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- - 1326 consecutive patients underwent EBCT coronary artery scoring exams
- 25 % former or current smokers
- 2 Board -certified CT radiologists reviewed examinations on a workstation using mediastinal windows, lung windows and bone windows
- Significant extra-cardiac abnormalities were seen
Prevalence of Significant Noncardiac Findings on Electron-Beam Computed Tomography Coronary Artery Calcium Screening Examinations
Horton KM, Post WS, Blumenthal RS, Fishman EK
Circulation 2002;106:532-534 - “In this study, 7.8% of patients undergoing screening EBCT examinations for coronary artery calcification were found to have important extracardiac pathology requiring additional work-up. Therefore, it is essential that a radiologist review the entire examination.”
Prevalence of Significant Noncardiac Findings on Electron-Beam Computed Tomography Coronary Artery Calcium Screening Examinations
Horton KM, Post WS, Blumenthal RS, Fishman EK
Circulation 2002;106:532-534 - “Extracardiac findings were detected in 41 patients (24.7%). Findings were classified as minor (19.9%) or major (4.8%). Among the major findings, which had an immediate impact on patient management and treatment, were bronchial carcinoma and pulmonary emboli.”
Coronary artery imaging with contrast-enhanced MDCT: extracardiac findings
Haller S et al
AJR 2006 July; 187(1):105-110 - “In the present study, 56.2% of asymptomatic patients undergoing coronary MDCT angiography were found to have significant extracardiac pathology requiring additional workup. Therefore it is essential that a radiologist should review the scans for abnormalities in structures other than the coronary arteries.”
Prevalance of Significant Noncardiac Findings on coronary Multidetector Computed Tomography Angiography in Asymptomatic Patients
Gil BN et al.
J Comput Assist Tomogr 2007;31:1-4 - “Among 6920 patients, 1642 (23.7%) had one or more extracardiac findings for a total of 1,901 findings in the broad viewing scheme. Of the 6.920 patients, 16.2% had a finding necessitating therapy, workup or followup.”
Extracardiac Findings on Coronary CT Angiograms: Limited Versus Complete Image Review
Johnson KM et al.
AJR 2010; 195:143-148 - “Volume analysis revealed that 35.5% of the total chest volume was displayed on dedicated coronary artery MDCT focused on the heart, whereas 70.3% of the chest was visible when MDCT raw data were reconstructed with the maximal field of view.”
Coronary artery imaging with contrast-enhanced MDCT: extracardiac findings
Haller S et al
AJR 2006 July; 187(1):105-110 - “Viewing of cardiac CT scans obtained only at a limited field of view can result in missing more than 67% of nodules greater than 1 cm. and more than 80% of nodules smaller than 1 cm.”
Pulmonary Nodules Detected at Cardiac CT: Comparison of Images in Limited and Full Fields of View
Northam M et al.
AJR 2008; 191;878-881 - “The prevalence of lung cancer at Cardiac CT was 0.31%; and 68% of these malignancies were at a resectable stage. Use of a limited FOV at cardiac scanning led to a large majority (89% (32 of 36 cancers) of the lung cancers detected at full thoracic scanning being missed; thus, inclusion of the entire chest at cardiac CT is advisable.”
Lung Cancer Detected at Cardiac CT: Prevalence, Clinicoradiologic Features, and Importance of Full Field of View Images
Kim TJ et al.
Radiology 2010; 255:369-376 - “The prevalence of lung cancer at Cardiac CT was 0.31%; and 68% of these malignancies were at a resectable stage. Use of a limited FOV at cardiac scanning led to a large majority (89% (32 of 36 cancers) of the lung cancers detected at full thoracic scanning being missed; thus, inclusion of the entire chest at cardiac CT is advisable.”
- “It is essential that the entire imaging data set, including full-FOV images, be evaluated at cardiac CT, because viewing in the limited FOV at cardiac scanning may result in the majority of lung cancers that could be detected on full-FOV images being missed.”
Lung Cancer Detected at Cardiac CT: Prevalence, Clinicoradiologic Features, and Importance of Full Field of View Images
Kim TJ et al .
Radiology 2010; 255:369-376 - Large field of view vs Small field of view
- Large field of view was 35-40 cm and review was of soft tissue and lung windows
- Small field of view was 25 cm to include the heart and was reviewed at soft tissue windows only - “Almost one fourth of all patients who underwent diagnostic coronary CT angiography in this study had extracardiac findings. Several serious diagnoses were missed with the limited viewing approach, but use of the broad viewing approach led to more workup and follow-up imaging.”
Extracardiac Findings on Coronary CT Angiograms: Limited Versus Complete Image Review
Johnson KM et al.
AJR 2010; 195:143-148 - “In the focused viewing scheme, 90.9% of the findings necessitating therapy, 64.1% necessitating workup, and 51.2% necessitating follow-up were missed. Use of the focused approach resulted in fewer false positive diagnosis but 5 malignant tumors of the breast, 88 lung infiltrates, 43 cases of lymphadenopathy, 2 cases of polycystic kidney, one breast abscess and one case of splenic flexure diverticulitis were missed.”
- “ The average prevalence of ECF was 41% and 16% for clinically significant ECF. Clinically significant ECF were most commonly detected in the lungs (50.2%), the abdomen (26.7%),the vessels (13.1%), the mediastinum (3.6%), and in other adjacent anatominal regions (6.4%). The presence of acutely life threatening and malignant ECF accounted for 2.2% and 0.3% respectively.”
Extracardiac findings on coronary CT angiography: A systematic review
Karius P et al.
J Cardiovasc Comput Tomogr 8(2014) 174-182 - “ The average prevalence of ECF was 41% and 16% for clinically significant ECF. Clinically significant ECF were most commonly detected in the lungs (50.2%), the abdomen (26.7%),the vessels (13.1%), the mediastinum (3.6%), and in other adjacent anatominal regions (6.4%). The presence of acutely life threatening and malignant ECF accounted for 2.2% and 0.3% respectively. In conclusion, clinically significant and acutely life threatening ECF are common.”
Extracardiac findings on coronary CT angiography: A systematic review
Karius P et al.
J Cardiovasc Comput Tomogr 8(2014) 174-182 - Acute Life Threatening Events Seen on CCTA
- Aortic aneurysm/dissection
- Aortic thrombus
- Splenic artery aneurysm
- SVC thrombosis
- Pulmonary embolism
- Pulmonary thrombus
- “Significant noncardiac findings are common in patients referred to routine preprocedural DSCT for planning TAVI (17.1%).”
Prevalence of noncardiac findings in computed tomography angiography before transcatheter aortic valve replacement.
Staab W et al.
J Cardiovasc Comput Tomogr. 2014 May-Jun;8(3):222-9 - “In 60 of 204 DSCT examinations (29.4%) no noncardiac findings were observed. Of the remaining 144 examinations (70.6%), 260 had noncardiac findings; 35 of 204 patients (17.1%) had a total of 37 clinically significant noncardiac findings. Eight malignancies were detected; 5 of them were incidentally diagnosed on DSCT and changed patient management. A total of 223 nonsignificant findings were observed in 116 of 204 patients (56.9%; group A), the most frequent findings were pleural effusions or colorectal diverticulosis. The prevalence of incidental and significant findings on DSCT before TAVI increased with patient age (r(2) = 0.69; P = .01).”
Prevalence of noncardiac findings in computed tomography angiography before transcatheter aortic valve replacement.
Staab W et al.
J Cardiovasc Comput Tomogr. 2014 May-Jun;8(3):222-9 - “In 60 of 204 DSCT examinations (29.4%) no noncardiac findings were observed. Of the remaining 144 examinations (70.6%), 260 had noncardiac findings; 35 of 204 patients (17.1%) had a total of 37 clinically significant noncardiac findings. Eight malignancies were detected; 5 of them were incidentally diagnosed on DSCT and changed patient management. A total of 223 nonsignificant findings were observed in 116 of 204 patients (56.9%; group A), the most frequent findings were pleural effusions or colorectal diverticulosis.”
Prevalence of noncardiac findings in computed tomography angiography before transcatheter aortic valve replacement.
Staab W et al.
J Cardiovasc Comput Tomogr. 2014 May-Jun;8(3):222-9 - “ Of the remaining 144 examinations (70.6%), 260 had noncardiac findings; 35 of 204 patients (17.1%) had a total of 37 clinically significant noncardiac findings. Eight malignancies were detected; 5 of them were incidentally diagnosed on DSCT and changed patient management..”
Prevalence of noncardiac findings in computed tomography angiography before transcatheter aortic valve replacement.
Staab W et al.
J Cardiovasc Comput Tomogr. 2014 May-Jun;8(3):222-9 - “This study highlights the importance to assess the noncardiac anatomy on DSCT images in patients planned for TAVI, because a total number of 260 noncardiac findings were observed in 144 of 204 patients (70.6%). Significant noncardiac findings that required follow-up examinations or noncardiac findings with a demand for clinical treatment, including 8 malignancies (3.9%), were detected in 35 patients. The preva- lence of incidental and significant findings on DSCT before TAVI increases with patient age.”
Prevalence of noncardiac findings in computed tomography angiography before transcatheter aortic valve replacement.
Staab W et al.
J Cardiovasc Comput Tomogr. 2014 May-Jun;8(3):222-9 
- “ Nineteen studies including 15,877 patients (64% male) were analyzed. A three level analysis was performed to determine the prevalence of patients with incidental extracardiac findings, the prevalence of patients with major incidental extracardiac findings, and the prevalence of patients with a proven cancer.”
Malignant Incidental Extracardiac Findings on Cardiac CT: Systematic Review and Meta-Analysis
Flor N et al.
AJR 2013; 201:555-564 - “ Although the prevalence of reported incidental extracardiac finding at cardiac CT was highly variable, a homogeneous prevalence of previously unknown malignancies was reported across the studies, for a pooled estimate of 0.7%; more than 70% of the previously unknown malignancies were lung cancer.”
Malignant Incidental Extracardiac Findings on Cardiac CT: Systematic Review and Meta-Analysis
Flor N et al.
AJR 2013; 201:555-564
- “ The choice regarding whether to interpret cardiac CT with a FOV restricted to the heart or a larger FOV that encompasses the entire thorax is complicated and multifaceted. At present no societal guideline recommends that a secondary wider FOV reconstruction be obtained, including the Practice Guideline for the Performance and Interpretation of Cardiac Computed Tomography published by the American College of Radiology.”
The Pros and Cons of Searching for Extracardiac Findings at Cardiac CT: Use of a Restricted Field of View is Acceptable
White CS
Radiology 2011; 261:338-341 - “ Thus, the crux of debate centers not on whether to ignore or seek incidental findings outside the heart, but whether it is appropriate to reconstruct only the standard cardiac FOV for which the examination is intended rather than secondarily reconstructing a full FOV to include the entire thorax.”
The Pros and Cons of Searching for Extracardiac Findings at Cardiac CT: Use of a Restricted Field of View is Acceptable
White CS
Radiology 2011; 261:338-341 - “ While there is no obvious harm in reconstructing a wide FOV at cardiac CT, on the basis of logistical considerations and current practice patterns, at present, it appears equally justifiable to use a FOV restricted to the heart.”
The Pros and Cons of Searching for Extracardiac Findings at Cardiac CT: Use of a Restricted Field of View is Acceptable
White CS
Radiology 2011; 261:338-341 - “ Reviewing reconstructed large FOV images from cardiac CT examinations for extracardiac disease has potential to benefit patients by early detection of unsuspected disease.”
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 JP
Radiology 2011; 261:342-346 - “ Until the data are further clarified, all cardiac CT studies should be reconstructed in the maximum FOV available, and the images should be adequately reviewed by a qualified thoracic reader to detect pathologic findings.”
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 JP
Radiology 2011; 261:342-346 - “ Large FOV images depict a considerably increased number of clinically important and indeterminate pathologic findings, including unsuspected lung cancers and indeterminate pulmonary nodules.”
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 JP
Radiology 2011; 261:342-346 - Key Questions
- How much can one use the NLST screening data
- Will the additional cost for workup of an incidental finding be justified after analyzing data?
- Do we do similar things for studies ranging from spine CT to spine MRI? And if no then why not?
- Is the issue a question of turf or “doing the right thing” "Once an examination is performed, the noblest approach is to view and evaluate all available data, to apply appropriate judgment, and to proceed in the best interest of the patient and society."
Incidental Findings on Cardiac CT
Colletti PM
AJR 2008; 191:882-884"The issue of incidental findings in medical imaging will always be with us. Budoff et al. reminded us of the cost of pursuing unrequested information. Northam et al. found potential benefit. We may debate whether to perform an imaging examination. Once an examination is performed, the noblest approach is to view and evaluate all available data, to apply appropriate judgment, and to proceed in the best interest of the patient and society."
Incidental Findings on Cardiac CT
Colletti PM
AJR 2008; 191:882-884"Volume analysis revealed that 35.5% of the total chest volume was displayed on dedicated coronary artery MDCT focused on the heart, whereas 70.3% of the chest was visible when MDCT raw data were reconstructed with the maximal field of view."
Coronary artery imaging with contrast-enhanced MDCT: extracardiac findings
Haller S et al
AJR 2006 July; 187(1):105-110"Extracardiac findings were detected in 41 patients (24.7%). Findings were classified as minor (19.9%) or major (4.8%). Among the major findings, which had an immediate impact on patient management and treatment, were bronchial carcinoma and pulmonary emboli."
Coronary artery imaging with contrast-enhanced MDCT: extracardiac findings
Haller S et al
AJR 2006 July; 187(1):105-110"In this study, 7.8% of patients undergoing screening EBCT examinations for coronary artery calcification were found to have important extracardiac pathology requiring additional work-up. Therefore, it is essential that a radiologist review the entire examination."
Prevalence of Significant Noncardiac Findings on Electron-Beam Computed Tomography Coronary Artery Calcium Screening Examinations
Horton KM, Post WS, Blumenthal RS, Fishman EK
Circulation 2002;106:532-534- Findings
- 103/1326 patients had extracardiac pathology requiring clinical or imaging follow-up 53 patients with noncalcified nodules < 1 cm
- 12 patients with noncalcified nodules > 1 cm
- 24 patients with infiltrates
- 7 patients with indeterminate liver lesions
- 2 patients with sclerotic bone lesions
- 2 patients with breast findings
- 1 patient with polycystic liver disease
- 1 patient with esophageal thickening
- 1 patient with ascites
Prevalence of Significant Noncardiac Findings on Electron-Beam Computed Tomography Coronary Artery Calcium Screening Examinations
Horton KM, Post WS, Blumenthal RS, Fishman EK
Circulation 2002;106:532-534 - - 1326 consecutive patients underwent EBCT coronary artery scoring exams
- 25 % former or current smokers
- 2 Board -certified CT radiologists reviewed examinations on a workstation using mediastinal windows, lung windows and bone windows
- Significant extra-cardiac abnormalities were noted
Prevalence of Significant Noncardiac Findings on Electron-Beam Computed Tomography Coronary Artery Calcium Screening Examinations
Horton KM, Post WS, Blumenthal RS, Fishman EK
Circulation 2002;106:532-534 Circulation. 2002;106:532-534
Prevalence of Significant Noncardiac Findings on Electron-Beam Computed Tomography Coronary Artery Calcium Screening ExaminationsKaren M. Horton, MD; Wendy S. Post, MD; Roger S. Blumenthal, MD; Elliot K. Fishman, MD
Background— Screening electron-beam computed tomography (EBCT) examinations for the detection and quantification of coronary artery calcification are being performed throughout the country. In addition to information about the heart, great vessels, and coronary arteries, these examinations include portions of the lungs, bony thorax, and upper abdomen. The purpose of this study was to determine the prevalence of significant noncardiac findings in a series of patients undergoing coronary artery calcification screening studies with EBCT scanning.
Methods and Results— Between January 1, 2001, and October 1, 2001, 1326 consecutive patients underwent coronary artery calcification screening with EBCT (3-mm-thick slices were obtained at 3-mm intervals). Two board-certified radiologists reviewed the examinations on a workstation using standard mediastinal windows, lung windows, and bone windows. Significant extracardiac abnormalities were noted. Of 1326 patients, 103 (7.8%) had significant extracardiac pathology requiring clinical or imaging follow-up. These included 53 patients with noncalcified lung nodules <1 cm, 12 patients with lung nodules
1 cm, 24 patients with infiltrates, 7 patients with indeterminate liver lesions, 2 patients with sclerotic bone lesions, 2 patients with breast abnormalities, 1 patient with polycystic liver disease, 1 patient with esophageal thickening, and 1 patient with ascites. Conclusions— In this study, 7.8% of patients undergoing screening EBCT examinations for coronary artery calcification were found to have important extracardiac pathology requiring additional work-up. Therefore, it is essential that a radiologist review the entire examination.
- "MacHaalany et al. examined the costs of further diagnostic workup and followup in the cases of 966 patients who underwent cardiac CT. The total cost of further diagnostic steps was $83,035, $39,597 of which was attributed to care of a single patient with complicatios from alung biopsy. The average cost was $86 per patient and the median cost closer to $45; the authors cautioned that these figures were likely underestimates because costs incurred later were not included."
"RESULTS: Of 966 patients (58 +/- 16 years of age, 55.4% men, >98% outpatients), 401 (41.5%) patients had noncardiac IF. A total of 12 (1.2%) patients had CS findings, and 68 (7.0%) patients had indeterminate findings. At follow-up (18.4 +/- 7.6 months), none of the indeterminate findings became CS. Although 3 patients with indeterminate findings were diagnosed with malignant lesions, they were unrelated to the IF. After adjusting for age, IF were not an independent predictor of noncardiac death. Noncardiac death and cancer death in patients with and without IF were not statistically different. One patient suffered a major complication related to the investigation of an IF. The total direct cost associated with investigating IF was Canadian $57,596 (U.S. $83,035)."
Potential clinical and economic consequences of noncardiac incidental findings on cardiac computed tomography.
Machaalany J et al.
J Am Coll Cardiol 2009 Oct 13;54(16):1533-1541"CONCLUSIONS: Although noncardiac IF are common, clinically significant or indeterminate IF are less prevalent. Rates of death were similar in patients with and without IF, and IF was not an independent predictor of noncardiac death. The investigation of IF is not without cost or risk. Larger studies are required to assess the potential mortality benefit of identifying IF."
Potential clinical and economic consequences of noncardiac incidental findings on cardiac computed tomography.
Machaalany J et al.
J Am Coll Cardiol 2009 Oct 13;54(16):1533-1541J Am Coll Cardiol, 2009; 54:1533-1541,
Potential Clinical and Economic Consequences of Noncardiac Incidental Findings on Cardiac Computed Tomography
Jimmy MacHaalany, MD, Yeung Yam, BSc, Terrence D. Ruddy, MD, Arun Abraham, MBBS, Li Chen, MSc, Rob S. Beanlands, MD, and Benjamin J.W. Chow, MD
Objectives: We sought to determine the incidence, clinical significance, and potential financial impact of noncardiac incidental findings (IF) identified with cardiac computed tomography (CT).
Background: Cardiac CT is gaining acceptance and may lead to the frequent discovery of extracardiac IF.
Methods: Consecutive patients undergoing cardiac CT had noncardiac structures evaluated after full field of view (32 to 50 cm) reconstruction. IF were categorized as clinically significant (CS), indeterminate, or clinically insignificant. Patient follow-up was performed by telephone, and verified with hospital records and/or communication with physicians.
Results: Of 966 patients (58 ± 16 years of age, 55.4% men, >98% outpatients), 401 (41.5%) patients had noncardiac IF. A total of 12 (1.2%) patients had CS findings, and 68 (7.0%) patients had indeterminate findings. At follow-up (18.4 ± 7.6 months), none of the indeterminate findings became CS. Although 3 patients with indeterminate findings were diagnosed with malignant lesions, they were unrelated to the IF. After adjusting for age, IF were not an independent predictor of noncardiac death. Noncardiac death and cancer death in patients with and without IF were not statistically different. One patient suffered a major complication related to the investigation of an IF. The total direct cost associated with investigating IF was Canadian $57,596 (U.S. $83,035).
Conclusions: Although noncardiac IF are common, clinically significant or indeterminate IF are less prevalent. Rates of death were similar in patients with and without IF, and IF was not an independent predictor of noncardiac death. The investigation of IF is not without cost or risk. Larger studies are required to assess the potential mortality benefit of identifying IF.
"Because minor findings far outnumber major findings, the ability to differentiate the two will be a crucial factor in determining the overall cost to benefit analysis."
Extracardiac Findings on Coronary CT Angiograms: Limited Versus Complete Image Review
Johnson KM et al.
AJR 2010; 195:143-148- "In the focused viewing scheme, 90.9% of the findings necessitating therapy, 64.1% necessitating workup, and 51.2% necessitating follow-up were missed. Use of the focused approach resulted in fewer false positive diagnosis but 5 malignant tumors of the breast, 88 lung infiltrates, 43 cases of lymphadenopathy, 2 cases of polycystic kidney, one breast abscess and one case of splenic flexure diverticulitis were missed."
"There were 102 incidental extracardiac findings in 43% (65/151) of patients. 52% (53/102) of findings were potentially clinically significant and 81% (43/530) of these findings were newly discovered. The radiology reports made specific follow-up recommendations for 36% of new significant findings. Only 4% (6/151) of patient actually underwent follow-up imaging or intervention for incidental findings."
Incidental Extracardiac Findings at Coronary CT: Clinical and Economic Impact
Lee CI et al.
AJR 2010l 194:1531-1538"This retrospective study examined incidental extracardiac findings in 151 consecutive adults undergoing coronary CT during a 7 year period. Incidental findings were recorded and medical records reviewed for downstream diagnostic examinations for a follow-up period of 1 year (minimum) to 7 years (maximum)."
Incidental Extracardiac Findings at Coronary CT: Clinical and Economic Impact
Lee CI et al.
AJR 2010l 194:1531-1538"Coronary CT frequently reveals potentially significant incidental extracardiac abnormalities, yet radiologists recommend further evaluation in only one third of cases. An even smaller fraction of cases receive further workup. The failure to follow-up abnormal incidental findings may result in missed opportunities to detect early disease, but also limits the short term attibutable costs."
Incidental Extracardiac Findings at Coronary CT: Clinical and Economic Impact
Lee CI et al.
AJR 2010 194:1531-1538"The review of extracardiac structures by a qualified reader is of paramount importance so that correct diagnosis can be made, and an appropriate management plan can be instituted."
Noncardiac findings on Cardiac CT part I: Pros and cons
Killeen RP, Dodd JD, Cury RC
J Cardiovasc Comput Tomogr (2009) 3, 293-299"If extracardiac structures are not systematically analyzed, alternative causes of patients symptoms may go undetected, and of even greater concern, treatable asymptomatic malignancies may be overlooked. The review of extracardiac structures by a qualified reader is of paramount importance so that correct diagnosis can be made, and an appropriate management plan can be instituted"
Noncardiac findings on Cardiac CT part I: Pros and cons
Killeen RP, Dodd JD, Cury RC
J Cardiovasc Comput Tomogr (2009) 3, 293-299"Because we observed a cross-association between coronary plaques and the degree of fatty liver, we cannot exclude the possibility that the duration of hepatic fatty infiltration may be a determining factor for atherosclerosis in these patients."
Presence of Coronary Plaques in patients with Nonalcoholic Fatty Liver Disease
Assy N et al.
Radiology 2010; 254:393-4000"Presence of fatty liver is a strong predictor of subclinical CAD."
Presence of Coronary Plaques in patients with Nonalcoholic Fatty Liver Disease
Assy N et al.
Radiology 2010; 254:393-4000"Patients with nonalcoholic fatty liver disease (NAFLD), even without metabolic syndrome, have more instances of coronary artery disease (CAD) and coronary plaques than patients without NAFLD."
Presence of Coronary Plaques in patients with Nonalcoholic Fatty Liver Disease
Assy N et al.
Radiology 2010; 254:393-4000"Patients with NAFLD (nonalcoholic fatty liver disease), even without metabolic syndrome, are at high risk for atherosclerosis. Assessment of NAFLD may be helpful for cardiovascular risk stratification."
Presence of Coronary Plaques in patients with Nonalcoholic Fatty Liver Disease
Assy N et al.
Radiology 2010; 254:393-4000- Cardiac CT Angiography After Coronary Bypass Surgery: Prevalence of Incidental Findings
Mueller J et al. AJR 2007; 189:414-419
- 24 patients with cardiac findings (ventricular pseudoaneurysm, ventricular perfusion defect, intracardiac thrombus)
- 34 patients had a noncardiac finding PE, lung cancer, pneumonia)
- 17 patients had at least one graft occluded "In the immediate postoperative period 51 patients (19.7%) had at least one unsuspected potential significant finding."
Cardiac CT Angiography After Coronary Bypass Surgery: Prevalence of Incidental Findings
Mueller J et al.
AJR 2007; 189:414-419"Cardiac CTA after CABG revealed a high prevalence of unsuspected cardiac and noncardiac findings with potential clinical significance. Interpreters of these studies should be familiar with the spectrum of these abnormalities."
Cardiac CT Angiography After Coronary Bypass Surgery: Prevalence of Incidental Findings
Mueller J et al.
AJR 2007; 189:414-419- Non-Cardiac CT findings
- Lung parenchyma (i.e. lung cancer, pneumonia)
- Mediastinum (i.e. lymphoma)
- Pulmonary embolism
- Aortic aneurysm and/or aortic dissection
- Hiatal hernia
- Liver pathology "A review of noncardiac structures provides the opportunity to make alternative diagnoses that may account for the patient's presentation or to detect important but clinically silent problems such as lung cancer."
Noncardiac findings on Cardiac CT. Part II: Spectrum of imaging findings
Killeen RP et al.
J Cardiovasc Comput Tomogr (2009) 3, 361-371"It is essential that the entire imaging data set, including full-FOV images, be evaluated at cardiac CT, because viewing in the limited FOV at cardiac scanning may result in the majority of lung cancers that could be detected on full-FOV images being missed."
Lung Cancer Detected at Cardiac CT: Prevalence, Clinicoradiologic Features, and Importance of Full Field of View Images
Kim TJ et al.
Radiology 2010; 255:369-376"The prevalence of lung cancer at Cardiac CT was 0.31%; and 68% of these malignancies were at a resectable stage. Use of a limited FOV at cardiac scanning led to a large majority (89% (32 of 36 cancers) of the lung cancers detected at full thoracic scanning being missed; thus, inclusion of the entire chest at cardiac CT is advisable."
Lung Cancer Detected at Cardiac CT: Prevalence, Clinicoradiologic Features, and Importance of Full Field of View Images
Kim TJ et al.
Radiology 2010; 255:369-376- "Preliminary studies are showing that enlarging the field for CTA scans to look for incidental findings will suffer the same fate as body scanning and chest x-rays, as another form of screening that cannot be medicolegally justified because of severely high false positive rates and no improvement in outcomes. Until data are available to the opposite, we should use our good judgment and restraint and not perform large-field reconstructions for the explicit purpose of screening."
- "Preliminary studies are showing that enlarging the field for CTA scans to look for incidental findings will suffer the same fate as body scanning and chest x-rays, as another form of screening that cannot be medicolegally justified because of severely high false positive rates and no improvement in outcomes."
Incidental Findings on Cardiac Computed Tomography. Should We Look?
Budoff MJ, Gopal A
J Cardiovascular Comput Tomogr (2007) 1: 97-105
- "Until data are available to the opposite, we should use our good judgment and restraint and not perform large-field reconstructions for the explicit purpose of screening."
Incidental Findings on Cardiac Computed Tomography. Should We Look?
Budoff MJ, Gopal A
J Cardiovascular Comput Tomogr (2007) 1: 97-105
- "With the newer generations of multidetector CT scanners, the diagnostic performance for the assessment of coronary artery disease has significantly improved, and the proportion of nonassessable segments has decreased."
Diagnostic Performance of Multidetector CT Angiography for Assessment of Coronary Artery Disease: Meta-analysis
Vanhoenacker PK et al
Radiology 2007; 244:419-428
- "Extracardiac findings were detected in 41 patients (24.7%). Findings were classified as minor (19.9%) or major (4.8%). Among the major findings, which had an immediate impact on patient management and treatment, were bronchial carcinoma and pulmonary emboli."
Coronary Artery Imaging with Contrast-Enhanced MDCT: Extracardiac Findings
Haller S et al.
AJR 2006; 187:105-110.
- "Volume analysis revealed that 35.5% of the total chest volume was displayed on dedicated coronary artery MDCT focused on the heart, whereas 70.3% of the chest was visible when MDCT raw data were reconstructed with the maximal field of view."
Coronary Artery Imaging with Contrast-Enhanced MDCT: Extracardiac Findings
Haller S et al.
AJR 2006; 187:105-110.
- "Coronary artery MDCT can reveal important findings and disease in extracardiac structures. Thus, the entire examination should be reconstructed with the maximum field of view and should be reviewed by a qualified radiologist."
Coronary Artery Imaging with Contrast-Enhanced MDCT: Extracardiac Findings
Haller S et al.
AJR 2006; 187:105-110.