Phil Wu, Presenter: Nothing to Disclose

Farhood Saremi MD, Abstract Co-Author: Nothing to Disclose

Christopher Lee MD, Abstract Co-Author: Nothing to Disclose

To determine the prevalence of significant incidental findings (SIF’s) on CT angiography (CTA) in patients undergoing evaluation for transcatheter aortic valve replacement (TAVR). To evaluate the implications of SIF’s on clinical practice.

181 patients underwent CTA of the chest, abdomen, and pelvis for TAVR evaluation between January 2011 and January 2014. CTA’s were retrospectively reviewed for concerning imaging findings (CIF’s). Electronic medical records were reviewed to determine which CIF’s represented SIF’s, with SIF defined as: (a) no clinical or imaging history of CIF prior to CTA and (b) no follow-up disproving the imaging finding. SIF’s were assigned to the following categories: possible malignancy, cardiovascular, non-malignant thoracic, non-malignant gastrointestinal, and non-malignant genitourinary.

112 of 181 patients (61.9%) were men; the mean age was 82.7±8.8 years. 90.6% (164/181) of patients had at least one CIF. 4.5% of CIF’s had clinical follow-up, surveillance imaging, or other diagnostic studies. Of the CIF’s that were followed-up, 42.2% resulted in new diagnoses or therapeutic interventions. 11% of CIF’s were known prior to CTA or were disproven on follow-up. 84.5% of CIF’s were not followed-up at our institution for the following reasons: immediate follow-up was not deemed clinically necessary as severe aortic valve disease was the primary determinant of patient prognosis, patients were often referred to our institution solely for TAVR, and 16 patients died within 3 months of CTA. Possible malignancy SIF's were present in 54.7% (99/181), cardiovascular SIF’s in 52.5% (95/181), non-malignant thoracic SIF’s in 17.7% (32/181), non-malignant GI SIF’s in 22.7% (41/181), and non-malignant GU SIF’s in 6.6% (12/181) of patients. Attached table summarizes findings.

Although CTA evaluation of TAVR candidates is primarily utilized to characterize the anatomy of the aortic root and aortoiliofemoral arteries for candidate selection and procedural planning, CTA frequently reveals SIF's that may alter the pre- or post-procedural management of TAVR candidates. Even if management is not altered per se, SIF's can result in new diagnoses with implications on overall prognosis.

As SIF's can alter patient management and prognosis, radiologists should carefully examine preoperative CTA’s for CIF’s.

Wu, P, Saremi, F, Lee, C, Troubling TAVR Studies: Incidental Findings in Patients Undergoing CT Angiography for Transcatheter Aortic Valve Replacement.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009421.html