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Hwang M, Choi DS, Choi KH, Baek HJ, Cho E, Park JM. Prevalence and Clinical Implications of Incidental Aortic Arch Abnormalities on Contrast-Enhanced Neck MR Angiography: A Single-Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1172. [PMID: 37374376 DOI: 10.3390/medicina59061172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Vascular abnormalities within the anatomical coverage are frequently encountered in imaging studies. The aortic arch is often overlooked as an anatomical blind spot, especially in neck magnetic resonance (MR) angiography. This study investigated the prevalence of incidental aortic arch abnormalities. We also estimated the potential clinical significance of aortic arch abnormalities as blind spots detected on contrast-enhanced neck MR angiography. Materials and Methods: Between February 2016 and March 2023, 348 patients were identified based on contrast-enhanced neck MR angiography reports. The clinical and radiological characteristics of the patients and the presence of additional imaging studies were assessed. The aortic arch abnormalities and coexisting non-aortic arterial abnormalities were classified into two categories according to their clinical significance. We performed the χ2 test and Fisher's exact test for group comparisons. Results: Of the 348 study patients, only 29 (8.3%) had clinically significant incidental aortic arch abnormalities. Among these 348 patients, 250 (71.8%) and 136 (39%) had intracranial and extracranial abnormalities, respectively; the clinically significant intracranial abnormalities in the two groups were 130 lesions (52.0%) and 38 lesions (27.9%), respectively. In addition, there was a significantly higher tendency of clinically significant aortic arch abnormalities (13/29, 44.8%) in the patients who had clinically significant coexisting non-aortic arterial abnormalities than in the other group (87/319, 27.3%) (p = 0.044). The patient groups with clinically significant intracranial or extracranial arterial abnormalities had higher rates of clinically significant aortic abnormalities (31.0% and 17.2%), but there was no statistical significance (p = 0.136). Conclusions: The incidence of clinically significant aortic arch abnormalities was 8.3% on neck MR angiography, with a significant association between aortic and coexisting non-aortic arterial abnormalities. The findings of this study could improve the understanding of incidental aortic arch lesions on neck MR angiography, which is of crucial clinical importance for radiologists to achieve accurate diagnoses and management.
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Affiliation(s)
- Minhee Hwang
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
| | - Dae-Seob Choi
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, 79 Gangnam-ro, Jinju 52727, Republic of Korea
| | - Kwang-Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan-si 50612, Republic of Korea
| | - Hye-Jin Baek
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea
- Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Republic of Korea
| | - Eun Cho
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea
- Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Republic of Korea
| | - Jong-Myung Park
- Department of Thoracic and Cardiovascular Surgery, Busan Medical Center, 359 World cup-daero, Yeonje-gu, Busan 47527, Republic of Korea
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Qureshi WT, Alirhayim Z, Khalid F, Al-Mallah MH. Prognostic value of extracardiac incidental findings on attenuation correction cardiac computed tomography. J Nucl Cardiol 2016; 23:1266-1274. [PMID: 26202878 DOI: 10.1007/s12350-015-0223-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/23/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Attenuation corrected computed tomography (CTAC) is often performed to improve the specificity of single-photon emission tomography imaging. Extracardiac incidental findings are frequently observed. It is unclear whether these findings have any prognostic value. METHODS Consecutive patients (n = 1139) at a tertiary care center were retrospectively evaluated for incidental findings on CTAC. Clinically significant incidental findings were defined as findings warranting physician follow-up. Information regarding subsequent resource utilization was obtained by chart review. Cox proportional hazard model adjusted for demographic and clinical variables was used to evaluate association of these incidental findings with all-cause and cancer-specific mortality. RESULTS A total of 135 (12%) patients with incidental findings were identified, 83 of whom (68%) were newly diagnosed. Lung nodules were the most common finding, present in 92 (68%) patients. Over a median follow-up of 468 days, incidental findings were not significantly associated with increased risk of all-cause mortality (HR 1.34; 95% CI 0.77-2.33, P = 0.29) but was significantly associated with cancer-specific mortality (HR 3.21; 95% CI 1.26-8.14, P = 0.01). This association remained statistically significant when the analysis was limited to newly diagnosed incidental findings. Among patients with incidental findings, follow-up radiographic studies were conducted in 87%, and invasive procedures performed in 32%. Physician office-based follow-up of these findings occurred in 42% of patients and incidental finding-related hospitalization occurred in 14%. CONCLUSIONS This study shows that incidental findings are common and were associated with all-cause and cancer-specific mortality but only the later remained statistically significant after multivariable adjustment.
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Affiliation(s)
- Waqas T Qureshi
- Wake Forest University School of Medicine, Winston Salem, NC, 27157, USA
| | - Zaid Alirhayim
- Henry Ford Hospital/Wayne State University, 2799 W. Grand Blvd., Detroit, MI, 48202, USA
- The University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Fatima Khalid
- Wake Forest University School of Medicine, Winston Salem, NC, 27157, USA
| | - Mouaz H Al-Mallah
- Henry Ford Hospital/Wayne State University, 2799 W. Grand Blvd., Detroit, MI, 48202, USA.
- Wayne State University, 540 E Canfield St., Detroit, MI, 48201, USA.
- King Abdul-Aziz Cardiac Center, King Abdul-Aziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, MC 1413, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.
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Value of “large FOV” calcium score as a screening method for detection of extracardiac incidental findings. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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An incidentally detected solitary fibrous tumor on (99m)Tc-sestamibi myocardial perfusion imaging. Clin Nucl Med 2015; 40:526-8. [PMID: 25706789 DOI: 10.1097/rlu.0000000000000730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 55-year-old woman with a mild transient chest pain but normal laboratory examination results underwent Tc-sestamibi myocardial perfusion imaging. An abnormal nodular radioactive uptake, which appeared protruding from the anterior segments, was detected. This activity was later proved to be benign solitary fibrous tumor of pleura after histopathological examination after the surgical exploration.
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Bazzocchi A, Ferrari F, Diano D, Albisinni U, Battista G, Rossi C, Guglielmi G. Incidental findings with dual-energy X-ray absorptiometry: spectrum of possible diagnoses. Calcif Tissue Int 2012; 91:149-56. [PMID: 22623178 DOI: 10.1007/s00223-012-9609-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 04/17/2012] [Indexed: 12/21/2022]
Abstract
New dual-energy X-ray absorptiometry (DXA) technologies provide improved spatial resolution and high image quality. Our purpose was to review DXA examinations to detect collateral findings and to understand their potential impact on patient healthcare. We retrospectively and randomly reviewed 739 DXA examinations (191 of 739, 25.8 %, whole body; 96 of 739, 13.0 %, vertebral fracture assessment; 231 of 739, 31.3 %, lumbar spine; 221 of 739, 29.9 %, femur) that were performed in our institution with a new DXA equipment. Whenever an extra finding was discovered, the physician's report was read and the clinical history of the patient was investigated to understand whether that finding was already known, as well as to check the diagnosis. The population included 208 male and 531 female subjects (58 ± 14 years old). Incidental findings were detected in 117 (15.8 %) of 739 DXA examinations (17 of 117, 14.5 %, whole body; 41 of 117, 35.0 %, vertebral fracture assessment; 32 of 117, 27.4 %, lumbar spine; 27 of 117, 23.1 %, femur): biliary and urinary stones (4.8 %), vascular calcifications (33.7 %), other soft tissue calcifications (25.3 %-e.g., tendons, lymph nodes, intraparenchymatous calcifications), vertebral abnormalities (14.5 %), other bone abnormalities (12.1 %), and morphovolumetric alterations or abnormal anatomical structures (9.6 %). Among all these findings, 50 (42.7 %) of 117 could be verified by other imaging modalities. Forty-nine (98.0 %) of 50 incidental findings were identified as true findings, and DXA was able to orient the diagnosis (exact diagnosis in 37 of 50, 74.0 %); however, none of them was mentioned on available DXA reports. An interpreting physician should treat the DXA image with the same attention given to any other X-ray image. Sometimes DXA may allow a qualitative diagnosis of collateral findings. However, potential negative effects on healthcare economy should be considered for false-positive or insignificant findings.
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Affiliation(s)
- Alberto Bazzocchi
- Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, Malpighi Hospital, University of Bologna, Sant'Orsola, Via G. Massarenti 9, 40138 Bologna, BO, Italy
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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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Lee SY, Landis MS, Ross IG, Goela A, Leung AE. Extraspinal Findings at Lumbar Spine CT Examinations: Prevalence and Clinical Importance. Radiology 2012; 263:502-9. [DOI: 10.1148/radiol.12112152] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Economic analysis of the use of coronary calcium scoring as an alternative to stress ECG in the non-invasive diagnosis of coronary artery disease. Eur Radiol 2011; 22:579-87. [PMID: 21993982 DOI: 10.1007/s00330-011-2304-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 09/26/2011] [Accepted: 09/27/2011] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To conduct an economic analysis (EA) of coronary calcium scoring (CCS) using a 0 score, as alternative to stress electrocardiography (sECG) in diagnosing coronary artery disease (CAD). METHOD A decision tree was constructed to compare four strategies for investigation of suspected CAD previously assessed in the formulation of clinical guidelines for the United Kingdom (UK) to two new strategies incorporating CCS. Sensitivity (96%; 95% CI 95.4-96.4%) and specificity (40%; 95% CI 38.7-41.4%) values for CCS were derived from a meta-analysis of 10,760 patients. Other input variables were obtained from a previous EA and average prices for hospital procedures in the UK. A threshold of £30,000/Quality-adjusted Life Year (QALY) was considered cost-effective. RESULTS Using net monetary benefit calculations, CCS-based strategies were found to be cost-effective compared to sECG equivalents at all assessed prevalence of CAD. Using CCS prior to myocardial perfusion scintigraphy (MPS) and catheter angiography (CA) was found to be cost-effective at pre-test probabilities (PTP) below 30%. CONCLUSIONS Adoption of CCS as an alternative to sECG in investigating suspected stable angina in low PTP population (<30%) would be cost-effective. In patients with PTP of CAD >30%, proceeding to MPS or CA would be more cost-effective than performing either CCS or sECG. KEY POINTS Coronary calcium scoring (CCS) is useful for assessing coronary artery atherosclerosis It can be performed with multi-detector CT, which is now widely available It plays a role in excluding disease in suspected stable angina Our study assesses its role in this setting as alternative to stress-ECG Adoption of CCS as an alternative to sECG could prove cost-effective.
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The Prevalence and Clinical Significance of Noncardiac Findings on Cardiac MRI. AJR Am J Roentgenol 2011; 196:W387-93. [PMID: 21427301 DOI: 10.2214/ajr.09.3302] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Quantitative Assessment of Percentage of Lung Parenchyma Visualized on Cardiac Computed Tomographic Angiography. J Comput Assist Tomogr 2010; 34:385-7. [DOI: 10.1097/rct.0b013e3181ce07d3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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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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Ethical issues related to lung nodules on cardiac CT. AJR Am J Roentgenol 2009; 192:W146; author reply W147. [PMID: 19234243 DOI: 10.2214/ajr.08.1802] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Reply. AJR Am J Roentgenol 2009. [DOI: 10.2214/ajr.08.2009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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