treatment related to major IEFs, and 2) hospitalization related to major IEFs during follow-up. Results Major IEFs were proven in 129 patients (18.6% of the study population), 14% of those being unknown before CMR. During 15±6 month follow-up, treatment of confirmed major IEFs was initiated in 1.4%, and no non-cardiac deaths occurred. Hospitalization occurred in 8 patients (1.0% of the study population) with confirmed major IEFs and none occurred in the remaining 110 patients with unconfirmed/unexplored major IEFs (p<0.001). Conclusions Screening for major IEFs in a population referred for routine CMR changed management in 1.4% of patients. Major IEFs unknown before CMR but without further exploration, however, carried a favorable prognosis over a follow-up period of 15 months.
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Affiliation(s)
- Vincent Dunet
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Heloise Barras
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Xavier Boulanger
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Monney
- Cardiac MR Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Salah D Qanadli
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Reto Meuli
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Juerg Schwitter
- Cardiac MR Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Catherine Beigelman-Aubry
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
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25
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Incidental abdominopelvic findings on expanded field-of-view lumbar spinal MRI: frequency, clinical importance, and concordance in interpretation by neuroimaging and body imaging radiologists. Clin Radiol 2015; 70:161-7. [DOI: 10.1016/j.crad.2014.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/16/2014] [Accepted: 10/27/2014] [Indexed: 12/21/2022]
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26
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Shawgi M, Arumugam P. Looking outside the "cardiac" box: incidental detection of a metastatic lung tumor on cardiac position emission tomography/computed tomography. World J Nucl Med 2014; 13:197-200. [PMID: 25538493 PMCID: PMC4262880 DOI: 10.4103/1450-1147.144822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Incidental extracardiac findings are not uncommon in patients undergoing cardiac positron emission tomography/computed tomography (PET/CT) and some of these findings can have significant clinical impact. We report a case of a 74-year-old man who presented with dyspnea and left sided chest pain. 82-rubidium PET/CT imaging showed normal myocardial perfusion. Review of the low dose CT scan performed for attenuation correction purposes (CTAC) incidentally revealed a 4 cm mass in the left lung, which was histologically shown to be a squamous cell carcinoma. A subsequent staging CT showed chest wall metastases and rib destruction in the upper left thorax, which were outside the image reconstruction field of view of the CTAC. This report illustrates the importance of vigilant review of all acquired images by the PET/CT reader to look for extracardiac abnormalities that may explain symptoms in the absence of coronary artery disease. It also raises the question as to whether a larger field of CT image acquisition should be routinely performed to scan the entire chest during cardiac PET/CT imaging. However, the latter needs to be weighed against the increase in patient dose, which we estimated to be an additional 15%.
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Affiliation(s)
- Mohamed Shawgi
- Department of Nuclear Medicine, Central Manchester University Hospitals, Manchester, United Kingdom
| | - P Arumugam
- Department of Nuclear Medicine, Central Manchester University Hospitals, Manchester, United Kingdom
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27
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Safe and rapid disposition of low-to-intermediate risk patients presenting to the emergency department with chest pain: A 1-year high-volume single-center experience. J Cardiovasc Comput Tomogr 2014; 8:375-83. [DOI: 10.1016/j.jcct.2014.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/02/2014] [Accepted: 08/05/2014] [Indexed: 12/21/2022]
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28
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Loy A, Morgan R, O'Dea S, Daly C, Mulcahy F. Clinically significant extra-cardiac findings in asymptomatic HIV-positive men undergoing cardiac magnetic resonance imaging. Int J STD AIDS 2014; 26:346-51. [PMID: 24872375 DOI: 10.1177/0956462414538005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Increased research-based imaging has led to an increase in clinically significant extra-cardiac findings. HIV patients are at increased risk of having polypathology at a younger age; therefore, it may be hypothesised that they would have more incidental findings on imaging. We reviewed the magnetic resonance imaging results of 169 HIV-positive and 40 HIV-negative, clinically well volunteers undergoing cardiac magnetic resonance imaging scanning to assess the prevalence of subclinical cardiac pathology. This sub-study assessed the prevalence of clinically significant extra-cardiac findings. Associated risk factors were assessed and clinical follow-up and outcome were ascertained. Of the HIV-positive study group, 12/169 (7.1%) vs. 1/40 (2.5%) control patients had a clinically significant extra-cardiac finding which warranted further radiological or clinical intervention (p = 0.28). A total of three out of 169 (1.1%) were highly clinically significant findings. On logistic regression analysis, age was the only significant contributing factor (p = 0.049); no HIV-associated factors were found to be significant. The prevalence of clinically significant extra-cardiac findings of 7.1% in this HIV-positive cohort is comparable to the prevalence found in previous studies carried out on an older, sicker general population. This highlights the need for planning for unexpected outcomes and also the high rate of clinically significant findings in a seemingly well HIV-positive population.
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Affiliation(s)
- A Loy
- Genito-Urinary Infectious Disease Department, St James's Hospital, Dublin, Ireland
| | - R Morgan
- Cardiology Department, St James's Hospital, Dublin, Ireland
| | - S O'Dea
- Genito-Urinary Infectious Disease Department, St James's Hospital, Dublin, Ireland
| | - C Daly
- Cardiology Department, St James's Hospital, Dublin, Ireland
| | - F Mulcahy
- Genito-Urinary Infectious Disease Department, St James's Hospital, Dublin, Ireland
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Karius P, Schuetz GM, Schlattmann P, Dewey M. Extracardiac findings on coronary CT angiography: A systematic review. J Cardiovasc Comput Tomogr 2014; 8:174-82.e1-6. [DOI: 10.1016/j.jcct.2014.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/03/2014] [Accepted: 04/09/2014] [Indexed: 12/21/2022]
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Fleming LM, Manning WJ. Extracardiac Findings on Echocardiography: Blissful Ignorance or a Call to Improve Our Training? J Am Soc Echocardiogr 2014; 27:547-8. [DOI: 10.1016/j.echo.2014.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fussner LA, Midthun DE. Characteristics and management strategies for the incidental pulmonary nodule. Lung Cancer Manag 2014. [DOI: 10.2217/lmt.14.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY: Pulmonary nodules are frequent, unanticipated findings on imaging studies obtained for other purposes across all areas of medical practice. As nodule detection raises concern for malignancy, evaluation and follow-up of an incidental nodule is imperative. Clinicians are charged with counseling patients and directing further evaluation amid uncertainty and anxiety. The goals of follow-up and management are to identify malignant lesions at an early stage, while avoiding unnecessary procedures and potential harm to patients with benign nodules. In this review, we aim to outline the clinical and radiographic characteristics that can aid in likelihood stratification, to identify gaps in our current knowledge, and to present a logical approach to nodule management, based on the available evidence.
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Affiliation(s)
- Lynn A Fussner
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - David E Midthun
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Sohns JM, Staab W, Menke J, Bergau L, Dabir D, Schwarz A, Spiro JE, Dorenkamp M, Harrison JL, Steinmetz M, Lotz J, Sohns C. Vascular and extravascular findings on magnetic resonance angiography of the thoracic aorta and the origin of the great vessels. J Magn Reson Imaging 2013; 40:988-95. [DOI: 10.1002/jmri.24442] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 09/11/2013] [Indexed: 12/21/2022] Open
Affiliation(s)
- Jan M. Sohns
- Institute for Diagnostic and Interventional Radiology; Georg-August University; Göttingen Germany
- DZHK (German Cardiovascular Research Center), partner site; Göttingen Germany
| | - Wieland Staab
- Institute for Diagnostic and Interventional Radiology; Georg-August University; Göttingen Germany
- DZHK (German Cardiovascular Research Center), partner site; Göttingen Germany
| | - Jan Menke
- Institute for Diagnostic and Interventional Radiology; Georg-August University; Göttingen Germany
| | - Leonard Bergau
- Department of Cardiology and Pneumology; Georg-August University; Göttingen Germany
| | - Darius Dabir
- Department of Radiology; Rheinische Friedrich-Wilhelms University; Bonn Germany
| | - Alexander Schwarz
- Institute for Diagnostic and Interventional Radiology; Georg-August University; Göttingen Germany
- DZHK (German Cardiovascular Research Center), partner site; Göttingen Germany
| | - Judith E. Spiro
- Department of Radiology; University Hospital Cologne; Cologne Germany
| | - Marc Dorenkamp
- Department of Cardiology; Charité University Hospital; Virchow Hospital Berlin Germany
| | - James L. Harrison
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London UK
| | - Michael Steinmetz
- DZHK (German Cardiovascular Research Center), partner site; Göttingen Germany
- Clinic for Pediatric Cardiology and Intensive Care Medicine; Georg-August University; Göttingen Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology; Georg-August University; Göttingen Germany
- DZHK (German Cardiovascular Research Center), partner site; Göttingen Germany
| | - Christian Sohns
- Department of Cardiology and Pneumology; Georg-August University; Göttingen Germany
- Division of Imaging Sciences and Biomedical Engineering; King's College London; London UK
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Malignant incidental extracardiac findings on cardiac CT: systematic review and meta-analysis. AJR Am J Roentgenol 2013; 201:555-64. [PMID: 23971446 DOI: 10.2214/ajr.12.10306] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objective of our study was to systematically review the evidence on incidental extracardiac findings on cardiac CT with a focus on previously unknown malignancies. MATERIALS AND METHODS A systematic search was performed (PubMed, EMBASE, Cochrane databases) for studies reporting incidental extracardiac findings on cardiac CT. Among 1099 articles initially found, 15 studies met the inclusion criteria. The references of those articles were hand-searched and 14 additional studies were identified. After review of the full text, 10 articles were excluded. Nineteen studies including 15,877 patients (64% male) were analyzed. A three-level analysis was performed to determine the prevalence of patients with incidental extracardiac findings, the prevalence of patients with major incidental extracardiac findings, and the prevalence of patients with a proven cancer. Heterogeneity was explored for multiple variables. Pooled prevalence and 95% CI were calculated. RESULTS The prevalence of both incidental extracardiac findings and major incidental extracardiac findings showed a high heterogeneity (I2>95%): The pooled prevalence was 44% (95% CI, 35-54%) and 16% (95% CI, 14-20%), respectively. No significant explanatory variables were found for using or not using contrast material, the size of the FOV, and study design (I2>85%). The pooled cancer prevalence for 10 studies including 5082 patients was 0.7% (95% CI, 0.5-1.0%), with an almost perfect homogeneity (I2<0.1%). Of 29 reported malignancies, 21 (72%) were lung cancers; three, thyroid cancers; two, breast cancers; two, liver cancers; and one, mediastinal lymphoma. CONCLUSION Although the prevalence of reported incidental extracardiac finding at cardiac CT was highly variable, a homogeneous prevalence of previously unknown malignancies was reported across the studies, for a pooled estimate of 0.7%; more than 70% of these previously unknown malignancies were lung cancers. Extracardiac findings on cardiac CT require careful evaluation and reporting.
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Noncardiac findings in clinical cardiac magnetic resonance: prevalence in 300 examinations after blind reassessment. J Comput Assist Tomogr 2013; 37:382-6. [PMID: 23674009 DOI: 10.1097/rct.0b013e3182845bdb] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To assess the prevalence of noncardiac findings (NCFs) in a consecutive series of 300 cardiac magnetic resonance (CMR) studies. METHODS We retrospectively evaluated CMRs of 192 males and 108 females (42 ± 22 years), comparing findings included in reports to those detected after focused reassessment of CMR images. Noncardiac findings were classified as relevant if additional workup was required. RESULTS We found 19 NCFs, 14 (4.7%) tagged as nonrelevant and 5 (1.7%) as relevant. Images' reassessment presented 45 NCFs, 26 (8.7%) nonrelevant and 16 (5.3%) relevant (P < 0.003). CONCLUSIONS Cardiac magnetic resonance involves the study of areas larger than the heart alone, and NCFs are found in 1 of 7 patients; more than a half of them are not included in the initial CMR report. A small part is relevant, but detection can be unnecessarily stressful and harmful for patients and could increase costs. Risks of overdiagnosis or underreporting are to be taken into account.
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Sohns JM, Schwarz A, Menke J, Staab W, Spiro JE, Lotz J, Unterberg-Buchwald C. Prevalence and clinical relevance of extracardiac findings at cardiac MRI. J Magn Reson Imaging 2013; 39:68-76. [PMID: 23589475 DOI: 10.1002/jmri.24142] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 02/25/2013] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To assess the incidence of extracardiac findings in patients undergoing clinical cardiac magnetic resonance imaging (CMRI) of the heart, and to determine the influence of those findings on patient management. MATERIALS AND METHODS During 40 months, 854 CMRI were performed at 1.5 T. Extracardiac findings were classified as significant (group A), if recommended for additional diagnostics or therapeutic interventions, and as nonsignificant (group B). RESULTS The most frequent indication for CMRI was evaluation of cardiac stress ischemia. In all, 631 CMRI (74% of 854) showed no extracardiac pathologies. In the remaining 223 CMRI (26% of 854), a total of 286 extracardiac findings were detected. Among these findings, 49 were considered significant (group A) and 237 nonsignificant (group B). In group A, the most common findings were suspicious pulmonary nodules or masses. In group B, the most frequent findings were hepatic cysts or hemangiomas. Eight malignancies were observed with certainty at CMRI. Seven of them had been incidentally diagnosed on CMRI for the first time, and subsequently changed the patients' management. CONCLUSION Extracardiac findings in clinically indicated CMRI are common (about 26%). Radiologists and cardiologists should be aware of relevant extracardiac findings that might require additional diagnostics or treatment.
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Affiliation(s)
- Jan Martin Sohns
- Institute for Diagnostic and Interventional Radiology, Heart Center, University Medical Center Goettingen, Germany
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36
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Coronary Computed Tomography Angiography: Costs and Current Reimbursement Status. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9158-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Irwin RB, Newton T, Peebles C, Borg A, Clark D, Miller C, Abidin N, Greaves M, Schmitt M. Incidental extra-cardiac findings on clinical CMR. Eur Heart J Cardiovasc Imaging 2012; 14:158-66. [DOI: 10.1093/ehjci/jes133] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Khosa F, Warraich H, Khan A, Mahmood F, Markson L, Clouse ME, Manning WJ. Prevalence of Non-Cardiac Pathology on Clinical Transthoracic Echocardiography. J Am Soc Echocardiogr 2012; 25:553-7. [DOI: 10.1016/j.echo.2012.01.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Indexed: 12/21/2022]
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Buckens CF, Verkooijen HM, Gondrie MJ, Jairam P, Mali WP, van der Graaf Y. Unrequested findings on cardiac computed tomography: looking beyond the heart. PLoS One 2012; 7:e32184. [PMID: 22536315 PMCID: PMC3334960 DOI: 10.1371/journal.pone.0032184] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 01/23/2012] [Indexed: 12/21/2022] Open
Abstract
Objectives To determine the prevalence of clinically relevant unrequested extra-cardiac imaging findings on cardiac Computed Tomography (CT) and explanatory factors thereof. Methods A systematic review of studies drawn from online electronic databases followed by meta-analysis with meta-regression was performed. The prevalence of clinically relevant unrequested findings and potentially explanatory variables were extracted (proportion of smokers, mean age of patients, use of full FOV, proportion of men, years since publication). Results Nineteen radiological studies comprising 12922 patients met the inclusion criteria. The pooled prevalence of clinically relevant unrequested findings was 13% (95% confidence interval 9–18, range: 3–39%). The large differences in prevalence observed were not explained by the predefined (potentially explanatory) variables. Conclusions Clinically relevant extra-cardiac findings are common in patients undergoing routine cardiac CT, and their prevalence differs substantially between studies. These differences may be due to unreported factors such as different definitions of clinical relevance and differences between populations. We present suggestions for basic reporting which may improve the interpretability and comparability of future research.
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May CW, Mansfield WT, Landes AB, Moran AM. Prevalence of noncardiac findings in patients undergoing cardiac magnetic resonance imaging. ScientificWorldJournal 2012; 2012:474582. [PMID: 22566770 PMCID: PMC3324172 DOI: 10.1100/2012/474582] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 10/26/2011] [Indexed: 12/21/2022] Open
Abstract
Purpose. We sought to determine the prevalence of clinically significant non-cardiac abnormalities found in pediatric and adult patients undergoing cardiac magnetic resonance imaging (CMRI), and understand the impact of age on it's occurrence. Methods. We retrospectively reviewed all patients undergoing CMRI between May 2004 and July 2007. Findings were considered significant if they required radiographic or clinical follow-up. Results. A total of 408 patients underwent CMRI during the study period. Twenty two (16%) pediatric patients (age < 19 years, n = 135) were found to have a total of 22 non- cardiac abnormalities, 3 of which were clinically significant. Sixty four (23%) adult patients (age > 19 years, n = 273) were found to have a total of 77 non-cardiac abnormalities, 33 of which were clinically significant. The prevalence of clinically significant non-cardiac abnormalities was 2% in the pediatric cohort and 11% in the adult cohort (P = 0.05). Within the adult population, the prevalence of significant non-cardiac abnormalities increased with advancing age (P = 0.05). Conclusions. In a population of unselected patients undergoing CMRI, unanticipated noncardiac abnormalities were frequently seen. A small number of these were significant, with the prevalence increasing with age.
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Affiliation(s)
- Christopher W May
- Department of Cardiology, Maine Medical Center, 88 Beamhall st, Portland, ME 04102, USA
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41
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Extracardiac findings detected by cardiac magnetic resonance imaging. Eur Radiol 2012; 22:1295-302. [DOI: 10.1007/s00330-011-2369-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 11/15/2011] [Accepted: 12/07/2011] [Indexed: 12/21/2022]
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Earls JP. The pros and cons of searching for extracardiac findings at cardiac CT: studies should be reconstructed in the maximum field of view and adequately reviewed to detect pathologic findings. Radiology 2011; 261:342-6. [PMID: 22012900 DOI: 10.1148/radiol.11111099] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- James P Earls
- Fairfax Radiological Consultants, 5553 Rockpoint Dr, Clifton, VA 20124, USA.
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Coronary dual source multi detector computed tomography in patients suspected of coronary artery disease: Prevalence of incidental extra-cardiac findings. Eur J Radiol 2011; 80:109-14. [DOI: 10.1016/j.ejrad.2010.05.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 05/14/2010] [Accepted: 05/21/2010] [Indexed: 12/21/2022]
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Casella M, Perna F, Pontone G, Dello Russo A, Andreini D, Pelargonio G, Riva S, Fassini G, Pepi M, Ballerini G, Moltrasio M, Majocchi B, Bartoletti S, Formenti A, Santangeli P, Di Biase L, Natale A, Tondo C. Prevalence and clinical significance of collateral findings detected by chest computed tomography in patients undergoing atrial fibrillation ablation. Europace 2011; 14:209-16. [PMID: 21933801 DOI: 10.1093/europace/eur300] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIMS Chest computed tomography (CT) scanning is increasingly used as an imaging technique in patients undergoing atrial fibrillation (AF) catheter ablation. Chest CT scans visualize organs other than the heart and collateral findings may be identified incidentally. Our study aims to assess the prevalence and clinical relevance of such collateral findings in patients undergoing AF ablation. METHODS AND RESULTS One hundred and seventy-three patients (127 males, age 59 ± 10 years) underwent chest CT scan for image integration in AF ablation. Collateral findings from visualized thoracic and upper abdominal organs were collected. Findings that required further investigations or treatment according to current guidelines were considered as clinically significant. A total of 164 collateral findings were identified in 97 (56%) patients, and most patients showed abnormalities of the lungs (67 patients, 39%). Forty-nine (28%) patients had clinically significant findings needing further investigation and 17 (10%) of them required specific treatments, including three cases (1.7 %) of lung malignancy. CONCLUSIONS Chest CT images acquired for integration in AF ablation should be read thoroughly as they may serve as a screening tool for otherwise unrecognized clinically significant conditions of the heart, lungs, or other visualized organs.
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Affiliation(s)
- Michela Casella
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy.
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Atalay MK, Walle NL, Egglin TK. Prevalence and nature of excluded findings at reduced scan length CT angiography for pulmonary embolism. J Cardiovasc Comput Tomogr 2011; 5:325-32. [DOI: 10.1016/j.jcct.2011.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 07/26/2011] [Accepted: 08/03/2011] [Indexed: 12/21/2022]
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The Prevalence and Clinical Significance of Noncardiac Findings on Cardiac MRI. AJR Am J Roentgenol 2011; 196:W387-93. [PMID: 21427301 DOI: 10.2214/ajr.09.3302] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Mark DB, Berman DS, Budoff MJ, Carr JJ, Gerber TC, Hecht HS, Hlatky MA, Hodgson JM, Lauer MS, Miller JM, Morin RL, Mukherjee D, Poon M, Rubin GD, Schwartz RS. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 2010; 55:2663-99. [PMID: 20513611 DOI: 10.1016/j.jacc.2009.11.013] [Citation(s) in RCA: 222] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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50
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Incidental extracardiac findings at coronary CT: clinical and economic impact. AJR Am J Roentgenol 2010; 194:1531-8. [PMID: 20489093 DOI: 10.2214/ajr.09.3587] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the prevalence of incidental extracardiac findings on coronary CT, to determine the associated downstream resource utilization, and to estimate additional costs per patient related to the associated diagnostic workup. MATERIALS AND METHODS This retrospective study examined incidental extracardiac findings in 151 consecutive adults (69.5% men and 30.5% women; mean age, 54 years) undergoing coronary CT during a 7-year period. Incidental findings were recorded, and medical records were reviewed for downstream diagnostic examinations for a follow-up period of 1 year (minimum) to 7 years (maximum). Costs of further workup were estimated using 2009 Medicare average reimbursement figures. RESULTS There were 102 incidental extracardiac findings in 43% (65/151) of patients. Fifty-two percent (53/102) of findings were potentially clinically significant, and 81% (43/53) of these findings were newly discovered. The radiology reports made specific follow-up recommendations for 36% (19/53) of new significant findings. Only 4% (6/151) of patients actually underwent follow-up imaging or intervention for incidental findings. One patient was found to have a malignancy that was subsequently treated. The average direct costs of additional diagnostic workup were $17.42 per patient screened (95% CI, $2.84-$32.00) and $438.39 per patient with imaging follow-up (95% CI, $301.47-$575.31). CONCLUSION Coronary CT frequently reveals potentially significant incidental extracardiac abnormalities, yet radiologists recommend further evaluation in only one-third of cases. An even smaller fraction of cases receive further workup. The failure to follow-up abnormal incidental findings may result in missed opportunities to detect early disease, but also limits the short-term attributable costs.
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