Jay Koonce MD, Presenter: Nothing to Disclose

Meredith Northam BA, Abstract Co-Author: Nothing to Disclose

Shaun A. Nguyen MD, Abstract Co-Author: Nothing to Disclose

U. Joseph Schoepf MD, Abstract Co-Author: Speakers Bureau, Bracco Group Speakers Bureau, General Electric Company Speakers Bureau, Bayer AG (MedRad, Inc) Speakers Bureau, TeraRecon, Inc Medical Advisory Board, Bracco Group Medical Advisory Board, General Electric Company Medical Advisory Board, Bayer AG Research grant, Bayer AG Research grant, Bracco Group Research grant, General Electric Company Research grant, Bayer AG (MedRad, Inc) Research grant, Siemens AG

James G. Ravenel MD, Abstract Co-Author: Nothing to Disclose

To investigate extra-cardiac findings at cardiac CT, their frequency based on indication for study and potential impact on patients.

We retrospectively reviewed the reports of 1761 subjects who underwent a cardiac CT imaging study over a 3 year period (1/1/04-12/31/06) including 460 calcium scoring (CS), 737 coronary CTA (CTA), 341 evaluation for pulmonary vein stenosis following radiofrequency ablation (PVS) and 223 evaluation of bypass grafts (CABG). This study was approved with a waiver from our local IRB. The incidental cardiac findings were classified as 1) relating to the aorta and pulmonary arteries, 2) relating to the mediastinum, 3) relating to the lung and 4) relating to the chest wall and pleura and 5) upper abdomen. In addition we reviewed all lung lesions > 1cm (suspicious for lung neoplasm) to determine if they could be visualized on limited field of view (FOV) images of the coronary arteries.

There was at least one extra-cardiac finding in 469 patients (26.6%). By exam, there was at least 1 extra cardiac finding in 79/460 CS (17.2%); 231/737 CTA (31.3%); 77/341 PVS (22.6%); 82/223 CABG (36.7%). In group1, there were 25 findings including 6 pulmonary emboli; group 2 there were 17 findings (13 adenopathy, 2 cysts, 2 mass); group 3 there were 329 findings including 186 nodules 1cm, 16 pneumonia, and 14 ILD; group 4 there were 70 findings including 50 effusion, 3 breast nodules, 3 thyroid nodules and 3 neoplasms) and in group 5 there were 57 findings including 20 indeterminate liver lesions and 1 mass. Of 13 lesions suspicious for lung cancer, 4 were visible within the limited FOV, 1 was partially visible and 8 were excluded from view. In 82 patients (4.7%), the findings were considered important enough to warrant short term follow-up/further work up. If small nodules (4-10mm) were considered, the number would rise to 268 (15.2%)

Extra-cardiac findings requiring follow-up occur in 15% of patients. The majority of pulmonary neoplasms would be missed if studies were reconstructed only with a limited FOV.

Significant extra-cardiac findings occur in up to 15% of patients undergoing cardiac CT.

Koonce, J, Northam, M, Nguyen, S, Schoepf, U, Ravenel, J, Extracardiac Findings at Cardiac CT: Experience with 1761 Patients.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5014427.html