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Thomas-Orogan O, Barratt SL, Zafran M, Kwok A, Simons A, Judge EP, Wells M, Daly R, Sharp C, Jeyabalan A, Plummeridge M, Chandratreya L, Spencer LG, Medford ARL, Adamali HI. A Retrospective Analysis of 2-Year Follow-Up of Patients with Incidental Findings of Sarcoidosis. Diagnostics (Basel) 2024; 14:237. [PMID: 38337753 PMCID: PMC10855033 DOI: 10.3390/diagnostics14030237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Sarcoidosis is a multi-system granulomatous disease most commonly involving the lungs. It may be incidentally diagnosed during imaging studies for other conditions or non-specific symptoms. The appropriate follow-up of incidentally diagnosed asymptomatic stage 1 disease has not been well defined. OBJECTIVE To define the clinical course of incidentally diagnosed asymptomatic stage 1 sarcoidosis and propose an algorithm for the follow-up of these patients. METHODOLOGY A retrospective case note analysis was performed of all EBUS-TBNA (endobronchial ultrasound-guided transbronchial needle aspiration)-confirmed cases of stage 1 sarcoidosis presenting incidentally to Bristol and Liverpool Interstitial Lung Disease services. Clinical history, serology results, imaging scans, and lung function parameters were examined at baseline, 12, and 24 months. A cost analysis was performed comparing the cost of the current 2-year follow-up guidance to a 1 year follow-up period. RESULTS Sixty-seven patients were identified as the final cohort. There was no significant change in the pulmonary function tests over the two-year follow-up period. Radiological disease stability was observed in the majority of patients (58%, n = 29), and disease regression was evidenced in 40% (n = 20) at 1 year. Where imaging was performed at 2 years, the majority (69.8%, n = 37) had radiological evidence of disease regression, and 30.2% (n = 16) showed radiological evidence of stability. All patients remained asymptomatic and did not require therapeutic intervention over the study period. CONCLUSIONS Our results show that asymptomatic patients with incidental findings of thoracic lymph nodal non-caseating granulomas do not progress over a 2-year period. Our results suggest that the prolonged secondary-care follow-up of such patients may not be necessary. We propose that these patients are followed up for 1 year with a further year of patient-initiated follow-up (PIFU) prior to discharge.
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Affiliation(s)
- Oluwabukola Thomas-Orogan
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK; (O.T.-O.); (S.L.B.); (M.P.)
| | - Shaney L. Barratt
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK; (O.T.-O.); (S.L.B.); (M.P.)
| | - Muhammad Zafran
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK; (O.T.-O.); (S.L.B.); (M.P.)
| | - Apollo Kwok
- Liverpool Interstitial Lung Disease Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK; (A.K.); (A.S.)
| | - Anneliese Simons
- Liverpool Interstitial Lung Disease Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK; (A.K.); (A.S.)
| | - Eoin P. Judge
- Liverpool Interstitial Lung Disease Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK; (A.K.); (A.S.)
| | - Matthew Wells
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK; (O.T.-O.); (S.L.B.); (M.P.)
| | - Richard Daly
- Department of Cellular Pathology, North Bristol NHS Trust, Bristol BS10 5NB, UK;
| | - Charles Sharp
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK; (O.T.-O.); (S.L.B.); (M.P.)
| | - Abiramy Jeyabalan
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK; (O.T.-O.); (S.L.B.); (M.P.)
| | - Martin Plummeridge
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK; (O.T.-O.); (S.L.B.); (M.P.)
| | | | - Lisa G. Spencer
- Liverpool Interstitial Lung Disease Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK; (A.K.); (A.S.)
| | | | - Huzaifa I. Adamali
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol BS10 5NB, UK; (O.T.-O.); (S.L.B.); (M.P.)
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Pathak V, Adhikari N, Conklin C. Management of Isolated Thoracic Lymphadenopathy of Unclear Etiology: A Survey of Physicians and Literature Review. Cureus 2023; 15:e41867. [PMID: 37581152 PMCID: PMC10423459 DOI: 10.7759/cureus.41867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/16/2023] Open
Abstract
Background After identifying incidental mediastinal lymph nodes, decisions need to be made regarding the required follow-up imaging, the intervals at which this imaging should be performed, the types of imaging and procedures needed, and when to discontinue the follow-up. The purpose of this study is to determine the majority opinion on the management of these findings and provide recommendations for future management of incidental mediastinal lymphadenopathy. Methodology Sixty-two healthcare providers from a variety of specializations were surveyed on their preference for diagnostic workup and subsequent follow-up following the finding of incidental mediastinal lymphadenopathy on computed tomography (CT) of the chest. Results For thoracic lymphadenopathy of unclear etiology and patients who are not offered endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), most providers (47/62, 75.8%) initiate the CT scan follow-up at size 10 to 14 mm. Of those patients, 51.6% (32/62) of providers repeat the initial CT scan in three months and 41.9% (26/62) repeat the initial CT scan in six months. If the follow-up CT chest shows stable lymphadenopathy, 47.5% (29/62) repeat a CT chest every six months and 37% (23/62) repeat a CT chest every 12 months. The majority of providers (42/62, 67.7%) do not use positron emission tomography (PET)-CT for the initial evaluation of isolated thoracic lymphadenopathy and follow-up of lymphadenopathy with increasing size. For thoracic lymph nodes with a maximum diameter of 10 mm, only 4.8% (3/62) of providers continue CT screening after 24 months, while 24.6% (15/62) of providers continue CT screening after 24 months for sizes greater than 20 mm. Regarding the timing of EBUS-TBNA, 40.3% (25/62) of providers consider referring/performing this procedure at lymph nodes of size 11-15 mm, followed by 21% (13/62) of providers referring/performing the procedure at size 10 mm. Conclusions The majority of providers initiate CT scan follow-ups at 10 to 14 mm size for patients with isolated thoracic lymphadenopathy. The majority of providers do not use PET-CT for the initial evaluation of isolated thoracic lymphadenopathy. We found variable responses from providers regarding the timing of follow-up intervals and total duration. There is a need for consensus guidelines regarding the management of thoracic lymphadenopathy of unclear etiology.
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Affiliation(s)
- Vikas Pathak
- Pulmonary and Critical Care, Virginia Institute of Lung Diseases, Richmond, USA
| | - Nawaraj Adhikari
- Internal Medicine, Bon Secours Memorial Regional Medical Center, Mechanicsville, USA
| | - Courtney Conklin
- Primary Care Sports Medicine, University of Alabama, Tuscaloosa, USA
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Horst C, Patel S, Nair A. Reporting and management of incidental lung findings on computed tomography: beyond lung nodules. Br J Radiol 2023; 96:20220207. [PMID: 36124681 PMCID: PMC9975526 DOI: 10.1259/bjr.20220207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Non-nodular incidental lung findings can broadly be categorised as airway- or airspace-related abnormalities and diffuse parenchymal abnormalities. Airway-related abnormalities include bronchial dilatation and thickening, foci of low attenuation, emphysema, and congenital variants. Diffuse parenchymal abnormalities relate to the spectrum of diffuse parenchymal lung diseases cover a spectrum from interstitial lung abnormalities (ILAs) and pulmonary cysts to established diffuse parenchymal lung abnormalities such as the idiopathic interstitial pneumonias and cystic lung diseases. In this review, we discuss the main manifestations of these incidental findings, paying attention to their prevalence and importance, descriptors to use when reporting, the limits of what can be considered "normal", and conclude each section with some pragmatic reporting recommendations. We also highlight technical and patient factors which can lead to spurious abnormalities.
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Affiliation(s)
- Carolyn Horst
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | | | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
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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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Salimova N, Hinrichs JB, Gutberlet M, Meyer BC, Wacker FK, von Falck C. The impact of the field of view (FOV) on image quality in MDCT angiography of the lower extremities. Eur Radiol 2021; 32:2875-2882. [PMID: 34902060 PMCID: PMC9038851 DOI: 10.1007/s00330-021-08391-x] [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: 05/20/2021] [Revised: 09/14/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022]
Abstract
Objectives To evaluate the impact of the reconstructed field-of-view (FOV) on image quality in computed-tomography angiography (CTA) of the lower extremities.
Methods A total of 100 CTA examinations of the lower extremities were acquired on a 2 × 192-slice multidetector CT (MDCT) scanner. Three different datasets were reconstructed covering both legs (standard FOV size) as well as each leg separately (reduced FOV size). The subjective image quality was evaluated for the different vessel segments (femoral, popliteal, crural, pedal) by three readers using a semi-quantitative Likert scale. Additionally, objective image quality was assessed using an automated image quality metric on a per-slice basis. Results The subjective assessment of the image quality showed an almost perfect interrater agreement. The image quality of the small FOV datasets was rated significantly higher as compared to the large datasets for all patients and vessel segments (p < 0.05) with a tendency towards a higher effect in smaller vessels. The difference of the mean scores between the group with the large FOV and small FOV was 0.68 for the femoral level, 0.83 for the popliteal level, 1.12 for the crural level, and 1.08 for the pedal level. The objective image quality metric also demonstrated a significant improvement of image quality in the small FOV datasets. Conclusions Side-separated reconstruction of each leg in CTA of the lower extremities using a small reconstruction FOV significantly improves image quality as compared to a standard reconstruction with a large FOV covering both legs. Key Points • In CT angiography of the lower legs, the side-separated reconstruction of each leg using a small field-of-views improves image quality as compared to a standard reconstruction covering both legs. • The side-separated reconstruction can be readily implemented at every commercially available CT scanner. • There is no need for additional hardware or software and no additional burden to the patient.
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Affiliation(s)
- Nigar Salimova
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Marcel Gutberlet
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Bernhard C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Christian von Falck
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
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Eldeş T, Kara BY. Incidental lung findings in coronary computed tomography angiography. Rev Assoc Med Bras (1992) 2021; 67:1328-1332. [DOI: 10.1590/1806-9282.20210662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/03/2021] [Indexed: 11/22/2022] Open
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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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Higher prevalence of incidental findings identified upon coronary calcium score assessment in type 2 and type 3 diabetes versus type 1 diabetes. PLoS One 2021; 16:e0251693. [PMID: 34029335 PMCID: PMC8143389 DOI: 10.1371/journal.pone.0251693] [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: 11/19/2020] [Accepted: 05/03/2021] [Indexed: 11/24/2022] Open
Abstract
Aim Noninvasive assessment of infraclinic coronary atherosclerosis by coronary artery calcium score (CAC) measurement leads to the identification of incidental findings. The aim of this study was to determine the prevalence of incidental findings following systematic CAC assessment in diabetic patients with high cardiovascular risk, to identify the determinants, and to assess the midterm consequences of these findings in patient care. Methods 732 consecutive asymptomatic patients (187 type 1 diabetes (TD1), 482 type 2 diabetes (TD2) and 63 type 3 diabetes (TD3)) aged 60.6±0.7 years who had a CAC assessment by Multiple Detector Computed Tomography between 2015 and 2017 were systematically included. Clinical and biological data were collected from medical electronic files. Results 117/732 diabetic patients (16.0%) had incidental findings of which 105 (14.3%) were unknown. Incidental findings were more frequent in TD3 (23.8%) and TD2 (17.0%) than in TD1 (10.7%) (p = 0.05). 76 diabetic patients (10.4%) had lung abnormalities, mainly pulmonary nodules (31 patients, 4.2%). The other incidental finding were pericardial (1.5%), vascular (1.2%), thymic (0.7%) and digestive diseases (0.5%). 42.6% of patients with incidental findings had an additional TDM and 56.8% a specialized medical advice. In 10 patients (9.3% of incidental findings), the identification of incidental finding led to a specific treatment of the underlying disease. In multivariate analysis, microalbuminuria, type of diabetes (TD2/TD3 vs TD1) and smoking were significantly associated with incidental findings (p = 0.003; p = 0.026; p = 0.050 respectively). Conclusions Incidental findings are not rare in diabetic patients upon CAC assessment. A fraction of them are accessible to specific treatment. These findings raise the question if a systematic low dose chest TDM should be conducted in TD2 or TD3 patients and in any diabetic smokers by enlarging the window used for CAC assessment.
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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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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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Klok FA, Huisman MV. Management of incidental pulmonary embolism. Eur Respir J 2017; 49:49/6/1700275. [PMID: 28663318 DOI: 10.1183/13993003.00275-2017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/23/2017] [Indexed: 12/26/2022]
Abstract
Incidental pulmonary embolism (PE) is a frequent finding on routine computed tomography (CT) scans of the chest, occurring in 1.1% of coronary CT scans and 3.6% of oncological CT scans. Despite this high frequency, optimal management of incidental PE has not been addressed in clinical trials and remains the subject of debate. Although these CT scans have not been performed with a dedicated PE protocol and have suboptimal contrast enhancement, diagnosis of incidental PE has been shown to be accurate up to the segmental and subsegmental arteries. The embolic load in incidental PE is lower than that in symptomatic PE. Even so, observational studies suggest that the natural course of incidental PE is similar to that of symptomatic PE with regard to the risk of recurrent venous thrombotic disease and mortality. Interestingly, the increased use of more advanced CT technology has coincided with an increase in the rate of incidental subsegmental PE, as is the case for symptomatic subsegmental PE. Although clinical trials are lacking, and observational data are limited to cancer-associated incidental PE, the consensus is that the management of incidental PE is identical to that of symptomatic PE, including the choice of optimal drug class, outpatient treatment and total duration of treatment.
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Affiliation(s)
- Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
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Sohns JM, Menke J, Bergau L, Weiss BG, Schmuck S, Weiberg D, Staab W, Derlin T, Dorenkamp M, Sohns C. Extra-vascular findings in patients undergoing magnetic resonance angiography of the abdomen, pelvis and lower extremities: A retrospective study of 352 patients. Vascular 2017; 26:27-38. [DOI: 10.1177/1708538117714401] [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]
Abstract
Background The aim of this study was to assess the prevalence and clinical significance of extra-vascular findings in patients undergoing magnetic resonance angiography of the abdomen, pelvis and lower extremities. Materials and methods Three hundred fifty-two patients underwent abdominal, pelvic and lower extremity 1.5 T magnetic resonance angiography. Clinically relevant vascular and extra-vascular findings were identified. Relevant vascular findings were classified as stenosis, occlusion, aneurysm, sclerosis, dissection or vasculitis. Relevant extra-vascular findings were categorized as ‘safe’ (Group A), intermediate – requiring additional investigation – (Group B) and malignant/endangering – requiring change of therapy (Group C). Results A total of 2152 clinically relevant vascular findings was identified (6.1/patient). The most frequent vascular finding was femoral artery stenosis (10.6%). Four hundred fifty-one extra-vascular findings were observed (1.3/patient) and classified into Group A (78%), Group B (19.5%) and Group C findings (2.4%). The most frequent malignant findings were lung cancer, lymphoma, osteosarcoma, hepatocellular carcinoma and renal cell carcinoma (7/352 patients). Conclusions Extravascular findings are frequently encountered in magnetic resonance angiography performed for vascular indications. Clinically relevant findings are seen in a substantial part of patients and should prompt further diagnostic work-up.
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Affiliation(s)
- Jan M Sohns
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
- German Center for Cardiovascular Research, DZHK, Berlin, Germany
| | - Jan Menke
- Institute for Diagnostic and Interventional Radiology, Georg-August University, UMG, Göttingen, Germany
| | - Leonard Bergau
- German Center for Cardiovascular Research, DZHK, Berlin, Germany
- Department of Cardiology and Pneumology, Georg-August University, UMG, Göttingen, Germany
| | - Bernhard G Weiss
- Department of Otorhinolaryngology-Head and Neck Surgery, Georg-August University, UMG, Göttingen, Germany
| | - Sebastian Schmuck
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
| | - Desiree Weiberg
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
| | - Wieland Staab
- German Center for Cardiovascular Research, DZHK, Berlin, Germany
- Institute for Diagnostic and Interventional Radiology, Georg-August University, UMG, Göttingen, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
| | - Marc Dorenkamp
- Department of Medicine, Cardiology Division, Charité Campus Virchow Klinikum, Berlin, Germany
| | - Christian Sohns
- Electrophysiology Bremen, Heart Center Bremen, Am Klinikum Links der Weser, Bremen, Germany
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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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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Impact of Implementing Cardiac CT in Evaluating Patients Suspected of Cardioembolic Stroke. J Comput Assist Tomogr 2017; 40:380-6. [PMID: 26854417 DOI: 10.1097/rct.0000000000000369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES In practice, clinical and logistic hurdles may hamper performing transesophageal echocardiography in stroke patients. Cardiac computed tomography (CT) is a recently introduced noninvasive modality able to detect various embolic causes. Thus, we retrospectively assessed possible added values of applying cardiac CT in the real-world work-up of suspected cardioembolic stroke cases. METHODS Forty-seven patients were neurology service referrals for suspected cardioembolic stroke. The CT images and clinical reports of our cardiac CT radiologists were retrospectively evaluated. Cardiac CT was assessed in terms of detecting major embolic potential findings, potentially significant stroke-unrelated findings, and coronary arterial disease (CAD). Computed tomography results were correlated with echocardiographic reports. RESULTS Cardiac CT showed findings of major embolic potential in 10 patients (21%, 5 thrombi cases, 2 vasculitis cases, 1 case of metastasis invading the left superior pulmonary artery, 1 myocardial infarction case, and 1 pulmonary arteriovenous malformations case), none of which were documented in echocardiography reports. Two cases (4%) with findings of major embolic potential where identified on echocardiography but not on CT (1 left atrial appendage thrombus and 1 mitral valve vegetation). Computed tomography of 13 patients (28%) showed 16 potentially significant stroke-unrelated findings. Twenty-one patients (47%) had unexpected CAD on CT, 11 (52%) of which were obstructive. CONCLUSIONS Implementing cardiac CT in assessing patients suspected of cardioembolic stroke added value to echocardiographic evaluation, by detecting major embolic potential findings. In addition, cardiac CT revealed additional potentially significant stroke-unrelated findings and CAD.
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16
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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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17
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Thoracic Malignancies and Pulmonary Nodules in Patients under Evaluation for Transcatheter Aortic Valve Implantation (TAVI): Incidence, Follow Up and Possible Impact on Treatment Decision. PLoS One 2016; 11:e0155398. [PMID: 27171441 PMCID: PMC4865104 DOI: 10.1371/journal.pone.0155398] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/28/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with severe aortic valve stenosis who are not eligible for operative replacement and an alternative for those with high surgical risk. Due to high age and smoking history in a high proportion of TAVI patients, suspicious findings are frequently observed in pre-procedural chest computer tomography (CCT). METHODS CCT scans of 484 consecutive patients undergoing TAVI were evaluated for incidentally discovered solitary pulmonary nodules (SPN). RESULTS In the entire study population, SPN ≥ 5 mm were found in 87 patients (18%). These patients were compared to 150 patients who were incidentally collected from the 397 patients without SPN or with SPN < 5 mm (control group). After a median follow-up of 455 days, lung cancer was diagnosed in only two patients. Neither SPN ≥ 5 mm (p = 0.579) nor SPN > 8 mm (p = 0.328) were significant predictors of overall survival. CONCLUSIONS Despite the high prevalence of SPNs in this single center TAVI cohort lung cancer incidence at midterm follow-up seems to be low. Thus, aggressive diagnostic approaches for incidentally discovered SPN during TAVI evaluation should not delay the treatment of aortic stenosis. Unless advanced thoracic malignancy is obvious, the well documented reduction of morbidity and mortality by TAVI outweighs potentially harmful delays regarding further diagnostics. Standard guideline-approved procedure for SPN can be safely performed after TAVI.
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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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19
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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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Bentsen L, Christensen A, Havsteen I, Hansen H, Ovesen C, Christensen H. Frequency of New Pulmonary Neoplasm Incidentally Detected by Computed Tomography Angiography in Acute Stroke Patients—A Single-Center Study. J Stroke Cerebrovasc Dis 2015; 24:1008-12. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/16/2014] [Accepted: 12/20/2014] [Indexed: 12/16/2022] Open
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Taniguchi T, Kato M, Ueda S, Yokomatsu T, Mizoguchi T, Miki S, Yoshida A. Prevalence and significance of clinically unsuspected pulmonary embolism: detection using coronary computed tomography angiography. J Card Surg 2015; 30:301-6. [PMID: 25640453 DOI: 10.1111/jocs.12512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Clinically unsuspected pulmonary embolism can be detected using coronary computed tomography (CT), but the clinical significance of unsuspected pulmonary embolism remains unclear. METHODS Pulmonary embolism was assessed using consecutive coronary CT from March 2003 to June 2007 to assess 1077 patients. Coronary CT was performed using a 16-row multidetector CT (MDCT) scanner with ECG-gating. A radiologist and a cardiologist retrospectively assessed the images of pulmonary arteries to arrive at a consensus diagnosis. RESULTS Unsuspected pulmonary embolism was detected in 32/1,077 (3.0%) patients. No significant difference was observed with regard to death and acute pulmonary embolism between patients with and without unsuspected pulmonary embolism at five years (6.7% vs. 4.1%, p = 0.61). Prior cardiac surgery within three months of diagnosis of pulmonary embolism was an independent risk factor for unsuspected pulmonary embolism, which was detected in 10/89 (11%) of such patients. The absence of anticoagulant therapy was a risk factor (p = 0.015) for unsuspected pulmonary embolism post-cardiac surgery. Although only one out of 10 patients received anticoagulant therapy, none of the 10 experienced critical events. Five of the 10 patients underwent repeated coronary CT, and the embolus disappeared regardless of its size and location in four of the five patients who did not receive anticoagulant therapy. CONCLUSIONS The prevalence of unsuspected pulmonary embolism detected using coronary CT was 3.0%. Prior cardiac surgery within three months of diagnosing pulmonary embolism was an independent risk factor for unsuspected pulmonary embolism. The long-term clinical outcomes of patients with unsuspected pulmonary embolism were favorable.
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22
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Erol C, Koplay M, Seker M, Paksoy Y. The prevalence and clinical importance of incidentally detected noncoronary cardiovascular findings with coronary multidetector CT angiography. Wien Klin Wochenschr 2014; 126:460-7. [PMID: 24970312 DOI: 10.1007/s00508-014-0556-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 04/17/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence and clinical importance of incidental findings of noncoronary cardiac structures and mediastinal great vessels in patients who underwent coronary computed tomography angiography (CCTA). METHODS The study included 2,096 consecutive patients (1,472 men and 624 women, with a mean age of 55 years). Cardiovascular findings were categorized into three groups according to the clinical importance: group 1 included findings necessitating immediate treatment or intervention; group 2 included findings requiring clinical awareness, follow-up, or further clinical and/or radiological investigations; and group 3 included findings not requiring any follow-up or further tests. We also evaluated whether there was any previous diagnosis of cardiovascular findings. RESULTS A total of 174 abnormalities (8.3 %) were detected in 170 patients. Of these abnormalities, 21 findings (12 %) were considered as group 1, 121 (69.5 %) as group 2, and 32 (18.5 %) as group 3. The majority of cardiovascular findings (140 of 174, 80.5 %) were unknown by the reporter during the interpretation of CCTA examinations and regarded as incidental findings. CONCLUSION Noncoronary incidental cardiovascular findings in patients who underwent CCTA are common. It is important to be aware of these findings necessitating immediate treatment or intervention, and follow-up or further investigations, and careful attention must be paid to all the structures included in the images.
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Affiliation(s)
- Cengiz Erol
- Department of Radiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
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23
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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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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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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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Gufler H, Schulze CG, Wagner S. Incidental findings in computed tomographic angiography for planning percutaneous aortic valve replacement: advanced age, increased cancer prevalence? Acta Radiol 2014; 55:420-6. [PMID: 23966366 DOI: 10.1177/0284185113500164] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Increased age is linked with a higher cancer risk according to model calculations. Patients with severe atherosclerotic aortic stenosis are of old age, therefore, a high incidence of malignancies should be found. PURPOSE To evaluate the prevalence of clinically significant and potentially malignant incidental findings at computed tomographic angiography (CTA) performed in patients with severe aortic stenosis being assessed as to their suitability for transcatheter aortic valve replacement (TAVR). MATERIAL AND METHODS Between August 2008 and April 2010, CTA of the thoraco-abdominal aorta and the pelvic arterial vessels was performed in 131 patients. There were 62 women (47%) and 69 men (53%); the mean age was 81.6 years (range, 64-91 years). Incidental findings were recorded and categorized as potentially malignant, clinically significant, and clinically insignificant. Clinically significant findings were defined as those requiring immediate therapy, intervention or imaging, or follow-up examination. RESULTS Of the 131 study patients, 31 (23.7%) presented significant extravascular incidental findings, 19 (14.5%) in the thorax, and 12 (9.2%) in the abdomen. Five lesions (3.8%) were considered potentially malignant, three of them (2.3%) were new and highly suspicious for malignancies (two renal cell carcinomas and one hepatocellular carcinoma). In two patients (1.5%) mediastinal lymphadenopathy was found (recurrent malignant lymphoma und new metastases from known bladder cancer). CONCLUSION The prevalence of highly suspicious malignant incidental findings in patients undergoing TAVR is 3.8% with an average age of 81.6 years which is not high compared to prevalence in the literature dealing with patients aged <70 years.
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Affiliation(s)
- Hubert Gufler
- Department of Diagnostic and Interventional Radiology, University of Rostock, Rostock, Germany
| | - Christian G Schulze
- Department of Diagnostic and Interventional Radiology, University of Rostock, Rostock, Germany
| | - Sabine Wagner
- Department of Diagnostic and Interventional Radiology, University of Rostock, Rostock, Germany
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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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30
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Boxt LM. Coronary computed tomography angiography: a practical guide to performance and interpretation. Semin Roentgenol 2012; 47:204-19. [PMID: 22657111 DOI: 10.1053/j.ro.2012.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Lawrence M Boxt
- Department of Radiology, Albany Medical Center, Albany, NY 12208, USA.
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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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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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Seker D, Seker G, Ozturk E, Bayar B, Kulacoglu H. An incidentally detected breast cancer on tc-99m MIBI cardiac scintigraphy. J Breast Cancer 2012; 15:252-4. [PMID: 22807946 PMCID: PMC3395752 DOI: 10.4048/jbc.2012.15.2.252] [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] [Received: 08/12/2011] [Accepted: 01/03/2012] [Indexed: 11/30/2022] Open
Abstract
Tc-99m methoxyisobutylisonitrile (MIBI) scintigraphy is generally used as a second-line diagnostic tool for obscured breast lesions. When the entire field of view is examined carefully, it is often possible to detect additional lesions unrelated to the initial intent and purpose of the examination. Herein we present a case of breast cancer incidentally detected by cardiac Tc-99m MIBI scintigraphy. An area of uptake was detected in the breast during a cardiac imaging test. Further evaluation of this lesion revealed a histopathological diagnosis of invasive ductal carcinoma of the breast. Sensitivity of this scintigraphic technique is not enough sufficient to use this test as a screening test for breast cancer, but it may provide supplemental information. Since it is not uncommon to find incidental lesions during imaging studies, examination of the image field may help clinicians find otherwise unrecognized or undiagnosed pathologies.
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Affiliation(s)
- Duray Seker
- Department of Surgery, Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
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34
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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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Teague SD, Rissing S, Mahenthiran J, Achenbach S. Learning to interpret the extracardiac findings on coronary CT angiography examinations. J Cardiovasc Comput Tomogr 2012; 6:232-45. [DOI: 10.1016/j.jcct.2012.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 02/04/2012] [Accepted: 02/27/2012] [Indexed: 12/21/2022]
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36
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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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37
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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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Frank L, Quint LE. Chest CT incidentalomas: thyroid lesions, enlarged mediastinal lymph nodes, and lung nodules. Cancer Imaging 2012; 12:41-8. [PMID: 22391408 PMCID: PMC3335330 DOI: 10.1102/1470-7330.2012.0006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A computed tomography (CT) incidentaloma is an incidentally detected and previously unsuspected finding or abnormality that is not related to the indication for obtaining the CT examination. The aim of this article is to review the frequency of incidentalomas on chest CT scans, discuss the potential clinical significance of the findings, and suggest guidelines for reporting, further evaluation, and follow-up, with particular focus on thyroid lesions, enlarged mediastinal lymph nodes and lung nodules.
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Affiliation(s)
- Luba Frank
- Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
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Newman TM, Cham MD, Zhang H, Hentel KD, Mennitt K, Heier L, Prince MR. Clinical demand for chest/abdomen/pelvis anatomy following thoracic or lumbar spine CT. Emerg Radiol 2012; 19:211-5. [PMID: 22370693 DOI: 10.1007/s10140-012-1028-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 02/10/2012] [Indexed: 12/21/2022]
Abstract
The purpose of this study is to determine how often CT is repeated to obtain chest/abdomen/pelvis data outside the reconstructed field of view (FOV) on a prior spine CT. Radiology records of 1,239 consecutive thoracic and lumbar spine CT exams of 1,025 patients from January 1, 2006 to December 31, 2008 were retrospectively reviewed to identify patients who subsequently had CT studies of the chest, abdomen, and/or pelvis. The CT data were also evaluated for contrast enhancement, slice thickness, radiation dose, and reason for subsequent CT exam. Over 3 years, 290 of the 1,239 (24%) spine CT exams were followed by CT of the same anatomic region to evaluate extraspinal anatomy. The use or nonuse of contrast in these follow-up studies was the same as the preceding spine study in 91 cases, which were repeated on the same day (n = 37), within 7 days (n = 19), within 8-30 days (n = 15), or after 30 days (n = 20). Fourteen of 25 (56%) T spine CTs and 34 of 52 (65%) L spine CTs without contrast were followed by a chest CT or abdomen/pelvis CT without contrast within 7 days, respectively. Among 31 pediatric exams, 6 of 31 (19%) spine CTs were followed by a CT of the same anatomic region, all within 7 days. Reconstructing full FOV images of spine CT scans in addition to the standard coned down spine FOV may reduce redundant CT imaging and radiation dose.
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Affiliation(s)
- Tiffany M Newman
- Department of Radiology, New York Presbyterian/Weill Cornell Medical Center, New York, NY, USA.
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41
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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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43
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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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Crum-Cianflone N, Stepenosky J, Medina S, Wessman D, Krause D, Boswell G. Clinically significant incidental findings among human immunodeficiency virus-infected men during computed tomography for determination of coronary artery calcium. Am J Cardiol 2011; 107:633-7. [PMID: 21195379 PMCID: PMC3076059 DOI: 10.1016/j.amjcard.2010.10.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 10/07/2010] [Accepted: 10/11/2010] [Indexed: 12/21/2022]
Abstract
Those infected with the human immunodeficiency virus (HIV) have a greater risk of cardiovascular disease and might undergo computed tomographic (CT) scans for early detection. Incidental findings on cardiac CT imaging are important components of the benefits and costs of testing. We determined the prevalence and factors associated with incidental findings on CT scans performed to screen for coronary artery calcium (CAC) among HIV-infected men. A clinically significant finding was defined as requiring additional workup or a medical referral. A total of 215 HIV-infected men were evaluated. Their median age was 43 years; 17% were current tobacco users; the median CD4 count was 580 cells/mm(3); and 83% were receiving antiretroviral medications. Also, 34% had a positive CAC score of >0. An incidental finding was noted among 93 participants (43%), with 36 (17%) having ≥1 clinically significant finding. A total of 139 findings were noted, most commonly pulmonary nodules, followed by granulomas, scarring, and hilar adenopathy. Most of the incidental findings were stable on follow-up, and no malignancies were detected. The factors associated with the presence of an incidental finding in the multivariate model included increasing age (odds ratio 1.6 per 10 years, p <0.01), positive CAC score (odds ratio 2.3, p <0.01), and current tobacco use (odds ratio 2.5, p = 0.02). In conclusion, incidental findings were common among HIV-infected men undergoing screening CT imaging for CAC determination. The incidental findings were more common among older patients and those with detectable CAC.
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Affiliation(s)
- Nancy Crum-Cianflone
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
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Lu JG, Lv B, Chen XB, Tang X, Jiang SL, Dai RP. What is the best contrast injection protocol for 64-row multi-detector cardiac computed tomography? Eur J Radiol 2010; 75:159-65. [PMID: 19467812 DOI: 10.1016/j.ejrad.2009.04.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Revised: 04/13/2009] [Accepted: 04/15/2009] [Indexed: 11/16/2022]
Affiliation(s)
- Jin-guo Lu
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, China
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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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Sohns C, Sossalla S, Vollmann D, Luethje L, Seegers J, Schmitto JD, Zabel M, Obenauer S. Extra cardiac findings by 64-multidetector computed tomography in patients with symptomatic atrial fibrillation prior to pulmonal vein isolation. Int J Cardiovasc Imaging 2010; 27:127-34. [PMID: 20549365 PMCID: PMC3035788 DOI: 10.1007/s10554-010-9653-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 06/03/2010] [Indexed: 12/21/2022]
Abstract
The aim of this study was to investigate the prevalence of extracardiac findings diagnosed by 64-multidetector computed tomography (MDCT) examinations prior to circumferential pulmonary vein (PV) ablation of atrial fibrillation (AF). A total of 158 patients (median age, 60.5 years; male 68%) underwent 64-MDCT of the chest and upper abdomen to characterize left atrial and PV anatomy prior to AF ablation. MDCT images were evaluated by a thoracic radiologist and a cardiologist. For additional scan interpretation, bone, lung, and soft tissue window settings were used. CT scans with extra-cardiac abnormalities categorized for the anatomic distribution and divided into two groups: Group 1—exhibiting clinically significant or potentially significant findings, and Group 2—patients with clinically non-significant findings. Extracardiac findings (n = 198) were observed in 113/158 (72%) patients. At least one significant finding was noted in 49/158 patients (31%). Group 1 abnormalities, such as malignancies or pneumonias, were found in 85/198 findings (43%). Group 2 findings, for example mild degenerative spine disease or pleural thickening, were observed in 113/198 findings (72%). 74/198 Extracardiac findings were located in the lung (37%), 35/198 in the mediastinum (18%), 8/198 into the liver (4%) and 81/198 were in other organs (41). There is an appreciable prevalence of prior undiagnosed extracardiac findings detected in patients with AF prior to PV-Isolation by MDCT. Clinically significant or potentially significant findings can be expected in ~40% of patients who undergo cardiac MDCT. Interdisciplinary trained personnel is required to identify and interpret both cardiac and extra cardiac findings.
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Affiliation(s)
- Christian Sohns
- Department of Cardiology and Pneumology/Heart Center, Georg-August-University, Göttingen, Germany.
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