Incidental Non-cardiac Findings in Coronary Computed Tomography Angiography: Is It Worth Reporting?

Overview

Journal J Clin Imaging Sci

Specialty Radiology

Date 2019 Sep 21

PMID 31538038

Citations 2

Authors

Subramaniyan Ramanathan

Sushila B Ladumor

Willington Francis

Abdelnasser A Allam

Maryam Alkuwari

Affiliations

Soon will be listed here.

Abstract

Objectives: The objectives of this study were to estimate the prevalence and significance of incidental non-cardiac findings (INCFs) in coronary computed tomography angiography (CCTA) using a dual-source multidetector computed tomography.

Materials And Methods: Retrospective review of all CCTA studies performed over a time period for various indications was included in the study. After exclusions, CCTA of 1713 patients was evaluated by two experienced cardiac radiologists for non-cardiac abnormalities in the full field-of-view limited contrast chest series. The scans were acquired from the level of the carina to just below the diaphragm. INCFs were classified into three categories: Significant, indeterminate, and insignificant findings based on their clinical impact and availability of prior imaging and clinical details.

Results: The study cohort consisted of 1123 males (mean age of 58 years) and 590 females (mean age of 64 years). INCFs were seen in 600 patients of 1713 patients. A total of 812 INCFs (47.5%) were found in 1713 patients. Of those, 568 (70%) were considered insignificant, 205 (25.2%) indeterminate, and 39 significant findings (4.9%). The prevalence of significant findings was 2.3%. Among the 39 significant findings, after correlating with clinical details and other imaging, nine were really significant findings (0.5%) and out of this, four turned out to be cancers (0.2%).

Conclusion: Large number of INCFs can be found in CCTA with majority of them being insignificant or of minimal clinical impact. Although the proportion of significant findings is small and may not be cost beneficial, it is prudent to evaluate all the available data and to make appropriate classification of INCFs which can help in further management.

Citing Articles

Variability of pulmonary nodule volumetry on coronary CT angiograms.

Pinto E, Penha D, Hochhegger B, Monaghan C, Marchiori E, Taborda-Barata L Medicine (Baltimore). 2022; 101(35):e30332.

PMID: 36107569 PMC: 9439735. DOI: 10.1097/MD.0000000000030332.

The impact of cardiopulmonary hemodynamic factors in volumetry for pulmonary nodule management.

Guedes Pinto E, Penha D, Hochhegger B, Monaghan C, Marchiori E, Taborda-Barata L BMC Med Imaging. 2022; 22(1):49.

PMID: 35303820 PMC: 8932130. DOI: 10.1186/s12880-022-00774-w.

References

Budoff M, Fischer H, Gopal A . Incidental findings with cardiac CT evaluation: should we read beyond the heart?. Catheter Cardiovasc Interv. 2006; 68(6):965-73. DOI: 10.1002/ccd.20924. View

Sosnouski D, Bonsall R, Mayer F, Ravenel J . Extracardiac findings at cardiac CT: a practical approach. J Thorac Imaging. 2007; 22(1):77-85. DOI: 10.1097/RTI.0b013e3180317a5b. View

Northam M, Koonce J, Ravenel J . Pulmonary nodules detected at cardiac CT: comparison of images in limited and full fields of view. AJR Am J Roentgenol. 2008; 191(3):878-81. DOI: 10.2214/AJR.07.2939. View

Budoff M, Gopal A . Incidental findings on cardiac computed tomography. Should we look?. J Cardiovasc Comput Tomogr. 2008; 1(2):97-105. DOI: 10.1016/j.jcct.2007.04.002. View

Aglan I, Jodocy D, Hiehs S, Soegner P, Frank R, Haberfellner B . Clinical relevance and scope of accidental extracoronary findings in coronary computed tomography angiography: a cardiac versus thoracic FOV study. Eur J Radiol. 2009; 74(1):166-74. DOI: 10.1016/j.ejrad.2009.01.038. View

Killeen R, Dodd J, Cury R . Noncardiac findings on cardiac CT part I: Pros and cons. J Cardiovasc Comput Tomogr. 2009; 3(5):293-9. DOI: 10.1016/j.jcct.2009.05.003. View

MacHaalany J, Yam Y, Ruddy T, Abraham A, Chen L, Beanlands R . Potential clinical and economic consequences of noncardiac incidental findings on cardiac computed tomography. J Am Coll Cardiol. 2009; 54(16):1533-41. DOI: 10.1016/j.jacc.2009.06.026. View

Killeen R, Cury R, McErlean A, Dodd J . Noncardiac findings on cardiac CT. Part II: spectrum of imaging findings. J Cardiovasc Comput Tomogr. 2010; 3(6):361-71. DOI: 10.1016/j.jcct.2009.10.007. View

Lee C, Tsai E, Sigal B, Plevritis S, Garber A, Rubin G . Incidental extracardiac findings at coronary CT: clinical and economic impact. AJR Am J Roentgenol. 2010; 194(6):1531-8. PMC: 4827619. DOI: 10.2214/AJR.09.3587. View

10.

Johnson K, Dennis J, Dowe D . Extracardiac findings on coronary CT angiograms: Limited versus complete image review. AJR Am J Roentgenol. 2010; 195(1):143-8. DOI: 10.2214/AJR.08.1050. View

11.

Berland L, Silverman S, Gore R, Mayo-Smith W, Megibow A, Yee J . Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol. 2010; 7(10):754-73. DOI: 10.1016/j.jacr.2010.06.013. View

12.

Ding A, Eisenberg J, Pandharipande P . The economic burden of incidentally detected findings. Radiol Clin North Am. 2011; 49(2):257-65. PMC: 3094927. DOI: 10.1016/j.rcl.2010.11.004. View

13.

Goehler A, McMahon P, Lumish H, Wu C, Munshi V, Gilmore M . Cost-effectiveness of follow-up of pulmonary nodules incidentally detected on cardiac computed tomographic angiography in patients with suspected coronary artery disease. Circulation. 2014; 130(8):668-75. PMC: 4139449. DOI: 10.1161/CIRCULATIONAHA.113.007306. View

14.

Douglas P, Hoffmann U, Patel M, Mark D, Al-Khalidi H, Cavanaugh B . Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med. 2015; 372(14):1291-300. PMC: 4473773. DOI: 10.1056/NEJMoa1415516. View

15.

Mozaffarian D, Benjamin E, Go A, Arnett D, Blaha M, Cushman M . Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2015; 133(4):e38-360. DOI: 10.1161/CIR.0000000000000350. View

16.

Rybicki F, Udelson J, Peacock W, Goldhaber S, Isselbacher E, Kazerooni E . 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness.... J Am Coll Cardiol. 2016; 67(7):853-79. DOI: 10.1016/j.jacc.2015.09.011. View

17.

Levin D, Parker L, Halpern E, Rao V . Coronary CT Angiography: Use in Patients With Chest Pain Presenting to Emergency Departments. AJR Am J Roentgenol. 2018; 210(4):816-820. DOI: 10.2214/AJR.17.18740. View