The Pros and Cons of Searching for Extracardiac Findings at Cardiac CT: Studies Should Be Reconstructed in the Maximum Field of View and Adequately Reviewed to Detect Pathologic Findings

Earls, James P.

doi:10.1148/radiol.11111099

Cited by 26 publications

(15 citation statements)

References 23 publications

(43 reference statements)

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“…Incidental findings during computed tomography are also an important issue under debate. 17 Additionally, computed tomography scan is not widely available in low-income countries. 18 In this regard, IMTand ABI may have some advantages over CAC (e.g., no radiation, wider availability/accessibility, or lower cost).…”

Section: Discussionmentioning

confidence: 99%

Subclinical Atherosclerosis Measures for Cardiovascular Prediction in CKD

Matsushita

Sang

Ballew

et al. 2015

Journal of the American Society of Nephrology

109

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Whether inclusion of the coronary artery calcium score improves cardiovascular risk prediction in individuals with CKD, a population with unique calcium-phosphate homeostasis, is unknown. Among 6553 participants ages 45-84 years without prior cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis, coronary artery calcium score was assessed for cardiovascular risk prediction beyond the Framingham predictors in those with (n=1284) and without CKD and contrasted with carotid intimamedia thickness and ankle-brachial index (two other measures of subclinical atherosclerosis). During a median follow-up of 8.4 years, 650 cardiovascular events (coronary heart disease, stroke, heart failure, and peripheral artery disease) occurred (236 events in subjects with CKD). In Cox proportional hazards models adjusted for Framingham predictors, each subclinical measure was independently associated with cardiovascular outcomes, with larger adjusted hazard ratios (HRs; per 1 SD) for coronary artery calcium score than carotid intima-media thickness or ankle-brachial index in subjects without and with CKD (HR, 1.69; 95% confidence interval [95% CI], 1.45 to 1.97 versus HR, 1.12; 95% CI, 1.00 to 1.25 and HR, 1.20; 95% CI, 1.08 to 1.32, respectively). Compared with inclusion of carotid intima-media thickness or ankle-brachial index, inclusion of the coronary artery calcium score led to greater increases in C statistic for predicting cardiovascular disease and net reclassification improvement. Coronary artery calcium score performed best for the prediction of coronary heart disease and heart failure, regardless of CKD status. In conclusion, each measure improved cardiovascular risk prediction in subjects with CKD, with the greatest improvement observed with coronary artery calcium score.

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Section: Discussionmentioning

confidence: 99%

Subclinical Atherosclerosis Measures for Cardiovascular Prediction in CKD

Matsushita

Sang

Ballew

et al. 2015

Journal of the American Society of Nephrology

109

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“…Pulmonary nodules are one of the most common incidental findings, followed by lymphadenopathy reported in cardiac CT. Pulmonary nodules requiring further evaluation, intervention, additional imaging, or follow-up were found in 0.4-16.5% in the review of 15 studies of cardiac CT discussed by Earls (13). We found 12 studies (out of 15) listed in the review by Earls in which both the median age (58.65 years) of the patients (n ¼ 14,057) and the percentages of important pulmonary nodules (5.2%) were given.…”

Section: Discussionmentioning

confidence: 99%

Incidental findings in computed tomographic angiography for planning percutaneous aortic valve replacement: advanced age, increased cancer prevalence?

2014

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“…With the increasing clinical use of CCTA, referring physicians are more frequently challenged by the recommendation to follow-up on PN despite negative CAD assessment. Data on the prognostic benefits, costs, and impacts on quality of life of reporting incidental PN are needed to inform a policy of reporting incidental PN as this has important implications beyond CCTA 9, 10 .…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Follow-Up of Pulmonary Nodules Incidentally Detected on Cardiac Computed Tomographic Angiography in Patients With Suspected Coronary Artery Disease

et al. 2014

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Background Pulmonary nodules (PN) are often incidentally detected during coronary CT angiography (CCTA) which is increasingly used to evaluate patients with chest pain symptoms. However, the efficiency of following up on incidentally detected PN is unknown. Methods and Results We determined demographic and clinical characteristics of stable symptomatic patients referred for CCTA in whom incidentally detected PN warranted follow-up. A validated lung cancer simulation model was populated with data from these patients and clinical and economic consequences of follow-up per Fleischner guidelines versus no follow-up were simulated. Of the 3,665 patients referred to CCTA, 591 (16%) had PN requiring follow-up. Mean age of patients with PN was 59±10 years, 66% were male, 67% had ever smoked, and 21% had obstructive CAD. The projected overall lung cancer incidence was 5.8% in these patients, but the majority died from CAD (38%) and other causes (57%). Follow-up of PN was associated with a 4.6% relative reduction in cumulative lung cancer mortality (absolute mortality:FU: 4.33% vs. non-FU: 4.54%), more downstream testing (FU: 2.34 CTs/patient vs. non-FU: 1.01 CTs/patient), and an average increase of quality-adjusted life of seven days. Costs per quality adjusted life year (QALY) gained were $154,700 to follow-up the entire cohort and $129,800/QALY when only smokers were included. Conclusions Follow-up of PN incidentally detected in patients undergoing CCTA for chest pain evaluation is associated with a small reduction in lung cancer mortality. However, significant downstream testing contributes to limited efficiency as demonstrated by a high cost per QALY, especially in non-smokers.

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The Pros and Cons of Searching for Extracardiac Findings at Cardiac CT: Studies Should Be Reconstructed in the Maximum Field of View and Adequately Reviewed to Detect Pathologic Findings

Cited by 26 publications

References 23 publications

Subclinical Atherosclerosis Measures for Cardiovascular Prediction in CKD

Subclinical Atherosclerosis Measures for Cardiovascular Prediction in CKD

Incidental findings in computed tomographic angiography for planning percutaneous aortic valve replacement: advanced age, increased cancer prevalence?

Cost-Effectiveness of Follow-Up of Pulmonary Nodules Incidentally Detected on Cardiac Computed Tomographic Angiography in Patients With Suspected Coronary Artery Disease

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