Extracardiac findings on coronary computed tomography angiography in patients without significant coronary artery disease

Karius, Philipp; Lembcke, Alexander; Sokolowski, Fabian; Gandara, Ivan Dario Perez; Rodríguez, A. Aguilar; Hamm, Bernd; Dewey, Marc

doi:10.1007/s00330-018-5688-4

Cited by 17 publications

(22 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While this may be associated with potential procedural complications and increase healthcare costs, it can improve quality of life of affected patients. Two studies performed so far reported clinically relevant ECFs on CTA as a possible underlying cause of chest pain when CAD was ruled out by the procedure [1,2]. Karius et al [1] investigated 2330 patients with chest pain, identifying 7.9% ECFs that might explain their pain.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, patients in whom CTA rules out CAD while simultaneously detecting ECFs explaining chest pain might be spared an ICA. Previous studies show that ECFs are common in patients undergoing CTA [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. On the other hand, there is an ongoing debate in the scientific community on the need to look for ECFs in CTA scans [19,20].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Detection of relevant extracardiac findings on coronary computed tomography angiography vs. invasive coronary angiography

et al. 2021

Self Cite

View full text Add to dashboard Cite

Objectives To compare the detection of relevant extracardiac findings (ECFs) on coronary computed tomography angiography (CTA) and invasive coronary angiography (ICA) and evaluate the potential clinical benefit of their detection. Methods This is the prespecified subanalysis of ECFs in patients presenting with a clinical indication for ICA based on atypical angina and suspected coronary artery disease (CAD) included in the prospective single-center randomized controlled Coronary Artery Disease Management (CAD-Man) study. ECFs requiring immediate therapy and/or further workup including additional imaging were defined as clinically relevant. We evaluated the scope of ECFs in 329 patients and analyzed the potential clinical benefit of their detection. Results ECFs were detected in 107 of 329 patients (32.5%; CTA: 101/167, 60.5%; ICA: 6/162, 3.7%; p < .001). Fifty-nine patients had clinically relevant ECFs (17.9%; CTA: 55/167, 32.9%; ICA: 4/162, 2.5%; p < .001). In the CTA group, ECFs potentially explained atypical chest pain in 13 of 101 patients with ECFs (12.9%). After initiation of therapy, chest pain improved in 4 (4.0%) and resolved in 7 patients (6.9%). Follow-up imaging was recommended in 33 (10.0%; CTA: 30/167, 18.0%; ICA: 3/162, 1.9%) and additional clinic consultation in 26 patients (7.9%; CTA: 25/167, 15.0%; ICA: 1/162, 0.6%). Malignancy was newly diagnosed in one patient (0.3%; CTA: 1/167, 0.6%; ICA: 0). Conclusions In this randomized study, CTA but not ICA detected clinically relevant ECFs that may point to possible other causes of chest pain in patients without CAD. Thus, CTA might preclude the need for ICA in those patients. Trial registration NCT Unique ID: 00844220 Key Points • CTA detects ten times more clinically relevant ECFs than ICA. • Actionable clinically relevant ECFs affect patient management and therapy and may thus improve chest pain. • Detection of ECFs explaining chest pain on CTA might preclude the need for performing ICA.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Detection of relevant extracardiac findings on coronary computed tomography angiography vs. invasive coronary angiography

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Thus, it became clear that lower thresholds for managing nonsolid nodules seemed prudent for cardiac CT in a non-screening (5) Growth defined as > 1.5 mm. (6) Risk factor examples include Risk features: Spiculation, mediastinal lymph nodes > 1 cm small diameter, GGN that doubles in size in one year. (7) See main text for protocol details.…”

Section: Discussionmentioning

confidence: 99%

“…Lung nodules are one of the commonest incidental findings on cardiac CT in patients with a low-intermediate pretest probability of suspected stable coronary artery disease [6]. No lung nodule management recommendations specifically exist for cardiac CT, despite many such patients referred for cardiac CT fulfilling the above age and lungcancer risk criteria for CT lung-cancer screening.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Developing a lung nodule management protocol specifically for cardiac CT: Methodology in the DISCHARGE trial

Haase

Dodd

Kauczor

et al. 2020

European Journal of Radiology Open

Self Cite

View full text Add to dashboard Cite

In this methodology paper we describe the development of a lung nodule management algorithm specifically for patients undergoing cardiac CT. Methods: We modified the Lung-RADS algorithm specifically to manage lung nodules incidentally detected on cardiac CT (Lung-RADS for cardiac CT). We will evaluate the modified algorithm as part of the DISCHARGE trial (www.dischargetrial.eu) in which patients with suspected coronary artery disease are randomly assigned to cardiac CT or invasive coronary angiography across Europe at 16 sites involving 3546 patients. Patients will be followed for up to four years. Results: The major adjustments to Lung-RADS specifically for cardiac CT relate to 1) incomplete coverage of the lungs by cardiac CT compared with chest CT, and when to order a completion chest CT versus a follow up chest CT, 2) cardiac CT findings will not trigger annual lung-cancer screening, and 3) a lower threshold of at least 10 mm for classifying new ground glass nodules as probably benign (category 3). Conclusions: The DISCHARGE trial will assess a lung nodule management algorithm designed specifically for cardiac CT in patients with stable chest pain across Europe.

show abstract

Screening mit bildgebenden Verfahren

Layer

2018

Radiologe

View full text Add to dashboard Cite

Extracardiac findings on coronary computed tomography angiography in patients without significant coronary artery disease

Cited by 17 publications

References 38 publications

Detection of relevant extracardiac findings on coronary computed tomography angiography vs. invasive coronary angiography

Detection of relevant extracardiac findings on coronary computed tomography angiography vs. invasive coronary angiography

Developing a lung nodule management protocol specifically for cardiac CT: Methodology in the DISCHARGE trial

Screening mit bildgebenden Verfahren

Contact Info

Product

Resources

About