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Trussell TM, Kocaoglu M, Fleck RJ, Taylor MD, Zang H, Ollberding NJ, Lang SM. Extracardiac Findings on Cardiac Magnetic Resonance: A Children's Hospital Experience. Pediatr Cardiol 2023:10.1007/s00246-023-03190-1. [PMID: 37209187 DOI: 10.1007/s00246-023-03190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
Cardiac magnetic resonance (CMR) incorporates a field of view that has the potential to capture clinically relevant extracardiac findings (ECF); however, there has been minimal investigation of ECF prevalence in children's hospitals, where the patient population varies in age and diagnosis. We retrospectively reviewed consecutive, clinically indicated, CMR studies performed at a tertiary care children's hospital during a 1-year period from January 1 to December 31, 2019. ECFs were classified as significant or non-significant based on whether they were described in the final impression of the CMR report. A total of 851 distinct patients had a CMR study during the 1-year period. Mean age was 19.5 (range 0.2; 74.2) years. A total of 254 ECFs were present in 158 of the 851 studies (18.6%) with 9.8% of all studies having significant ECFs. A total of 40.2% of ECFs were previously unknown and 9.1% (23/254) of ECFs included further recommendations (2.1% of all studies). ECFs were most often found in the chest (48%) or abdomen/pelvis (46%). Three patients were incidentally found to have malignancy (renal cell, thyroid, and hepatocellular carcinoma). Comparing studies with significant ECFs to the group without, CMR indications for biventricular CHD (43% vs 31%, p = 0.036), single ventricle CHD (12% vs 3.9%, p = 0.002), and aortopathy/vasculopathy (16% vs 7.6%, p = 0.020) were more common. The odds of significant ECF increased with increasing age (OR 1.82, 95% CI 1.10-3.01) and increased most notably between ages 14 to 33 years old. Recognition of the high percentage of ECFs remains important for timely diagnosis of these incidental findings.
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Affiliation(s)
- Taylor M Trussell
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
- Heart Institute Research Core, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Murat Kocaoglu
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Robert J Fleck
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Michael D Taylor
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
- Heart Institute Research Core, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Huaiyu Zang
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Nicholas J Ollberding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Sean M Lang
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA.
- Heart Institute Research Core, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
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Coronary Computed Tomography Angiography Results in More Computed Tomography Chest Follow-up for Incidental Findings at 1 Year Relative to Stress-perfusion Cardiac Magnetic Resonance Imaging. J Thorac Imaging 2022; 37:292-299. [DOI: 10.1097/rti.0000000000000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jones TE, Wyse AJ, Gibson SE. Hematolymphoid neoplasms are common in bone marrow biopsies performed for non-specific, diffuse marrow signal alterations on magnetic resonance imaging. Ann Diagn Pathol 2019; 40:7-12. [DOI: 10.1016/j.anndiagpath.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 02/08/2019] [Indexed: 11/29/2022]
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Prevalence and Clinical Relevance of Extracardiac Findings in Cardiovascular Magnetic Resonance Imaging. J Thorac Imaging 2019; 34:48-55. [PMID: 30142138 DOI: 10.1097/rti.0000000000000360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess the prevalence of extracardiac findings (ECF) during cardiovascular magnetic resonance (CMR) examinations and their downstream effect on clinical management. MATERIALS AND METHODS We retrospectively identified 500 consecutive patients. Trans-axial balanced steady-state free precession nongated images acquired from the upper thorax to the upper abdomen were evaluated independently by 2 radiologists. ECF were classified as nonsignificant (benign, with no need for further investigation), significant (mandatory to be reported/monitored), and major (clinically remarkable pathology, mandatory to be reported/investigated/treated). Fifteen-month clinical follow-up information was collected through hospital records. RESULTS Of 500 patients, 108 (21.6%) showed a total of 153 ECF: 59 (11.8% of the entire study population; 38.5% of all ECF) nonsignificant, 76 (15.2%; 49.7%) significant, and 18 (3.6%; 11.8%) major ECF. The most frequent ECF were pleural effusion, hepatic cyst, renal cyst, and ascending aorta dilatation. Of 94 significant and major ECF, 46 were previously unknown and more common in older patients. Newly diagnosed major ECF (n=11, 2.2% of the entire study population, and 7.2% of all ECF)-including 5 tumors (1% of study population)-were confirmed by downstream evaluations and required specific treatment. Patients with major ECF were significantly older than patients without with major ECF. Newly diagnosed clinically significant and major ECF prompted downstream diagnostic tests in 44% and 100% of cases, respectively. CONCLUSIONS The detection of significant and major ECF is common during CMR reporting. The knowledge and the correct identification of most frequent ECF enable earlier diagnoses and faster treatment initiation of unknown extracardiac pathologies in patients referred to CMR imaging.
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Kanesa-Thasan R, Cox M, Patel M, Curtis B, Hurst RW, Kung D, Flanders AE. Actionable vascular and other incidental findings on CTA in patients undergoing acute stroke intervention. Neuroradiol J 2018; 31:572-577. [PMID: 30238833 DOI: 10.1177/1971400918800468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Providing a fast and accurate diagnosis of acute large-vessel occlusion on computed tomography angiograms (CTAs) is essential for timely intervention and good stroke outcomes. However, the detection and appropriate management of incidental findings are also important parts of any clinical radiology practice and can greatly affect patient care. The intricate anatomy covered by CTAs of the head and neck coupled with the time pressures of acute stroke diagnosis creates an environment in which unrelated, important findings can potentially be missed. The purpose of our study was to document clinically actionable incidental findings on CTA in 225 patients undergoing acute stroke intervention. After institutional review board approval, a retrospective six-year review of CTAs of the head and neck in patients undergoing acute stroke intervention was performed for actionable incidental vascular and nonvascular findings. A total of 225 patients undergoing acute stroke intervention with documented intracranial large-vessel occlusion on CTAs were consecutively enrolled in the study. Incidental vascular findings were identified in 17 of 225 patients (7.5%, 95% confidence interval 5% to 12%). Previously unreported aneurysms ranging from 2 mm to 10 mm in size represented 18 of 19 vascular findings in these patients. Incidental nonvascular findings were identified in 32 patients (14%, 95% confidence interval 5% to 12%). These included malpositioned support lines and tubes; pneumothorax; interstitial lung disease; newly diagnosed metastatic disease; nasopharyngeal, parotid, and pituitary masses; and cervical spine compression fractures. CTAs of the head and neck in patients undergoing acute stroke intervention contain a relatively high frequency of vascular and nonvascular incidental findings requiring further follow-up, and therefore should be evaluated carefully and systematically.
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Affiliation(s)
| | - Mougnyan Cox
- 2 Department of Radiology, Hospital of the University of Pennsylvania, USA
| | | | - Brian Curtis
- 4 Department of Radiology, University of California, San Diego, USA
| | - Robert W Hurst
- 2 Department of Radiology, Hospital of the University of Pennsylvania, USA
| | - David Kung
- 2 Department of Radiology, Hospital of the University of Pennsylvania, USA
| | - Adam E Flanders
- 1 Department of Radiology, Thomas Jefferson University Hospital, USA
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Sokolowski FC, Karius P, Rodríguez A, Lembcke A, Wagner M, Hamm B, Dewey M. Extracardiac findings at cardiac MR imaging: a single-centre retrospective study over 14 years. Eur Radiol 2018; 28:4102-4110. [PMID: 29713779 DOI: 10.1007/s00330-018-5432-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/05/2018] [Accepted: 03/16/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To determine the prevalence and significance of extracardiac findings (ECF) in a large set of cardiac magnetic resonance (MR) imaging examinations. METHODS The institutional review board (IRB) of the Charité approved this retrospective, single-centre study. A total of 4376 cardiac MR imaging reports of 3553 patients (age 37.4 ± 20 years, 60.8 % male) examined from 2000 to 2014 were included. Findings with a recommendation for follow-up were considered "major ECF". To analyse the association of indication, age and gender with ECF, Poisson regression and computed incidence rate ratios (IRR) were evaluated. RESULTS The overall prevalence of ECF was 34% (95% confidence interval [CI] 32.5-35.6%). Major ECF were present in 3.4% (95% CI 2.9-4.1%) while findings that changed patient management were found in 0.9% (95% CI 0.7-1.3%). In the cases of congenital heart disease, ECF prevalence was higher compared to myocarditis (IRR, 6.0; 95% CI 5.1-7.1%; p < 0.001), while the prevalence of major ECF was lower (IRR, 0.2; 95% CI 0.02-0.51%; p < 0.05). Older patient age was associated with more nonvascular ECF (p < 0.001). Female patients had the same probability of having an ECF as male patients (IRR, 1.04; 95% CI 0.95-1.1%; p = 0.43). CONCLUSION ECF in cardiac MR imaging are present in about every third patient while relevant ECF that change patient management can be found in about one out of 100 patients. Our data suggest that it is important to involve well-trained radiologists in reading cardiac MR images, which often reveal ECF if congenital heart disease is the clinical indication. KEY POINTS • Extracardiac findings are present in about every third patient. • Relevant ECF changing patient management are found in one out of 100 findings. • Chance of ECF is high in patients with CHD and vascular indications.
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Affiliation(s)
- Felix C Sokolowski
- Department of Radiology, Charite Medical School, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Philipp Karius
- Department of Radiology, Charite Medical School, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Alejandra Rodríguez
- Department of Radiology, Charite Medical School, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Alexander Lembcke
- Department of Radiology, Charite Medical School, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Moritz Wagner
- Department of Radiology, Charite Medical School, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charite Medical School, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charite Medical School, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Chariteplatz 1, 10117, Berlin, Germany.
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Incidental Extracardiac Findings and Their Characterization on Cardiac MRI. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2423546. [PMID: 29109956 PMCID: PMC5646298 DOI: 10.1155/2017/2423546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/28/2017] [Accepted: 08/20/2017] [Indexed: 01/05/2023]
Abstract
Background Cardiac magnetic resonance imaging (cMRI) has recently emerged as a new noninvasive imaging modality that offers superior structural and functional assessment of the heart. cMRI benefits from a large field of view but, consequently, may capture incidental extracardiac findings (IEFs). We aimed to evaluate the frequency and significance of IEFs reported from clinically indicated cMRI scans. Methods 742 consecutive patients (402 males and 340 females) referred to the Cardiac Magnetic Resonance Center of our University Hospital between January 2015 and December 2016 for clinically indicated cMRI were retrospectively enrolled for the evaluation of IEF prevalence and relevance. The median age of the subjects was 51 years (range: 5–85 years). Results A significant number of patients who underwent cMRI had incidental and clinically significant IEFs (2% of the population, 11.4% of cases). cMRI allowed a correct diagnosis in 116/131 cases with a diagnostic accuracy value of 88.5%. Conclusions IEFs on cMRI are not uncommon and lesions with mild or no clinical significance represent the most frequent findings. cMRI can characterize incidental findings with high accuracy in most cases.
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Sohns JM, Menke J, Schwarz A, Bergau L, Kowallick JT, Schuster A, Konietschke F, Placzek M, Weiberg D, Nordlohne S, Schmuck S, Schulz S, Derlin T, Staab W. Incidental findings in cardiac magnetic resonance imaging: superiority of bSSFP over T1w-HASTE for extra-cardiac findings assessment. Int J Cardiovasc Imaging 2017; 33:1581-1587. [PMID: 28451954 DOI: 10.1007/s10554-017-1145-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/20/2017] [Indexed: 12/21/2022]
Abstract
Incidental findings are frequent in radiological examinations and may have an impact on further patient management. The aim of this retrospective study was to analyze, which of two thoracic scout sequences is more suitable for detecting incidental extra-cardiac findings at cardiac magnetic resonance imaging (CMRI) with stress perfusion. During a 14-month period clinically indicated stress perfusion CMRI was performed in 97 consecutive patients. For anatomical orientation ECG-triggered (electrocardiography) T1w-Half-fourier acquisition single-shot turbo spin-echo (HASTE) and balanced steady state free precession (bSSFP) sequences were performed for planning the standard cardiac sequences. Two radiologists independently studied incidental extra-cardiac findings with both sequences and rated the diagnostic confidence of the sequences for this assessment using a multinomial model. Furthermore, the interobserver agreement between the observers was assessed by weighted kappa statistics. Eight patients without incidental findings were excluded. In the other 89 patients a total of 153 incidental extra-cardiac findings were observed. Overall, 47.1% of findings were seen with better diagnostic confidence at bSSFP as opposed to 20.6% at T1w-HASTE. 32.4% of findings were equally well seen with both sequences. Consequently the bSSFP sequence was significantly better in terms of diagnostic confidence for detecting the majority of extra-cardiac incidental findings (P < 0.01), whereas a minority of findings was better visible by the HASTE sequence. The weighted kappa statistics was 0.85, indicating good interobserver agreement. Compared with T1w-HASTE, the bSSFP sequence improved the visibility of incidental extra-cardiac findings at stress perfusion CMRI. While all findings were seen on both sequences, bSSFP resulted in improved diagnostic confidence, and the T1w-HASTE sequence provided complementary diagnostic information in only a minority of patients.
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Affiliation(s)
- Jan M Sohns
- Department of Nuclear Medicine, Center of Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. .,German Centre for Cardiovascular Research, DZHK, Berlin, Germany.
| | - Jan Menke
- Institute for Diagnostic and Interventional Radiology, Georg-August-University, UMG, Göttingen, Germany
| | - Alexander Schwarz
- Institute for Diagnostic and Interventional Radiology, Georg-August-University, UMG, Göttingen, Germany
| | - Leonard Bergau
- German Centre for Cardiovascular Research, DZHK, Berlin, Germany.,Department of Cardiology and Pneumology, Georg-August-University, UMG, Göttingen, Germany
| | - Johannes T Kowallick
- German Centre for Cardiovascular Research, DZHK, Berlin, Germany.,Institute for Diagnostic and Interventional Radiology, Georg-August-University, UMG, Göttingen, Germany
| | - Andreas Schuster
- German Centre for Cardiovascular Research, DZHK, Berlin, Germany.,Department of Cardiology and Pneumology, Georg-August-University, UMG, Göttingen, Germany
| | - Frank Konietschke
- Department of Mathematical Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Marius Placzek
- Department of Medical Statistics, Georg-August-University, UMG, Göttingen, Germany
| | - Desiree Weiberg
- Department of Nuclear Medicine, Center of Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefan Nordlohne
- Department of Nuclear Medicine, Center of Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sebastian Schmuck
- Department of Nuclear Medicine, Center of Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sebastian Schulz
- Department of Nuclear Medicine, Center of Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Center of Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Wieland Staab
- German Centre for Cardiovascular Research, DZHK, Berlin, Germany.,Institute for Diagnostic and Interventional Radiology, Georg-August-University, UMG, Göttingen, Germany
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Ulyte A, Valeviciene N, Palionis D, Kundrotaite S, Tamosiunas A. Prevalence and clinical significance of extracardiac findings in cardiovascular magnetic resonance. Hellenic J Cardiol 2016; 57:S1109-9666(16)30195-6. [PMID: 27756520 DOI: 10.1016/j.hjc.2016.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/01/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE In cardiac magnetic resonance imaging (CMR), incidental pathological findings are frequently found outside the investigated cardiovascular system. Some of these findings might have clinical implications. The aim of this study was to determine the prevalence of incidental extracardiac findings (ECF) in CMR and their clinical significance. METHODS A total of 4165 CMR reports from 2009-2012 were retrospectively reviewed for ECF. Two hundred-twenty reports with ECF were found. For each case, we obtained information on sex, age of the patient, reported ECF and radiologist recommendation. Follow-up data were analyzed by reviewing available electronic medical records. ECF was considered clinically significant if there was an associated diagnosis, additional treatment or further investigations in the clinical follow-up data. RESULTS In total, 356 ECF were recorded in 220 (5.3%) CMR reports. Sixty (23.7%) of the 253 ECF with follow-up data available were clinically significant. The most prevalent ECF were pleural effusions (n=54), kidney cysts (n=54), diffuse lung parenchyma changes (n=33) and liver cysts (n=29). Adrenal pathology (n=3, 100% significant), renal masses (n=3, 100%) and pulmonary masses (n=5, 62.5%) were the most clinically significant ECF. Although prevalence of these ECF was low, they were significant particularly frequently. When radiologist recommendations for further investigation were present in the report, the frequency of clinically significant ECF was higher compared to reports with no further investigation recommended (p<0.001). CONCLUSION In this study, ECF in CMR were reported not very commonly (5.3%). A substantial part of ECF was clinically significant, changing patient diagnosis or management, with an overall prevalence of 1.3%.
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Affiliation(s)
- Agne Ulyte
- Vilnius University, Faculty of Medicine, Lithuania.
| | - Nomeda Valeviciene
- Vilnius University, Faculty of Medicine, Lithuania; Radiology and Nuclear Medicine Center, Vilnius University Hospital Santariskiu Klinikos, Lithuania
| | - Darius Palionis
- Vilnius University, Faculty of Medicine, Lithuania; Radiology and Nuclear Medicine Center, Vilnius University Hospital Santariskiu Klinikos, Lithuania
| | - Simona Kundrotaite
- Vilnius University, Faculty of Medicine, Lithuania; Radiology and Nuclear Medicine Center, Vilnius University Hospital Santariskiu Klinikos, Lithuania
| | - Algirdas Tamosiunas
- Vilnius University, Faculty of Medicine, Lithuania; Radiology and Nuclear Medicine Center, Vilnius University Hospital Santariskiu Klinikos, Lithuania
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Rodrigues JCL, Lyen SM, Loughborough W, Amadu AM, Baritussio A, Dastidar AG, Manghat NE, Bucciarelli-Ducci C. Extra-cardiac findings in cardiovascular magnetic resonance: what the imaging cardiologist needs to know. J Cardiovasc Magn Reson 2016; 18:26. [PMID: 27156861 PMCID: PMC4860770 DOI: 10.1186/s12968-016-0246-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/21/2016] [Indexed: 12/21/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) is an established non-invasive technique to comprehensively assess cardiovascular structure and function in a variety of acquired and inherited cardiac conditions. A significant amount of the neck, thorax and upper abdomen are imaged at the time of routine clinical CMR, particularly in the initial multi-slice axial and coronal images. The discovery of unsuspected disease at the time of imaging has ethical, financial and medico-legal implications. Extra-cardiac findings at the time of CMR are common, can be important and can change clinical management. Certain patient groups undergoing CMR are at particular risk of important extra-cardiac findings as several of the cardiovascular risk factors for atherosclerosis are also risk factors for malignancy. Furthermore, the presence of certain extra-cardiac findings may contribute to the interpretation of the primary cardiac pathology as some cardiac conditions have multi-systemic extra-cardiac involvement. The aim of this review is to give an overview of the type of extra-cardiac findings that may become apparent on CMR, subdivided by anatomical location. We focus on normal variant anatomy that may mimic disease, common incidental extra-cardiac findings and important imaging signs that help distinguish sinister pathology from benign disease. We also aim to provide a framework to the approach and potential further diagnostic work-up of incidental extra-cardiac findings discovered at the time of CMR. However, it is beyond the scope of this review to discuss and determine the clinical significance of extracardiac findings at CMR.
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Affiliation(s)
- Jonathan C L Rodrigues
- Cardiovascular Magnetic Resonance Unit, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK
- Department of Clinical Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
- School of Physiology, Pharmacology and Neurosciences, Faculty of Biomedical Sciences, University of Bristol, Medical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Stephen M Lyen
- Department of Clinical Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - William Loughborough
- Department of Clinical Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Antonio Matteo Amadu
- Cardiovascular Magnetic Resonance Unit, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK
- Department of Surgical, Microsurgical and Medical Sciences, Institute of Radiological Sciences, University of Sassari, Sassari, Italy
| | - Anna Baritussio
- Cardiovascular Magnetic Resonance Unit, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK
- Department of Cardiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Amardeep Ghosh Dastidar
- Cardiovascular Magnetic Resonance Unit, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK
- Department of Cardiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Nathan E Manghat
- Department of Clinical Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Chiara Bucciarelli-Ducci
- Cardiovascular Magnetic Resonance Unit, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK.
- Department of Cardiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK.
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Research cardiac magnetic resonance imaging in end stage renal disease - incidence, significance and implications of unexpected incidental findings. Eur Radiol 2016; 27:315-324. [PMID: 27053260 PMCID: PMC5127861 DOI: 10.1007/s00330-016-4288-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/04/2016] [Accepted: 02/08/2016] [Indexed: 01/19/2023]
Abstract
Objectives Left ventricular mass (LVM) at cardiac magnetic resonance imaging (CMR) is a frequent end point in clinical trials in nephrology. Trial participants with end stage renal disease (ESRD) may have a greater frequency of incidental findings (IF). We retrospectively investigated prevalence of IF in previous research CMR and reviewed their subsequent impact on participants. Methods Between 2002 and 2006, 161 ESRD patients underwent CMR in a transplant assessment study. Images were used to assess LV mass and function. In the current study a radiologist reviewed the scans for IF. Review of patient records determined the subsequent clinical significance of IF. Results There were 150 IF in 95 study participants. Eighty-four (56 %) were new diagnoses. One hundred and two were non-cardiac. Fifteen were suspicious of malignancy. There was a clinically significant IF for 14.9 % of the participants. In six cases earlier identification of an IF may have improved quality of life or survival. Conclusions Without radiology support clinically important IF may be missed on CMR. Patients undergoing CMR in trials should be counselled about the frequency and implications of IF. Patients with ESRD have a higher prevalence of IF than reported in other populations. Nephrology studies require mechanisms for radiologist reporting and strategies for dealing with IF. Key Points • Incidental findings on research cardiac magnetic resonance imaging can have significant consequences. • We considered incidental findings in historical renal cardiac resonance imaging clinical trials. • Incidental findings are common and important in the chronic kidney disease population. • Without radiology support, clinically significant incidental findings may be missed on imaging. • Study protocols, approvals and consent processes should take account of possible findings.
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Mahani MG, Morani AC, Lu JC, Dehkordy SF, Jeph S, Dorfman AL, Agarwal PP. Non-cardiovascular findings in clinical cardiovascular magnetic resonance imaging in children. Pediatr Radiol 2016; 46:473-82. [PMID: 26754539 DOI: 10.1007/s00247-015-3512-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 10/15/2015] [Accepted: 11/13/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND With increasing use of pediatric cardiovascular MRI, it is important for all imagers to become familiar with the spectrum of non-cardiovascular imaging findings that can be encountered. OBJECTIVE This study aims to ascertain the prevalence and nature of these findings in pediatric cardiovascular MRIs performed at our institution. MATERIALS AND METHODS We retrospectively evaluated reports of all cardiovascular MRI studies performed at our institute from January 2008 to October 2012 in patients younger than18 years. Most studies (98%) were jointly interpreted by a pediatric cardiologist and a radiologist. We reviewed the electronic medical records of all cases with non-cardiovascular findings, defined as any imaging finding outside the cardiovascular system. Non-cardiovascular findings were classified into significant and non-significant, based on whether they were known at the time of imaging or they required additional workup or a change in management. RESULTS In 849 consecutive studies (mean age 9.7 ± 6.3 years), 145 non-cardiovascular findings were found in 140 studies (16.5% of total studies). Overall, 51.0% (74/145) of non-cardiovascular findings were in the abdomen, 30.3% (44/145) were in the chest, and 18.6% (27/145) were in the spine. A total of 19 significant non-cardiovascular findings were observed in 19 studies in individual patients (2.2% of total studies, 47% male, mean age 5.9 ± 6.7 years). Significant non-cardiovascular findings included hepatic adenoma, arterially enhancing focal liver lesions, asplenia, solitary kidney, pelvicaliectasis, renal cystic diseases, gastric distention, adrenal hemorrhage, lung hypoplasia, air space disease, bronchial narrowing, pneumomediastinum and retained surgical sponge. CONCLUSION Non-cardiovascular findings were seen in 16.5% of cardiovascular MRI studies in children, of which 2.2% were clinically significant findings. Prevalence and nature of these non-cardiovascular findings are different from those reported in adults. Attention to these findings is important during interpretation.
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Affiliation(s)
- Maryam Ghadimi Mahani
- Department of Radiology, Section of Pediatric Radiology, University of Michigan Health System, C.S. Mott Children's Hospital, 1540 E. Hospital Drive, SPC 4252, Ann Arbor, MI, 48019-4252, USA.
| | - Ajaykumar C Morani
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jimmy C Lu
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan Health System, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Soudabeh Fazeli Dehkordy
- Department of Radiology, Section of Pediatric Radiology, University of Michigan Health System, C.S. Mott Children's Hospital, 1540 E. Hospital Drive, SPC 4252, Ann Arbor, MI, 48019-4252, USA.,Department of Graduate Medical Education, Providence Hospital and Medical Centers, Southfield, MI, USA
| | - Sunil Jeph
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Radiology, Geisinger Medical Center, Danville, PA, USA
| | - Adam L Dorfman
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan Health System, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Prachi P Agarwal
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan Health System, Ann Arbor, MI, USA
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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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14
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Dunet V, Schwitter J, Meuli R, Beigelman-Aubry C. Incidental extracardiac findings on cardiac MR: Systematic review and meta-analysis. J Magn Reson Imaging 2015; 43:929-39. [PMID: 26397378 DOI: 10.1002/jmri.25053] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To perform a systematic review and meta-analysis to calculate the pooled prevalence of incidental extracardiac findings (IEFs) on cardiac magnetic resonance (MR) and to determine factors influencing reported prevalences. MATERIALS AND METHODS We examined studies published in the literature using the MEDLINE database. Studies reporting IEFs on cardiac MR were included. Meta-analysis provided pooled prevalences of total, minor, major IEFs, and major IEFs with patient management changes using a random-effects model. Heterogeneity and inconsistency (I-squared) between studies as well as publication bias were assessed. RESULTS Twelve studies including 7062 patients (mean age: 52 years, range: 0.5-93 years, 4476 male/2586 female) and 7122 cardiac MR examinations were considered in the meta-analysis. Overall, the pooled prevalence of total IEFs was 35% (95% confidence interval [CI]: 23-47%). The pooled prevalence of minor and major IEFs were 17% (95% CI: 9-26%) and 12% (95% CI: 7-18%), respectively. Newly diagnosed major IEFs changed patient management in 1% (95% CI: 1-2%) of the study population. A high heterogeneity and inconsistency (I-squared >74%) between studies without publication bias were observed, notably due to IEFs recording method (P < 0.002) and formal training of cardiac MR readers (P < 0.006). CONCLUSION Major IEFs may be found in 12% of patients undergoing cardiac MR examination and change the management in 1% of patients. Readers' training for the evaluation of noncardiac structures increases reported prevalence.
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Affiliation(s)
- Vincent Dunet
- Department of Radiodiagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Juerg Schwitter
- Cardiac MR Center, Lausanne University Hospital, Lausanne, Switzerland.,Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Reto Meuli
- Department of Radiodiagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland.,Cardiac MR Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Catherine Beigelman-Aubry
- Department of Radiodiagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland.,Cardiac MR Center, Lausanne University Hospital, Lausanne, Switzerland
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15
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Dunet V, Barras H, Boulanger X, Monney P, Qanadli SD, Meuli R, Schwitter J, Beigelman-Aubry C. Impact of extracardiac findings during cardiac MR on patient management and outcome. Med Sci Monit 2015; 21:1288-96. [PMID: 25943552 PMCID: PMC4548703 DOI: 10.12659/msm.893599] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Cardiac magnetic resonance (CMR) is increasingly used to assess heart diseases. Relevant non-cardiac diseases may also be incidentally found on CMR images. The aim of this study was to determine the prevalence and nature of incidental extra-cardiac findings (IEF) and their clinical impact in non-selected patients referred for CMR. Material/Methods MR images of 762 consecutive patients (515 men, age: 56±18 years) referred for CMR were prospectively interpreted by 2 radiologists blinded for any previous imaging study. IEFs were classified as major when requiring treatment, follow-up, or further investigation. Clinical follow-up was performed by checking hospital information records and by calling referring physicians. The 2 endpoints were: 1) non-cardiac death and new treatment related to major IEFs, and 2) hospitalization related to major IEFs during follow-up. Results Major IEFs were proven in 129 patients (18.6% of the study population), 14% of those being unknown before CMR. During 15±6 month follow-up, treatment of confirmed major IEFs was initiated in 1.4%, and no non-cardiac deaths occurred. Hospitalization occurred in 8 patients (1.0% of the study population) with confirmed major IEFs and none occurred in the remaining 110 patients with unconfirmed/unexplored major IEFs (p<0.001). Conclusions Screening for major IEFs in a population referred for routine CMR changed management in 1.4% of patients. Major IEFs unknown before CMR but without further exploration, however, carried a favorable prognosis over a follow-up period of 15 months.
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Affiliation(s)
- Vincent Dunet
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Heloise Barras
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Xavier Boulanger
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Monney
- Cardiac MR Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Salah D Qanadli
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Reto Meuli
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Juerg Schwitter
- Cardiac MR Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Catherine Beigelman-Aubry
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
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16
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Incidence and evaluation of incidental abnormal bone marrow signal on magnetic resonance imaging. ScientificWorldJournal 2014; 2014:380814. [PMID: 25374938 PMCID: PMC4211153 DOI: 10.1155/2014/380814] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 08/24/2014] [Indexed: 12/02/2022] Open
Abstract
Purpose. The increased use of magnetic resonance imaging (MRI) has resulted in reports of incidental abnormal bone marrow (BM) signal. Our goal was to determine the evaluation of an incidental abnormal BM signal on MRI and the prevalence of a subsequent oncologic diagnosis. Methods. We conducted a retrospective cohort study of patients over age 18 undergoing MRI between May 2005 and October 2010 at Tufts Medical Center (TMC) with follow-up through November 2013. The electronic medical record was queried to determine imaging site, reason for scan, evaluation following radiology report, and final diagnosis. Results. 49,678 MRIs were done with 110 patients meeting inclusion criteria. Twenty two percent underwent some evaluation, most commonly a complete blood count, serum protein electrophoresis, or bone scan. With median follow-up of 41 months, 6% of patients were diagnosed with malignancies including multiple myeloma, non-Hodgkins lymphoma, metastatic non-small cell lung cancer, and metastatic adenocarcinoma. One patient who had not undergone evaluation developed breast cancer 24 months after the MRI. Conclusions. Incidentally noted abnormal or heterogeneous bone marrow signal on MRI was not inconsequential and should prompt further evaluation.
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17
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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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18
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Loy A, Morgan R, O'Dea S, Daly C, Mulcahy F. Clinically significant extra-cardiac findings in asymptomatic HIV-positive men undergoing cardiac magnetic resonance imaging. Int J STD AIDS 2014; 26:346-51. [PMID: 24872375 DOI: 10.1177/0956462414538005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Increased research-based imaging has led to an increase in clinically significant extra-cardiac findings. HIV patients are at increased risk of having polypathology at a younger age; therefore, it may be hypothesised that they would have more incidental findings on imaging. We reviewed the magnetic resonance imaging results of 169 HIV-positive and 40 HIV-negative, clinically well volunteers undergoing cardiac magnetic resonance imaging scanning to assess the prevalence of subclinical cardiac pathology. This sub-study assessed the prevalence of clinically significant extra-cardiac findings. Associated risk factors were assessed and clinical follow-up and outcome were ascertained. Of the HIV-positive study group, 12/169 (7.1%) vs. 1/40 (2.5%) control patients had a clinically significant extra-cardiac finding which warranted further radiological or clinical intervention (p = 0.28). A total of three out of 169 (1.1%) were highly clinically significant findings. On logistic regression analysis, age was the only significant contributing factor (p = 0.049); no HIV-associated factors were found to be significant. The prevalence of clinically significant extra-cardiac findings of 7.1% in this HIV-positive cohort is comparable to the prevalence found in previous studies carried out on an older, sicker general population. This highlights the need for planning for unexpected outcomes and also the high rate of clinically significant findings in a seemingly well HIV-positive population.
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Affiliation(s)
- A Loy
- Genito-Urinary Infectious Disease Department, St James's Hospital, Dublin, Ireland
| | - R Morgan
- Cardiology Department, St James's Hospital, Dublin, Ireland
| | - S O'Dea
- Genito-Urinary Infectious Disease Department, St James's Hospital, Dublin, Ireland
| | - C Daly
- Cardiology Department, St James's Hospital, Dublin, Ireland
| | - F Mulcahy
- Genito-Urinary Infectious Disease Department, St James's Hospital, Dublin, Ireland
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Alkhouli M, Sandhu P, Wiegers SE, Patil P, Panidis J, Pursnani A. Extracardiac Findings on Routine Echocardiographic Examinations. J Am Soc Echocardiogr 2014; 27:540-6. [DOI: 10.1016/j.echo.2014.01.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Indexed: 11/30/2022]
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20
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Valente AM, Cook S, Festa P, Ko HH, Krishnamurthy R, Taylor AM, Warnes CA, Kreutzer J, Geva T. Multimodality Imaging Guidelines for Patients with Repaired Tetralogy of Fallot: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr 2014; 27:111-41. [DOI: 10.1016/j.echo.2013.11.009] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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21
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Greulich S, Backes M, Schumm J, Grün S, Steubing H, Sechtem U, Geissler A, Mahrholdt H. Extra cardiac findings in cardiovascular MR: why cardiologists and radiologists should read together. Int J Cardiovasc Imaging 2014; 30:609-17. [PMID: 24481722 DOI: 10.1007/s10554-014-0368-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/12/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess prevalence and significance of extra cardiac findings (ECF) in clinical routine cardiovascular magnetic resonance (CMR) studies reported by cardiologists alone versus cardiologist and radiologist working together. METHODS One-thousand-seventy-four consecutive patients presenting at our institution for CMR work-up of multiple cardiovascular disease entities were enrolled retrospectively in two groups (cardiologists reading alone vs. cardiologists and radiologist reading together). RESULTS In 1,074 routine CMR studies a total of 357 ECF's were identified in 235 patients yielding a prevalence of 21.9 %. Of these 357 ECF's more than one-third were previously known. In the remaining 223 previously unknown findings 118 (52.9 %) were considered as major ECF's (92 patients), and 105 (47.1 %) were considered as minor ECF's (69 patients). Cardiologists reading alone reported 23 previously unknown ECF's in 23 patients, versus 200 previously unknown ECF in 138 patients by cardiologists and radiologists working together, p < 0.0001. Nevertheless, highly significant ECF's with major prognostic implications, such as the initial diagnosis of malignancy in an individual with no history of cancer, are extremely rare (n = 3, 0.3 %). Cardiologists alone, as well as cardiologists and radiologists working together seem to do well with reporting of such extremely important ECF's. CONCLUSIONS The prevalence of all ECF's was 21.9 %, and 14.9 % of previously unknown ECF's, respectively. However, the prevalence of highly significant ECF's was low. Joint reading with cardiologists and radiologists may increase the number of ECF's detected in CMR studies, but it remains unclear if this could result in an improved long-term outcome of patients undergoing routine CMR.
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Affiliation(s)
- Simon Greulich
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376, Stuttgart, 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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Noncardiac findings in clinical cardiac magnetic resonance: prevalence in 300 examinations after blind reassessment. J Comput Assist Tomogr 2013; 37:382-6. [PMID: 23674009 DOI: 10.1097/rct.0b013e3182845bdb] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To assess the prevalence of noncardiac findings (NCFs) in a consecutive series of 300 cardiac magnetic resonance (CMR) studies. METHODS We retrospectively evaluated CMRs of 192 males and 108 females (42 ± 22 years), comparing findings included in reports to those detected after focused reassessment of CMR images. Noncardiac findings were classified as relevant if additional workup was required. RESULTS We found 19 NCFs, 14 (4.7%) tagged as nonrelevant and 5 (1.7%) as relevant. Images' reassessment presented 45 NCFs, 26 (8.7%) nonrelevant and 16 (5.3%) relevant (P < 0.003). CONCLUSIONS Cardiac magnetic resonance involves the study of areas larger than the heart alone, and NCFs are found in 1 of 7 patients; more than a half of them are not included in the initial CMR report. A small part is relevant, but detection can be unnecessarily stressful and harmful for patients and could increase costs. Risks of overdiagnosis or underreporting are to be taken into account.
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Sohns JM, Schwarz A, Menke J, Staab W, Spiro JE, Lotz J, Unterberg-Buchwald C. Prevalence and clinical relevance of extracardiac findings at cardiac MRI. J Magn Reson Imaging 2013; 39:68-76. [PMID: 23589475 DOI: 10.1002/jmri.24142] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 02/25/2013] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To assess the incidence of extracardiac findings in patients undergoing clinical cardiac magnetic resonance imaging (CMRI) of the heart, and to determine the influence of those findings on patient management. MATERIALS AND METHODS During 40 months, 854 CMRI were performed at 1.5 T. Extracardiac findings were classified as significant (group A), if recommended for additional diagnostics or therapeutic interventions, and as nonsignificant (group B). RESULTS The most frequent indication for CMRI was evaluation of cardiac stress ischemia. In all, 631 CMRI (74% of 854) showed no extracardiac pathologies. In the remaining 223 CMRI (26% of 854), a total of 286 extracardiac findings were detected. Among these findings, 49 were considered significant (group A) and 237 nonsignificant (group B). In group A, the most common findings were suspicious pulmonary nodules or masses. In group B, the most frequent findings were hepatic cysts or hemangiomas. Eight malignancies were observed with certainty at CMRI. Seven of them had been incidentally diagnosed on CMRI for the first time, and subsequently changed the patients' management. CONCLUSION Extracardiac findings in clinically indicated CMRI are common (about 26%). Radiologists and cardiologists should be aware of relevant extracardiac findings that might require additional diagnostics or treatment.
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Affiliation(s)
- Jan Martin Sohns
- Institute for Diagnostic and Interventional Radiology, Heart Center, University Medical Center Goettingen, Germany
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25
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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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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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Extracardiac findings detected by cardiac magnetic resonance imaging. Eur Radiol 2012; 22:1295-302. [DOI: 10.1007/s00330-011-2369-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 11/15/2011] [Accepted: 12/07/2011] [Indexed: 12/21/2022]
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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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