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.

Objectives:Coronary artery anomalies are uncommon, but important cardiac malformations, representing the second commonest cause of death in young athletes.Methods:We utilized computerized tomographic angiography to screen and precisely delineate coronary artery anomalies in patients with minimal cardiac symptoms.Results:During 3.5-year period, we performed 2888 computerized tomographic angiographies. A total of 33 (1.1%; 95% confidence interval = 0.7–1.5) cases of coronary artery anomalies were identified (mean age = 44 ± 13.5 (15–70) years). In total, 23 patients (mean age = 43 years) had malignant coronary artery anomalies with an inter-arterial course of the aberrant vessel: of which 3 had left main coronary artery arising from right coronary sinus and 20 right coronary artery from left sinus; 19 patients were of Asian and 14 were of Arab origins. Of interest, 21 out of 33 patients had chest pain, 5 had palpitations, and 2 had breathlessness. There were no examples of sudden cardiac death. All patients received appropriate advice regarding physical exertion and medical management, and remained well for 2–5 years of follow-up. Of 33 patients, 4 had significant symptomatic coronary artery disease requiring intervention: 1 percutaneous coronary intervention and 3 coronary artery bypass graft surgery.Conclusion:There is a relatively high incidence of coronary artery anomalies with malignant course in Asians. The vast majority were managed conservatively.

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SummaryBackgroundKawasaki Disease (KD) is a rare acute febrile illness due to multi-organ vasculitis. It most often affects children under five years of age. Coronary artery aneurysms are seen in about 25% of children with KD. Selective invasive coronary angiography was considered to be the gold standard for diagnosis and follow-up of coronary artery aneurysms, thrombosis and stenosis in patients with KD. Echocardiography is a non-invasive tool for imaging of this condition but it does have some limitations. Recently, a high-quality multislice CT coronary angiography has been advocated in the diagnosis of KD.Case ReportWe report a case of a 5-year-old boy who was diagnosed with Kawasaki disease and followed up by CT coronary angiography, which provided required excellent imaging findings in the terms of the number, size and location of coronary aneurysms.ConclusionsBased on imaging results of our case it can be stated that high-quality CT coronary angiography with the use of multi-slice dual source ultra-fast scanner can be considered a better and safer non-invasive diagnostic tool, an alternative to invasive catheter selective coronary angiography in the diagnosis and long-term follow-up of patients with KD, especially when echocardiographic images are limited or technically challenging.

Highlights This is the first study in the Asian region and one of the very few that established DRLs based on clinical indication for CT. Standardized CI nomenclature must be established as there are no guidelines for accurate comparison between studies on CT patient exposure. The established clinical DRL values for CT will further facilitate patient dose optimization and quality improvement process HMC in Qatar.