Imaging Pandora's Box: Incidental Findings in Elderly Patients Evaluated for Transcatheter Aortic Valve Replacement

Orme, Nicholas M.; Wright, Thomas C.; Harmon, Gil; Nkomo, Vuyisile T.; Williamson, Eric E.; Sorajja, Paul; Foley, Thomas A.; Greason, Kevin L.; Suri, Rakesh M.; Rihal, Charanjit S.; Young, Phillip M.

doi:10.1016/j.mayocp.2014.03.011

Cited by 16 publications

(14 citation statements)

References 20 publications

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“…Especially in the old and frail TAVI population, potentially malignant incidental findings are common. [8][9][10][11][12][13] Following CTA, a dedicated team considers the patients' suitability for the procedure. Guidelines recommend denying TAVI if the estimated survival is <1 year.…”

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confidence: 99%

“…Until now the only follow-up studies of incidental findings in TAVI workup include a small number of patients who eventually underwent TAVI. [8][9][10][11] The long-term impact of potentially malignant incidental finding after the procedure remains unknown. We aimed to gain insight in the influence of potentially malignant incidental findings on long-term survival after TAVI and evaluate if the findings are an independent predictor of mortality.…”

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confidence: 99%

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Impact of Potentially Malignant Incidental Findings by Computed Tomographic Angiography on Long-Term Survival After Transcatheter Aortic Valve Implantation

Kesteren

Wiegerinck

Mourik

et al. 2017

The American Journal of Cardiology

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Computed tomography angiography (CTA) in workup for transcatheter aortic valve implantation (TAVI) frequently reveals potentially malignant incidental findings. Most incidental findings provoke discussions on their influence. We aimed to analyze if these findings were a predictor of long-term survival after TAVI. In a single-center retrospective analysis, all consecutive patients with pre-TAVI CTA were included (years 2009 to 2014). Patients were divided by presence or absence of incidental findings. We analyzed up to 5 years of all-cause, non-cardiovascular and cardiovascular mortality for all 553 patients who underwent TAVI; 113 had a potentially malignant incidental finding (20.4%). At 5 years, all-cause mortality risk was 64.5% in patients with versus 49.1% in patients without a finding (hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.25 to 2.31). After adjustment, the findings remained an independent predictor of all-cause (adjusted HR 1.46, 95% CI 1.07 to 1.99) and non-cardiovascular mortality (adjusted subdistribution HR 1.84, 95% CI 1.06 to 3.20), but not of cardiovascular mortality. In conclusion, the presence of potentially malignant incidental findings on CTA is an independent predictor of long-term all-cause and noncardiovascular mortality but not of cardiovascular mortality.

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confidence: 99%

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confidence: 99%

Impact of Potentially Malignant Incidental Findings by Computed Tomographic Angiography on Long-Term Survival After Transcatheter Aortic Valve Implantation

Kesteren

Wiegerinck

Mourik

et al. 2017

The American Journal of Cardiology

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“…The scan extends from the mandible to the femoral head and is required for identification and accurate sizing of the annulus, the assessment of calcification burden particularly within the left ventricular outflow tract, assessment of the potential risk of coronary occlusion and in order to determine the most appropriate vascular access route . As severe AS patients are often elderly and due to the number of non‐cardiac organs captured in MDCT, incidental findings (IF) are common and are reported in up to 70% of cases …”

Section: Introductionmentioning

confidence: 99%

“…Such findings may reduce the likelihood of receiving TAVI and delay time from MDCT to the TAVI procedure . Previous studies have focused on the impact of MDCT‐IF on survival, yielding conflicting results . Differences likely reflect variations in the definition of IF, the threshold of reporting findings, and malignant potential of individual findings.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of incidental findings on multi‐detector computed tomography for transcatheter aortic valve implantation assessment: A single‐centre study and review of the literature

Tham

Paleri

et al. 2019

J Med Imag Rad Onc

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Introduction: Patients with severe aortic stenosis (AS) require multi-detector computed tomography (MDCT) when considered for transcatheter aortic valve implantation (TAVI). Incidental findings on MDCT are common given the age group and region imaged. Our aim was to evaluate the frequency and outcome of incidental findings (IF) identified on MDCT and the impact on survival.Methods: This single-centre analysis retrospectively reviewed severe AS patients who underwent MDCT during TAVI workup. MDCT reports were reviewed for any IF and defined into three categories: IF of no relevant clinical significance (IF-NoCS), IF of non-immediate clinical significance (IF-NICS) and IF of immediate clinical significance (IF-ICS). Demographics, follow-up of IF and survival were calculated from MDCT date. Results: Two hundred and sixty-five patients underwent MDCT for TAVI suitability (mean age 83 AE 6 years, 52% male). The majority proceeded to TAVI (65%). Renal lesions (25%) and lung nodules (18%) were the most common IF. Fifty-nine patients (22%) had IF-NICS; 39% (23/59) were benign, 59% were not further investigated and one patient had suspected lung cancer. Six patients (2.3%) had IF-ICS and all were diagnosed with lung cancer. During a median follow-up of 272 days, there was no survival difference between patients with IF-ICS or IF-NICS versus patients without IF or IF-NoCS in the overall cohort (P = 0.44) or in TAVI patients (P = 0.88). Conclusion: Incidental findings on MDCT are common with one-quarter having IF-ICS or IF-NCIS. Most patients with IF-NICS did not undergo further investigation. Standardized reporting of MDCT may assist in clarifying the need for further investigation which will in turn influence decision and timing to proceed with TAVI.

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“…As stated by [1], images are central to a wide variety of fields ranging from history [2, 3] to medicine [4, 5], including astronomy [6, 7], oil exploration [8, 9] and weather forecasting [10, 11]. Image plays an important role in numerous human activities such as law enforcement [12, 13], agriculture and forestry management [14, 15], earth science [16] and so forth.…”

Section: Introductionmentioning

confidence: 99%

Classification of Suncus murinus species complex (Soricidae: Crocidurinae) in Peninsular Malaysia using image analysis and machine learning approaches

et al. 2016

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BackgroundTaxonomists frequently identify specimen from various populations based on the morphological characteristics and molecular data. This study looks into another invasive process in identification of house shrew (Suncus murinus) using image analysis and machine learning approaches. Thus, an automated identification system is developed to assist and simplify this task. In this study, seven descriptors namely area, convex area, major axis length, minor axis length, perimeter, equivalent diameter and extent which are based on the shape are used as features to represent digital image of skull that consists of dorsal, lateral and jaw views for each specimen. An Artificial Neural Network (ANN) is used as classifier to classify the skulls of S. murinus based on region (northern and southern populations of Peninsular Malaysia) and sex (adult male and female). Thus, specimen classification using Training data set and identification using Testing data set were performed through two stages of ANNs.ResultsAt present, the classifier used has achieved an accuracy of 100% based on skulls’ views. Classification and identification to regions and sexes have also attained 72.5%, 87.5% and 80.0% of accuracy for dorsal, lateral, and jaw views, respectively. This results show that the shape characteristic features used are substantial because they can differentiate the specimens based on regions and sexes up to the accuracy of 80% and above. Finally, an application was developed and can be used for the scientific community.ConclusionsThis automated system demonstrates the practicability of using computer-assisted systems in providing interesting alternative approach for quick and easy identification of unknown species.

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Imaging Pandora's Box: Incidental Findings in Elderly Patients Evaluated for Transcatheter Aortic Valve Replacement

Cited by 16 publications

References 20 publications

Impact of Potentially Malignant Incidental Findings by Computed Tomographic Angiography on Long-Term Survival After Transcatheter Aortic Valve Implantation

Impact of Potentially Malignant Incidental Findings by Computed Tomographic Angiography on Long-Term Survival After Transcatheter Aortic Valve Implantation

Outcomes of incidental findings on multi‐detector computed tomography for transcatheter aortic valve implantation assessment: A single‐centre study and review of the literature

Classification of Suncus murinus species complex (Soricidae: Crocidurinae) in Peninsular Malaysia using image analysis and machine learning approaches

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