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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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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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Özdemir M, Kavak RP. Incidentally Discovered Thyroid Nodules by Routine Magnetic Resonance Imaging of the Cervical Spine: Incidence and Clinical Significance. Curr Med Imaging 2020; 16:677-681. [PMID: 32723238 DOI: 10.2174/1573405615666190220105229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/20/2019] [Accepted: 01/30/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of our study was to present the prevalence of thyroid nodules we incidentally discovered by routine Magnetic Resonance Imaging (MRI) of the cervical spine, to evaluate their clinical significance, and to discuss the current clinical approach to incidental thyroid nodules. METHODS We retrospectively evaluated the cervical spinal MRI studies of 512 patients. Thyroid glands were evaluated for morphologic and signal characteristics and examined for the presence of nodule(s). The nodules with a maximum diameter of 5 mm or more were taken into analysis. RESULTS Of 512 MRI studies, 254 revealed incidental thyroid nodule(s) (49.6%). The mean maximum nodule diameter was 7.48±2.92 mm. Thirty-eight of 254 incidental thyroid nodules were radiologically reported, 35 reported nodules were evaluated by US, and 22 were further analyzed by fine needle aspiration cytology. The final diagnosis of 11 aspirated nodules was an adenomatous nodule, whereas 3 were papillary thyroid carcinoma. One of the patients with papillary thyroid carcinoma was a 32-year-old man with a nodule with a maximum diameter of 7 mm. CONCLUSION Incidental thyroid nodule is a frequent non-spinal lesion detected by routine cervical spinal MRI. The 3-tiered system which is recommended in the clinical approach to incidental thyroid nodules may miss some clinically significant thyroid nodules. We suggest the criteria of this system to be re-evaluated and modified if necessary. In addition, we would like to emphasize the need for a guideline for radiologists for reporting incidental thyroid nodules on MRI on the basis of a standard clinical approach.
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Affiliation(s)
- Meltem Özdemir
- Department of Radiology, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Rasime Pelin Kavak
- Department of Radiology, University of Health Sciences, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Coronavirus disease 2019 (COVID-19) pneumonia incidentally detected on coronary CT angiogram: a do-not-miss diagnosis. Emerg Radiol 2020; 27:721-726. [PMID: 32519293 PMCID: PMC7280472 DOI: 10.1007/s10140-020-01802-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/25/2020] [Indexed: 01/08/2023]
Abstract
Coronary CT angiograms are commonly performed for the evaluation of coronary artery disease and coronary arterial anatomy. However, extracardiac findings are frequently detected on these examinations and often can explain patients’ underlying symptoms, having a significant impact on patient management. Here in, we discuss three cases of incidentally detected novel COVID-19-infected pneumonia (NCIP). This case series highlights the image findings in NCIP and emphasizes the importance of evaluating all organs in the field of view on coronary CT angiograms. In addition, with the ongoing outbreak of COVID-19 and exponentially increasing incidence throughout the world, this report stresses the need for including NCIP in the differential diagnosis of patients with typical image findings in at-risk populations, as early diagnosis is crucial for appropriate patient management and post-exposure recommendations.
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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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Thoracic Incidental Findings in Preoperative Computed Tomography Evaluation for Transcatheter Aortic Valve Implantation (TAVI). J Thorac Imaging 2017; 31:183-8. [PMID: 27082418 DOI: 10.1097/rti.0000000000000208] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many older patients with aortic stenosis are excluded from surgical intervention due to multiple comorbidities. For these patients, transcatheter aortic valve implantation (TAVI) is a viable treatment alternative. Cardiothoracic computed tomography (CT) provides detailed anatomic assessment of the aortic root structures for patient selection, preprocedural planning, and intraoperative decision-making; however, nonaortic incidental findings are frequently detected. The prevalence and clinical significance of these findings have not been well described. MATERIALS AND METHODS This retrospective study examined incidental findings in 209 consecutive patients (96 women and 113 men; mean age, 70 y) with aortic stenosis undergoing preoperative cardiothoracic CT evaluation for TAVI during a 3-year period. Incidental findings were recorded, and medical records were reviewed for follow-up diagnostic examinations. RESULTS Incidental findings, both significant and nonsignificant, were observed in 85.6% of patients (179/209). Noncalcified pulmonary nodules were the most common incidental finding occurring in 59/209 (28.2%) patients, followed by pleural effusion and emphysema both of which occurred in 34/209 (16.3%) patients, respectively. CONCLUSIONS Cardiothoracic CT obtained for evaluation before TAVI has a high frequency of incidental findings.
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Maroules CD, Ghoshhajra BB, Malguria N, Landay M, Hummel J, Ferencik M, Abbara S. Noncardiac Incidental Findings on Cardiac CT: A Step-by-Step Approach. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9283-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Orme NM, Wright TC, Harmon GE, Nkomo VT, Williamson EE, Sorajja P, Foley TA, Greason KL, Suri RM, Rihal CS, Young PM. Imaging Pandora's Box: incidental findings in elderly patients evaluated for transcatheter aortic valve replacement. Mayo Clin Proc 2014; 89:747-53. [PMID: 24943693 DOI: 10.1016/j.mayocp.2014.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 02/26/2014] [Accepted: 03/13/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the frequency and clinical impact of noncardiovascular incidental findings (IFs) detected on preoperative computed tomographic angiography (CTA) of the chest/abdomen/pelvis performed in elderly patients with severe aortic stenosis being considered for transcatheter aortic valve replacement (TAVR). PATIENTS AND METHODS The CTA studies for 424 consecutive patients being evaluated for TAVR between January 1, 2009, through January 24, 2012, were reviewed for noncardiovascular IFs (62.0% male; median ± SD age, 82 ± 8.3 years). The electronic medical record was reviewed to assess for subsequent clinical management and survival. RESULTS Potentially pathologic IFs (PPIFs) were present in 285 patients (67.2%). The mean ± SD number of PPIFs per patient was 1.1 ± 1.0 (range, 0-4). Factors associated with higher numbers of PPIFs were reduced ejection fraction (P=.02) and history of smoking (P=.06). Potentially pathologic incidental findings prompted clinical work-up in 39 patients (9.2%) and delayed or canceled treatment plans for aortic stenosis in 7 patients (1.7%). The number needed to image to diagnose a new malignancy or medical condition was 19. The number of PPIFs was predictive of poor overall survival before (hazard ratio, 1.58; 95% CI, 1.31-1.88) and after (hazard ratio, 1.45; 95% CI, 1.19-1.76) adjustment for baseline clinical variables (P<.001 for both). CONCLUSION This investigation found that PPIFs are common in elderly patients undergoing TAVR-CTA scans and, once discovered, commonly generate further clinical evaluation. Higher numbers of PPIFs may be predictive of poorer survival, but further study is required to guide the appropriateness of pursuing diagnostic evaluations for asymptomatic PPIFs in this elderly population.
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Affiliation(s)
- Nicholas M Orme
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Paul Sorajja
- Division of Cardiovascular Diseases, Minneapolis Heart Institute Foundation, Minneapolis, MN
| | | | - Kevin L Greason
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Rakesh M Suri
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
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Jaar BG, Zhang L, Chembrovich SV, Sozio SM, Shafi T, Scialla JJ, Tomaselli GF, Lima JAC, Kao WHL, Parekh RS, Meoni LA. Incidental findings on cardiac computed tomography in incident hemodialysis patients: the predictors of arrhythmic and cardiovascular events in end-stage renal disease (PACE) study. BMC Nephrol 2014; 15:68. [PMID: 24885570 PMCID: PMC4019788 DOI: 10.1186/1471-2369-15-68] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 04/24/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND This is the first study that has examined non-cardiac incidental findings in research cardiac computed tomography (CT) of hemodialysis patients and their relationship with patient characteristics. METHODS We performed a cross-sectional analysis in the Predictors of Arrhythmic and Cardiovascular Events in End-Stage Renal Disease (PACE) study, a prospective cohort study on incident hemodialysis patients. Non-cardiac structures in the cardiac CT scan were reviewed and evaluated. The type and frequencies of non-cardiac incidental CT findings were summarized. Univariate and multivariate logistic regression were performed to analyze the associations between gender, older age, obesity, history of cardiovascular disease (CVD), smoking status, history of chronic pulmonary disease and history of cancer with presence of any incidental CT findings and, separately, pulmonary nodules. RESULTS Among the 260 participants, a total of 229 non-cardiac incidental findings were observed in 145 participants (55.8% of all participants). Of these findings, pulmonary nodules were the most common incidental finding (24.2% of all findings), and 41.3% of them requiring further follow-up imaging per radiology recommendation. Vascular and gastrointestinal findings occurred in 11.8% and 15.3% of participants, respectively. Participants 65 years or older had a higher odds of any incidental findings (Odds Ratio (OR) =2.55; 95% Confidence Intervals (CI) 1.30, 4.99) and pulmonary nodules (OR=4.80; 95% CI 2.51, 9.18). Prior history of CVD was independently and significantly associated with any incidental findings (OR=2.00; 95% CI 1.19, 3.40); but not with the presence of pulmonary nodules. CONCLUSIONS We demonstrate that the prevalence of incidental findings by cardiac CT scanning is extremely high among patients on hemodialysis. Further investigations to follow-up on the high occurrence of incidental findings during our research study and potentially clinical studies raises important practical, ethical and medico-legal issues that need to be carefully considered in research projects using imaging studies.
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Affiliation(s)
- Bernard G Jaar
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Alkhouli M, Sandhu P, Wiegers SE, Patil P, Panidis J, Pursnani A. Extracardiac Findings on Routine Echocardiographic Examinations. J Am Soc Echocardiogr 2014; 27:540-6. [DOI: 10.1016/j.echo.2014.01.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Indexed: 11/30/2022]
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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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KIM K, EMOTO N, MISHINA M, OKADA S, ISU T, YOSHIDA D, KOBAYASHI S, TERAMOTO A. Incidental Detection of Thyroid Nodules at Magnetic Resonance Imaging of the Cervical Spine. Neurol Med Chir (Tokyo) 2013; 53:77-81. [DOI: 10.2176/nmc.53.77] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kyongsong KIM
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School
| | - Naoya EMOTO
- Department of Internal Medicine, Chiba Hokuso Hospital, Nippon Medical School
| | | | - Susumu OKADA
- Department of Radiology, Chiba Hokuso Hospital, Nippon Medical School
| | - Toyohiko ISU
- Department of Neurosurgery, Kushiro Rosai Hospital
| | | | - Shiro KOBAYASHI
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School
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Topan R, Hyde T. A fateful kiss: the use of CT coronary angiogram in the diagnosis of non-cardiac chest pathology. BMJ Case Rep 2012; 2012:bcr-2012-006716. [PMID: 22922929 DOI: 10.1136/bcr-2012-006716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 34-year-old dental nurse presented with a 2-day history of retrosternal chest pain that was constant and 'burning' in nature. She was otherwise fit and well, no significant prior medical history and no ischaemic heart disease risk factors. Clinical examination was entirely normal apart from pyrexia of 38.3°C. Admission ECG showed ST depression in the inferior and anterolateral leads suggestive of myocardial ischaemia, consequently a CT coronary angiogram (CTCA) was performed. This showed normal coronary arteries, incidental distal oesophageal thickening was seen. Further history taking revealed that her youngest daughter had recently suffered from cold sores. The patient went on to have a diagnostic procedure, an oesophagogastroduodenoscopy. Biopsies confirmed acute oesophagitis with features suggestive of herpes virus infection. The patient responded promptly to oral acyclovir. This case highlights the value of CT coronary angiogram in identifying non-cardiac pathology in patients with a low pretest probability of coronary artery disease.
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Affiliation(s)
- Rabia Topan
- Department of Medicine, Great Western Hospital, Swindon, UK.
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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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Aortoiliac CT Angiography for Planning Transcutaneous Aortic Valve Implantation: Aortic Root Anatomy and Frequency of Clinically Significant Incidental Findings. AJR Am J Roentgenol 2012; 198:939-45. [DOI: 10.2214/ajr.11.7231] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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White CS. The pros and cons of searching for extracardiac findings at cardiac CT: use of a restricted field of view is acceptable. Radiology 2011; 261:338-41. [PMID: 22012899 DOI: 10.1148/radiol.11111131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Charles S White
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201, USA.
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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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Martins RP, Muresan L, Sellal JM, Mandry D, Régent D, Jarmouni S, Groben L, Zinzius PY, Schwartz J, Brembilla-Perrot B, Magnin-Poul I, Andronache M, Aliot E, De Chillou C. Incidental extracardiac findings in cardiac computed tomography performed before radiofrequency ablation of atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:1665-70. [PMID: 21913945 DOI: 10.1111/j.1540-8159.2011.03194.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Radiofrequency ablation has became a validated therapeutic technique for symptomatic drug refractory atrial fibrillation (AF). Cardiac computed tomography (CT) is used to evaluate left atrial (LA) anatomy in order to improve AF ablation. The analysis of noncardiac structures during cardiac CT may identify clinically significant incidental findings (IFs). The objective of this study was to determine the prevalence of IF in patients undergoing AF catheter ablation. METHODS Between February 2008 and March 2010, all patients planned for a first procedure of AF or LA tachycardia (LAT) ablation underwent a cardiac CT scan and were retrospectively included in this study. Extracardiac IFs were considered to be present if an abnormality was identified without previous clinical suspicion or known disease. RESULTS Two hundred and fifty patients (55.2 ± 9.6 years of age, 82.4% men) were enrolled (133 paroxysmal, 43 persistent, 58 permanent AF, and 16 LAT). Fifty-eight patients (23.2%) had a total of 76 IFs. Patients with IF were significantly older (59.5 ± 8.2 vs 53.8 ± 9.7 years old, P < 0.001). No relationship existed between the type of arrhythmia and IF existence. The majority of IFs were pulmonary (50%), with 15.8% of pulmonary emphysema. Two cases of lung cancer and of pulmonary fibrosis, 15 mediastinal adenopathies, and three congenital coronary arteries anomalies were found. CONCLUSIONS Cardiac CT scan is a useful tool to evaluate LA morphology before AF ablation. However, as a considerable prevalence of IF was found in our study, extracardiac structures should be routinely analyzed to detect unknown conditions, which could require specific management.
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Extracardiac findings on coronary CT angiograms: Limited versus complete image review. AJR Am J Roentgenol 2010; 195:143-8. [PMID: 20566808 DOI: 10.2214/ajr.08.1050] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Cardiac CT often reveals findings outside the heart and great vessels. A few cardiologists have suggested that the field of interpretation be restricted to avoid false-positive diagnoses. Radiologists generally favor a comprehensive review to avoid false-negative findings. The purpose of this study was to examine this tradeoff by comparing broad and focused approaches with viewing coronary CT angiograms. MATERIALS AND METHODS Outpatient coronary CT angiography was performed on consecutively registered patients. In the broad approach to review, both the large field-of-view and small field-of-view image sets, including lung windows, were evaluated. In the focused approach, attention was centered on the heart, great vessels, and immediately adjacent structures and did not include lung windows. Each finding was classified as necessitating immediate therapy, timely additional workup, longer-term follow-up, or no action. RESULTS Among 6,920 patients, 1,642 (23.7%) had one or more extracardiac findings for a total of 1,901 findings in the broad viewing scheme. Of the 6,920 patients, 16.2% had a finding necessitating therapy, workup, or follow-up. In the focused viewing scheme, 90.9% of the findings necessitating therapy, 64.1% necessitating workup, and 51.2% necessitating follow-up were missed. Use of the focused approach resulted in fewer false-positive diagnoses, but five malignant tumors of the breast, 88 lung infiltrates, 43 cases of adenopathy, two cases of polycystic kidney disease, one breast abscess, and one case of splenic flexure diverticulitis were missed. CONCLUSION Almost one fourth of all patients who underwent diagnostic coronary CT angiography in this study had extracardiac findings. Several serious diagnoses were missed with the limited viewing approach, but use of the broad viewing approach led to more workup and follow-up imaging.
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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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Kim TJ, Han DH, Jin KN, Won Lee K. Lung cancer detected at cardiac CT: prevalence, clinicoradiologic features, and importance of full-field-of-view images. Radiology 2010; 255:369-76. [PMID: 20413751 DOI: 10.1148/radiol.10091083] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To retrospectively evaluate the prevalence and clinicoradiologic features of lung cancer detected at cardiac computed tomography (CT) and compare the detection rates at different field-of-view (FOV) settings. MATERIALS AND METHODS The institutional review board approved this retrospective study and waived the requirement for patient consent. Patients with lung cancer initially detected at cardiac CT were identified by means of a retrospective search of a lung cancer registry patient database between January 2004 and December 2007. Patients known to have lung cancer at the time of cardiac CT were excluded. The prevalence and clinical and radiologic features of lung cancer were evaluated. The rates of lung cancer detection at three FOVs-limited and full FOV at cardiac scanning and full FOV at thoracic scanning-were compared by using McNemar testing. RESULTS The prevalence of lung cancer detected at CT was 0.31% (36 of 11654 patients, 16 [44%] never smokers) and was higher in patients suspected or known to have coronary artery disease (0.43% [24 of 5615 patients]) than in asymptomatic screening-examined patients (0.20% [12 of 5924 patients]) (P = .0457). Adenocarcinoma was the most common (in 31 [86%] of 36 patients) histologic subtype. Of 34 non-small cell lung cancers, 23 (68%)-including 16 stage IA cancers-were resectable. Four (11%) and 19 (53%) of the 36 CT-depicted cancers were visible in limited and full FOV at cardiac scanning, respectively, and 17 (47%) were visible in full FOV at thoracic scanning only. CONCLUSION The prevalence of lung cancer at cardiac CT was 0.31%; and 68% of these malignancies were at a resectable stage. Use of a limited FOV at cardiac scanning led to a large majority (89% [32 of 36 cancers]) of the lung cancers detected at full thoracic scanning being missed; thus, inclusion of the entire chest at cardiac CT is advisable.
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Affiliation(s)
- Tae Jung Kim
- Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea
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Ben-Dor I, Waksman R, Hanna NN, Raizon A, Satler LF, Torguson R, Weissman G, Okubagzi P, Xue Z, Li Y, Gonzalez MA, Maluenda G, Gaglia MA, Wakabayashi K, Delhaye C, Syed AI, Collins SD, Suddath WO, Kent KM, Lindsay J, Pichard AD. Utility of radiologic review for noncardiac findings on multislice computed tomography in patients with severe aortic stenosis evaluated for transcatheter aortic valve implantation. Am J Cardiol 2010; 105:1461-4. [PMID: 20451695 DOI: 10.1016/j.amjcard.2009.12.071] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 12/28/2009] [Accepted: 12/28/2009] [Indexed: 12/21/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) without replacement requires precise knowledge of the anatomic dimensions and physical characteristics of the peripheral vasculature and aortic valve annulus at the insertion of the aortic valve leaflet and root at the level of the sinus of Valsalva. Multislice computed tomography (CT) allows detailed and precise assessment of the anatomic variables. Noncardiovascular structures are also amenable to assessment by CT. Of the 394 patients screened for TAVI, 259 (65.7%) had non-contrast CT to evaluate chest anatomy and contrast CT to evaluate ilio-femoral anatomy. Significant noncardiac findings were defined as those requiring immediate evaluation or intervention or additional clinical or radiologic follow-up. Noncardiovascular findings known before CT were not included. Of the 259 patients, 105 (40.5%) were men. The mean age was 82.3 +/- 8.1 years. New, significant noncardiovascular findings were found in 89 (34.3%) and malignancy in 11 (4.2%) patients. Insignificant noncardiovascular findings were identified in 222 patients (85.7%). Signs of fluid retention were noted on CT in 105 patients (40.5%), with pleural effusion in 100 (38.6%), ascites in 17 (6.5%), and pericardial effusion in 14 (5.4%). Important peripheral vascular disease was found in 98 patients (37.8%), resulting in exclusion of 49 (19.1%) from TAVI using the transfemoral approach. An aortic aneurysm was found in 10 patients (3.8%) and a "porcelain" aorta (heavily calcified ascending aorta) in 19 (7.3%). In conclusion, malignancy and other noncardiovascular abnormalities are often found in patients who undergo CT for evaluation for TAVI. Populations must be meticulously examined to ensure that important findings are not missed.
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Lazoura O, Vassiou K, Kanavou T, Vlychou M, Arvanitis DL, Fezoulidis IV. Incidental non-cardiac findings of a coronary angiography with a 128-slice multi-detector CT scanner: should we only concentrate on the heart? Korean J Radiol 2009; 11:60-8. [PMID: 20046496 PMCID: PMC2799652 DOI: 10.3348/kjr.2010.11.1.60] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 07/28/2009] [Indexed: 12/15/2022] Open
Abstract
Objective To evaluate the spectrum, prevalence, and significance of incidental non-cardiac findings (INCF) in patients referred for a non-invasive coronary angiography using a 128-slice multi-detector CT (MDCT). Materials and Methods The study subjects included 1,044 patients; 774 males (mean age, 59.9 years) and 270 females (mean age, 63 years), referred for a coronary CT angiography on a 128-slice MDCT scanner. The scans were acquired from the level of the carina to just below the diaphragm. To evaluate INCFs, images were reconstructed with a large field of view (> 300 mm) covering the entire thorax. Images were reviewed in the axial, coronal, and sagittal planes, using the mediastinal, lung, and bone windows. The INCFs were classified as severe, indeterminate, and mild, based on their clinical importance, and as thoracic or abdominal based on their locations. Results Incidental non-cardiac findings were detected in 56% of patients (588 of 1,044), including 435 males (mean age, 65.6 years) and 153 females (mean age, 67.9 years). A total of 729 INCFs were observed: 459 (63%) mild (58% thoracic, 43% abdominal), 96 (13%) indeterminate (95% thoracic, 5% abdominal), and 174 (24%) severe (87% thoracic, 13% abdominal). The prevalence of severe INCFs was 15%. Two severe INCFs were histologically verified as lung cancers. Conclusion The 128-slice MDCT coronary angiography, in addition to cardiac imaging, can provide important information on the pathology of the chest and upper abdomen. The presence of severe INCFs is not rare, especially in the thorax. Therefore, all organs in the scan should be thoroughly evaluated in daily clinical practice.
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Affiliation(s)
- Olga Lazoura
- Department of Radiology, Medical School of Thessaly, Mezourlo, Larissa 41110, Greece.
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Killeen RP, Dodd JD, Cury RC. Noncardiac findings on cardiac CT part I: Pros and cons. J Cardiovasc Comput Tomogr 2009; 3:293-9. [DOI: 10.1016/j.jcct.2009.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 05/02/2009] [Accepted: 05/05/2009] [Indexed: 12/21/2022]
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Kim JW, Kang EY, Yong HS, Kim YK, Woo OH, Oh YW, Lee KY, Han H. Incidental extracardiac findings at cardiac CT angiography: comparison of prevalence and clinical significance between precontrast low-dose whole thoracic scan and postcontrast retrospective ECG-gated cardiac scan. Int J Cardiovasc Imaging 2009; 25 Suppl 1:75-81. [PMID: 19132543 DOI: 10.1007/s10554-008-9417-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 12/23/2008] [Indexed: 12/21/2022]
Abstract
PURPOSE To compare the prevalence and clinical significance of incidental extracardiac findings at cardiac CT angiography (CCTA) with precontrast low-dose whole thoracic scan (LDCT) and ECG-gated CCTA. MATERIALS AND METHODS We reviewed 254 patients who underwent CCTA. All participants first underwent LDCT to determine a range for CCTA and to screen unrecognized extracardiac lesions. CCTA was reconstructed with a small field of view of the heart. Clinically significant extracardiac findings were defined as abnormalities requiring further diagnostic work up, therapeutic intervention, or follow-up. RESULTS On LDCT, 285 extracardiac findings were detected in 62.6% patients; on CCTA, 18 findings in 7% patients. Among these, 66 findings in 20.4% patients were considered clinically significant on LDCT, and 4 findings in 1.6% patients on CCTA. CONCLUSION Clinically significant extracardiac findings are common in patients undergoing CCTA with a considerable number of extracardiac findings being detected only on LDCT. We advise performing whole thorax LDCT prior to CCTA.
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Affiliation(s)
- Jin Woo Kim
- Department of Radiology, Guro Hospital, Korea University, 97 Guro-dong, Guro-gu, Seoul, 152-703, South Korea
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Yiginer O, Bas S, Pocan S, Yildiz A, Alibek S. Incidental findings of cardiac MSCT: who might benefit from scanning the entire thorax on Ca score imaging? Int J Cardiol 2008; 140:239-41. [PMID: 19073349 DOI: 10.1016/j.ijcard.2008.11.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2008] [Accepted: 11/09/2008] [Indexed: 12/21/2022]
Abstract
PURPOSE We aimed to report incidental noncoronary findings of coronary MSCT angiography and to evaluate the feasibility of scanning the entire thorax on Ca score imaging. METHODS 514 patients underwent cardiac MSCT. Instead of scanning just the heart, 124 of them were scanned extensively from the lung apex to the base in order to evaluate the entire thorax for additional findings. Furthermore, we calculated dose length product (DLP) in order to determine mean increase of radiation exposure resulting from lengthened scan field. RESULTS Coronary artery disease were established in 122 patients (24%) and 273 noncoronary findings were identified in 189 patients (37%). 37 pulmonary nodules (PN) > or =5 mm, 6 of which were over the level of pulmonary trunk, were detected. The mean age (62+/-8 vs.49+/-10, respectively; p<0.0001) and the smoking rate (74% vs. 56%, respectively; p<0.05) of the patients with PN were significantly higher than subjects without PN. All patients with PN over the level of pulmonary artery were smokers >50 of age. On Ca score imaging, radiation exposure of widely scanned group was significantly higher than the others (221.3+/-35.2 mGy cm vs.145.3+/-11.7 mGy cm of DLP, respectively; p<0.0001). CONCLUSION Since MSCT data contain also information about the other structures in the thorax, the images should be evaluated by radiologist in addition to cardiologist. It seems reasonable to scan the entire thorax on Ca score imaging for smokers over 50 in order to detect pulmonary nodules having malignancy potential.
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Koonce J, Schoepf JU, Nguyen SA, Northam MC, Ravenel JG. Extra-cardiac findings at cardiac CT: experience with 1,764 patients. Eur Radiol 2008; 19:570-6. [PMID: 18925400 DOI: 10.1007/s00330-008-1195-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 08/08/2008] [Accepted: 08/11/2008] [Indexed: 12/21/2022]
Abstract
To investigate incidental extra-cardiac findings (ECF) at cardiac CT based on indication and impact on patient management. We retrospectively reviewed the reports of 1,764 patients who underwent a cardiac CT study between January 1, 2004 and December 31, 2006, including 463 calcium scorings (CS), 737 coronary CT angiograms (CTA), 341 pulmonary vein stenoses (PVS), and 223 bypass grafts (CABG). ECFs were categorized by type of examination, anatomical location and clinical significance. Comparisons were made between examination types to determine if incidental findings varied by indication. There were 507 ECFs with at least one ECF in 441 patients (25.0%). By examination, there was at least 1 ECF in 79/463 CS studies (17.1%), 196/737 CTAs (26.6%), 80/341 PVSs (23.4%) and 86/223 CABGs (38.6%). In 325 patients (18.4%), the findings were considered clinically important and occurred in 60/463 (12.9%) CSs, 149/737 (20.2%) CTAs, 56/341 (16.4%) PVSs and 60/223 (26.9%) CABGs. Differences between CABG and other indications and CTA vs. CS for incidental and clinically important findings were statistically significant (p < 0.05). Extra-cardiac findings requiring follow-up occur in 18% of patients and are significantly more frequent in coronary artery CTA and coronary artery bypass studies than in calcium scoring studies.
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Affiliation(s)
- Jay Koonce
- Department of Radiology, Medical University of South Carolina, Charleston, SC 29425, USA
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Pulmonary nodules detected at cardiac CT: comparison of images in limited and full fields of view. AJR Am J Roentgenol 2008; 191:878-81. [PMID: 18716122 DOI: 10.2214/ajr.07.2939] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [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 compare the frequency of detection of pulmonary nodules on cardiac CT scans acquired with a limited field of view with the frequency of detection at full field of view. CONCLUSION Viewing of cardiac CT scans obtained only at a limited field of view can result in missing more than 67% of nodules larger than 1 cm and more than 80% of nodules smaller than 1 cm.
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Min JK, Shaw LJ, Berman DS, Gilmore A, Kang N. Costs and clinical outcomes in individuals without known coronary artery disease undergoing coronary computed tomographic angiography from an analysis of Medicare category III transaction codes. Am J Cardiol 2008; 102:672-8. [PMID: 18773986 DOI: 10.1016/j.amjcard.2008.04.045] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 04/23/2008] [Accepted: 04/23/2008] [Indexed: 12/21/2022]
Abstract
Multidetector coronary computed tomographic angiography (CCTA) demonstrates high accuracy for the detection and exclusion of coronary artery disease (CAD) and predicts adverse prognosis. To date, opportunity costs relating the clinical and economic outcomes of CCTA compared with other methods of diagnosing CAD, such as myocardial perfusion single-photon emission computed tomography (SPECT), remain unknown. An observational, multicenter, patient-level analysis of patients without known CAD who underwent CCTA or SPECT was performed. Patients who underwent CCTA (n = 1,938) were matched to those who underwent SPECT (n = 7,752) on 8 demographic and clinical characteristics and 2 summary measures of cardiac medications and co-morbidities and were evaluated for 9-month expenditures and clinical outcomes. Adjusted total health care and CAD expenditures were 27% (p <0.001) and 33% (p <0.001) lower, respectively, for patients who underwent CCTA compared with those who underwent SPECT, by an average of $467 (95% confidence interval $99 to $984) for CAD expenditures per patient. Despite lower total health care expenditures for CCTA, no differences were observed for rates of adverse cardiovascular events, including CAD hospitalizations (4.2% vs 4.1%, p = NS), CAD outpatient visits (17.4% vs 13.3%, p = NS), myocardial infarction (0.4% vs 0.6%, p = NS), and new-onset angina (3.0% vs 3.5%, p = NS). Patients without known CAD who underwent CCTA, compared with matched patients who underwent SPECT, incurred lower overall health care and CAD expenditures while experiencing similarly low rates of CAD hospitalization, outpatient visits, myocardial infarction, and angina. In conclusion, these data suggest that CCTA may be a cost-efficient alternative to SPECT for the initial coronary evaluation of patients without known CAD.
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