Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Incidental Non-Cardiac Findings of a Coronary Angiography with a 128-Slice Multi-Detector CT Scanner: Should We Only Concentrate on the Heart?

  • Lazoura, Olga (Department of Radiology, Medical School of Thessaly) ;
  • Vassiou, Katerina (Department of Anatomy, Medical School of Thessaly) ;
  • Kanavou, Theodora (Department of Radiology, Medical School of Thessaly) ;
  • Vlychou, Marianna (Department of Radiology, Medical School of Thessaly) ;
  • Arvanitis, Dimitrios L. (Department of Anatomy, Medical School of Thessaly) ;
  • Fezoulidis, Ioannis V. (Department of Radiology, Medical School of Thessaly)
  • Received : 2009.05.09
  • Accepted : 2009.07.28
  • Published : 2010.02.01
⟨ Previous Next ⟩

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.

Keywords

References

  1. Schoepf UJ, Becker CR, Ohnesorge BM, Yucel EK. CT of coronary artery disease. Radiology 2004;232:18-37 https://doi.org/10.1148/radiol.2321030636
  2. Achenbach S. Current and future status on cardiac computed tomography imaging for diagnosis and risk stratification. J Nucl Cardiol 2005;12:703-713 https://doi.org/10.1016/j.nuclcard.2005.09.001
  3. Wann S, Rao P, Des Prez R. Cardiac computed tomographic angiography: evaluation of non-cardiac structures. J Nucl Cardiol 2009;16:139-150 https://doi.org/10.1007/s12350-008-9035-z
  4. Kawano Y, Tamura A, Goto Y, Shinozaki K, Zaizen H, Kadota J. Incidental detection of cancers and other non-cardiac abnormalities on coronary multislice computed tomography. Am J Cardiol 2007;99:1608-1609 https://doi.org/10.1016/j.amjcard.2007.01.038
  5. Dewey M, Schnapauff D, Teige F, Hamm B. Non-cardiac findings on coronary computed tomography and magnetic resonance imaging. Eur Radiol 2007;17:2038-2043 https://doi.org/10.1007/s00330-006-0570-1
  6. Haller S, Kaiser C, Buser P, Bongartz G, Bremerich J. Coronary artery imaging with contrast-enhanced MDCT: extracardiac findings. AJR Am J Roentgenol 2006;187:105-110 https://doi.org/10.2214/AJR.04.1988
  7. Mueller J, Jeudy J, Poston R, White CS. Cardiac CT angiography after coronary bypass surgery: prevalence of incidental findings. AJR Am J Roentgenol 2007;189:414-419 https://doi.org/10.2214/AJR.06.0736
  8. Onuma Y, Tanabe K, Nakazawa G, Aoki J, Nakajima H, Ibukuro K, et al. Noncardiac findings in cardiac imaging with multidetector computed tomography. J Am Coll Cardiol 2006;48:402-406 https://doi.org/10.1016/j.jacc.2006.04.071
  9. Gil BN, Ran K, Tamar G, Shmuell F, Eli A. Prevalence of significant noncardiac findings on coronary multidetector computed tomography angiography in asymptomatic patients. J Comput Assist Tomogr 2007;31:1-4 https://doi.org/10.1097/01.rct.0000233125.83184.33
  10. Law YM, Huang J, Chen K, Cheah FK, Chua T. Prevalence of significant extracoronary findings on multislice CT coronary angiography examinations and coronary artery calcium scoring examinations. J Med Imaging Radiat Oncol 2008;52:49-56 https://doi.org/10.1111/j.1440-1673.2007.01911.x
  11. Budoff MJ, Gopal A. Incidental findings on cardiac computed tomography. Should we look? J Cardiovasc Comput Tomogr 2007;1:97-105 https://doi.org/10.1016/j.jcct.2007.04.002
  12. Hendel RC, Patel MR, Kramer CM, Poon M, Hendel RC, Carr JC, et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol 2006;48:1475-1497 https://doi.org/10.1016/j.jacc.2006.07.003
  13. Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, et al. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 2006;114:1761-1791 https://doi.org/10.1161/CIRCULATIONAHA.106.178458
  14. Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 1979;300:1350-1358 https://doi.org/10.1056/NEJM197906143002402
  15. Kirsch J, Araoz PA, Steinberg FB, Fletcher JG, McCollough CH, Williamson EE. Prevalence and significance of incidental extracardiac findings at 64-multidetector coronary CTA. J Thorac Imaging 2007;22:330-334 https://doi.org/10.1097/RTI.0b013e31813434a9
  16. MacMahon H, Austin JH, Gamsu G, Herold CJ, Jett JR, Naidich DP, et al. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 2005;237:395-400 https://doi.org/10.1148/radiol.2372041887
  17. Horton KM, Post WS, Blumenthal RS, Fishman EK. Prevalence of significant noncardiac findings on electron-beam computed tomography coronary artery calcium screening examinations. Circulation 2002;106:532-534 https://doi.org/10.1161/01.CIR.0000027136.56615.DE
  18. Hunold P, Schmermund A, Seibel RM, Gronemeyer DH, Erbel R. Prevalence and clinical significance of accidental findings in electron-beam tomographic scans for coronary artery calcification. Eur Heart J 2001;22:1748-1758 https://doi.org/10.1053/euhj.2000.2586
  19. Schragin JG, Weissfeld JL, Edmundowicz D, Strollo DC, Fuhrman CR. Non-cardiac findings on coronary electron beam computed tomography scanning. J Thorac Imaging 2004;19:82-86 https://doi.org/10.1097/00005382-200404000-00004
  20. McKenna D, Laxpati M, Colletti PM. The prevalence of incidental findings at cardiac MRI. Open Cardiovasc Med J 2008;2:20-25 https://doi.org/10.2174/1874192400802010020
  21. Aglan I, Jodocy D, Hiehs S, Soegner P, Frank R, Haberfellner B, et al. Clinical relevance and scope of accidental extracoronary findings in coronary computed tomography angiography: a cardiac versus thoracic FOV study. Eur J Radiol 2009 [Epub ahead of print]
  22. Northam M, Koonce J, Ravenel JG. Pulmonary nodules detected at cardiac CT: comparison of images in limited and full fields of view. AJR Am J Roentgenol 2008;191:878-881 https://doi.org/10.2214/AJR.07.2939
  23. Yiginer O, Bas S, Pocan S, Yildiz A, Alibek S. Incidental findings of cardiac MSCT: who might benefit from scanning the entire thorax on Ca score imaging? Int J Cardiol 2008 [Epub ahead of print]
  24. Kim JW, Kang EY, Yong HS, Kim YK, Woo OH, Oh YW, et al. Incidental extracardiac findings at cardiac CT angiography: comparison of prevalence and clinical significance between precontrast low-dose whole thoracic scan and postcontrast retrospective ECG-gated cardiac scan. Int J Cardiovasc Imaging 2009;25:75-81 https://doi.org/10.1007/s10554-008-9417-y
  25. Bach PB, Jett JR, Pastorino U, Tockman MS, Swensen SJ, Begg CB. Computed tomography screening and lung cancer outcomes. JAMA 2007;297:953-961 https://doi.org/10.1001/jama.297.9.953
  26. Colletti PM. Incidental findings on cardiac imaging. AJR Am J Roentgenol 2008;191:882-884 https://doi.org/10.2214/AJR.08.1133

Cited by

  1. Unrequested Findings on Cardiac Computed Tomography: Looking Beyond the Heart vol.7, pp.4, 2010, https://doi.org/10.1371/journal.pone.0032184
  2. Prevalence and significance of extravascular incidental findings on computed tomographic angiography and magnetic resonance angiography vol.21, pp.6, 2013, https://doi.org/10.1177/1708538112473973
  3. Malignant Incidental Extracardiac Findings on Cardiac CT: Systematic Review and Meta-Analysis vol.201, pp.3, 2010, https://doi.org/10.2214/ajr.12.10306
  4. Detection of cardiac myxomas with non-contrast chest CT vol.55, pp.3, 2010, https://doi.org/10.1177/0284185113496561
  5. Using Coronary Artery Calcification Combined with Pretest Clinical Risk Assessment as a Means of Determining Investigation and Treatment in Patients Presenting with Chest Pain in a Rural Setting vol.2015, pp.None, 2010, https://doi.org/10.1155/2015/582590
  6. Diagnostic Accuracy of Dual-Source Computerized Tomography Coronary Angiography in Symptomatic Patients Presenting to a Referral Cardiovascular Center During Daily Clinical Practice vol.13, pp.2, 2010, https://doi.org/10.5812/iranjradiol.24350
  7. Update on Cardiovascular Applications of Multienergy CT vol.37, pp.7, 2017, https://doi.org/10.1148/rg.2017170100
  8. Detection of incidental cardiac findings in noncardiac chest computed tomography vol.96, pp.29, 2017, https://doi.org/10.1097/md.0000000000007531
  9. Extracardiac findings on coronary computed tomography angiography in patients without significant coronary artery disease vol.29, pp.4, 2010, https://doi.org/10.1007/s00330-018-5688-4
  10. Common Incidental Findings on Cardiac CT: a Systematic Review vol.12, pp.6, 2019, https://doi.org/10.1007/s12410-019-9494-4
  11. Incidental findings on computed tomography coronary angiography and its impact on respiratory services in a United Kingdom district general hospital vol.9, pp.None, 2010, https://doi.org/10.12688/f1000research.25206.1
  12. Coronavirus disease 2019 (COVID-19) pneumonia incidentally detected on coronary CT angiogram: a do-not-miss diagnosis vol.27, pp.6, 2020, https://doi.org/10.1007/s10140-020-01802-4
  13. Detection of relevant extracardiac findings on coronary computed tomography angiography vs. invasive coronary angiography vol.32, pp.1, 2022, https://doi.org/10.1007/s00330-021-07967-x