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

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.

Clinical and economic impact of extracardiac lesions on coronary CT angiography

“…This is one of the largest studies to have investigated the prevalence of extracardiac abnormalities on CCTA (online supplemental table 2). 2–12 We have focused on the need for a change in treatment as the most meaningful indication of a clinically ‘significant’ lesion. Importantly, we have considered the downstream costs and cost-effectiveness associated with detection of extracardiac abnormalities.…”

“…While this burden of extracardiac findings is significant, it is lower than that found in most previous studies where values up to 70% have been quoted (online supplemental table 2). 2–12 The discrepancy may be due to the varying threshold of radiologists for reporting borderline abnormalities. Moreover, in some previous studies extracardiac vascular findings (eg, aortic abnormalities) were included among the noncardiac abnormalities.…”

“…This allows a more extensive assessment of extracardiac structures (especially the lungs) that were not of primary interest to the referrer. Incidental findings are common,2–12 and review of the available reconstructions for extracardiac abnormalities is routine in radiology departments in many countries, increasing the time required to report CCTA. When cardiac findings have been reported by a cardiologist, this may necessitate a separate read by a radiologist.…”

“…Although incidental extracardiac abnormalities—typically lung nodules—are frequently seen on CCTA,2–12 only a minority will ultimately require specific treatment with the potential for prognostic benefit. To achieve this, a large proportion will be subjected to further imaging—often requiring additional radiation exposure—and clinical follow-up.…”

Diagnosis of coronary artery disease: potential complications of imaging techniques

“…The vast majority of them are benign, such as emphysema, pleural thickening, pulmonary nodules <6 mm, calcified granuloma, mediastinal lymph nodes <1 cm, segmental bronchiectasis, liver cyst, haemangioma, liver calcified granuloma, and fatty liver. In a recent retrospective review of 1713 patients, 70% of random findings were considered as insignificant, 25.1% indeterminate, and 4.9% as significant [16]. Among these, after further investigation, only 0.5% turned out to be really important.…”