Incidental Non-Cardiac Findings of a Coronary Angiography with a 128-Slice Multi-Detector CT Scanner: Should We Only Concentrate on the Heart?

다국어 초록 (Multilingual Abstract)

Objective: To evaluate the spectrum, prevalence, and significance of incidental non-cardiac findings (INCF) in patients referred for a non-invasive coronary angiography using a 128-slice multi-detector CT (MDCT).
Materials and Methods: The study subjects included 1,044 patients; 774 males (mean age, 59.9 years) and 270 females (mean age, 63 years), referred for a coronary CT angiography on a 128-slice MDCT scanner. The scans were acquired from the level of the carina to just below the diaphragm. To evaluate INCFs, images were reconstructed with a large field of view (> 300 mm) covering the entire thorax. Images were reviewed in the axial, coronal, and sagittal planes, using the mediastinal, lung, and bone windows. The INCFs were classified as severe, indeterminate, and mild, based on their clinical importance, and as thoracic or abdominal based on their locations.
Results: Incidental non-cardiac findings were detected in 56% of patients (588 of 1,044), including 435 males (mean age, 65.6 years) and 153 females (mean age, 67.9 years). A total of 729 INCFs were observed: 459 (63%) mild (58% thoracic, 43% abdominal), 96 (13%) indeterminate (95% thoracic, 5% abdominal), and 174 (24%) severe (87% thoracic, 13% abdominal). The prevalence of severe INCFs was 15%. Two severe INCFs were histologically verified as lung cancers.
Conclusion: The 128-slice MDCT coronary angiography, in addition to cardiac imaging, can provide important information on the pathology of the chest and upper abdomen. The presence of severe INCFs is not rare, especially in the thorax. Therefore, all organs in the scan should be thoroughly evaluated in daily clinical practice.

다국어 초록 (Multilingual Abstract)

Objective: To evaluate the spectrum, prevalence, and significance of incidental non-cardiac findings (INCF) in patients referred for a non-invasive coronary angiography using a 128-slice multi-detector CT (MDCT).
Materials and Methods: The study subjects included 1,044 patients; 774 males (mean age, 59.9 years) and 270 females (mean age, 63 years), referred for a coronary CT angiography on a 128-slice MDCT scanner. The scans were acquired from the level of the carina to just below the diaphragm. To evaluate INCFs, images were reconstructed with a large field of view (> 300 mm) covering the entire thorax. Images were reviewed in the axial, coronal, and sagittal planes, using the mediastinal, lung, and bone windows. The INCFs were classified as severe, indeterminate, and mild, based on their clinical importance, and as thoracic or abdominal based on their locations.
Results: Incidental non-cardiac findings were detected in 56% of patients (588 of 1,044), including 435 males (mean age, 65.6 years) and 153 females (mean age, 67.9 years). A total of 729 INCFs were observed: 459 (63%) mild (58% thoracic, 43% abdominal), 96 (13%) indeterminate (95% thoracic, 5% abdominal), and 174 (24%) severe (87% thoracic, 13% abdominal). The prevalence of severe INCFs was 15%. Two severe INCFs were histologically verified as lung cancers.
Conclusion: The 128-slice MDCT coronary angiography, in addition to cardiac imaging, can provide important information on the pathology of the chest and upper abdomen. The presence of severe INCFs is not rare, especially in the thorax. Therefore, all organs in the scan should be thoroughly evaluated in daily clinical practice.

참고문헌 (Reference)

1 McKenna D, "The prevalence of incidental findings at cardiac MRI" 2 : 20-25, 2008

2 Northam M, "Pulmonary nodules detected at cardiac CT: comparison of images in limited and full fields of view" 191 : 878-881, 2008

3 Horton KM, "Prevalence of significant noncardiac findings on electron-beam computed tomography coronary artery calcium screening examinations" 106 : 532-534, 2002

4 Gil BN, "Prevalence of significant noncardiac findings on coronary multidetector computed tomography angiography in asymptomatic patients" 31 : 1-4, 2007

5 Law YM, "Prevalence of significant extracoronary findings on multislice CT coronary angiography examinations and coronary artery calcium scoring examinations" 52 : 49-56, 2008

6 Kirsch J, "Prevalence and significance of incidental extracardiac findings at 64-multidetector coronary CTA" 22 : 330-334, 2007

7 Hunold P, "Prevalence and clinical significance of accidental findings in electron-beam tomographic scans for coronary artery calcification" 22 : 1748-1758, 2001

8 Onuma Y, "Noncardiac findings in cardiac imaging with multidetector computed tomography" 48 : 402-406, 2006

9 Schragin JG, "Non-cardiac findings on coronary electron beam computed tomography scanning" 19 : 82-86, 2004

10 Dewey M, "Non-cardiac findings on coronary computed tomography and magnetic resonance imaging" 17 : 2038-2043, 2007

11 Kawano Y, "Kadota J. Incidental detection of cancers and other non-cardiac abnormalities on coronary multislice computed tomography" 99 : 1608-1609, 2007

12 Colletti PM, "Incidental findings on cardiac imaging" 191 : 882-884, 2008

13 Budoff MJ, "Incidental findings on cardiac computed tomography. Should we look?" 1 : 97-105, 2007

14 Yiginer O, "Incidental findings of cardiac MSCT: who might benefit from scanning the entire thorax on Ca score imaging?" 2008

15 Kim JW, "Incidental extracardiac findings at cardiac CT angiography: comparison of prevalence and clinical significance between precontrast low-dose whole thoracic scan and postcontrast retrospective ECG-gated cardiac scan" 25 : 75-81, 2009

16 MacMahon H, "Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society" 237 : 395-400, 2005

17 Wann S, "Des Prez R. Cardiac computed tomographic angiography: evaluation of non-cardiac structures" 16 : 139-150, 2009

18 Achenbach S, "Current and future status on cardiac computed tomography imaging for diagnosis and risk stratification" 12 : 703-713, 2005

19 Haller S, "Coronary artery imaging with contrast-enhanced MDCT: extracardiac findings" 187 : 105-110, 2006

20 Bach PB, "Computed tomography screening and lung cancer outcomes" 297 : 953-961, 2007

21 Aglan I, "Clinical relevance and scope of accidental extracoronary findings in coronary computed tomography angiography: a cardiac versus thoracic FOV study" 2009

22 Mueller J, "Cardiac CT angiography after coronary bypass surgery: prevalence of incidental findings" 189 : 414-419, 2007

23 Schoepf UJ, "CT of coronary artery disease" 232 : 18-37, 2004

24 Budoff MJ, "Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology" 114 : 1761-1791, 2006

25 Diamond GA, "Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease" 300 : 1350-1358, 1979

26 Hendel RC, "ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology" 48 : 1475-1497, 2006