Extracardiac findings on coronary computed tomography angiography in patients without significant coronary artery disease.

OBJECTIVE: To analyse extracardiac findings in patients without significant coronary artery disease (CAD) in general and in symptomatic patients in particular. METHODS: We searched the Radiology Information System database for coronary computed tomography angiographies (CTA) performed from 2000-2014 and retrospectively enrolled 3,898 patients without significant CAD (coronary stenosis < 50%) in CTA. In 2,330 symptomatic patients, we analysed the spectrum of extracardiac findings and identified pathologies potentially explaining chest pain. Finally, we investigated variables affecting the number of extracardiac findings detected in CTA. RESULTS: Overall extracardiac findings were found in 1,177 patients (30.2%; 95%CI, 28.8-31.7%). 94 patients (2.4%; 95%CI, 2.0-2.9%) had extracardiac findings with a recommendation for follow-up, sixteen patients (0.4%; 95%CI, 0.3-0.7%) had incidental urgent, and another three patients (0.1%; 95%CI, 0.1-0.2%) had incidental malignant extracardiac findings. 185 of 2,330 symptomatic patients (7.9%; 95%CI, 6.9-9.1%) revealed extracardiac findings potentially explaining chest pain after exclusion of significant CAD. The number of extracardiac findings increased significantly with patient age (p < 0.001) and the cumulative experience of the CT reader (p < 0.001). CONCLUSION: 30.2% of patients undergoing CTA for exclusion of CAD had ECF, and 7.9% of symptomatic patients without significant CAD on their examination had findings that could potentially explain their symptoms. KEY POINTS: • Of patients undergoing CTA, 2.8% have relevant incidental extracardiac findings. • CTA could identify the differential diagnosis of chest pain when excluding significant CAD. • Patient age and reader's professional experience influence the number of detected ECFs.

Extracardiac findings at cardiac MR imaging: a single-centre retrospective study over 14 years.

OBJECTIVES: To determine the prevalence and significance of extracardiac findings (ECF) in a large set of cardiac magnetic resonance (MR) imaging examinations. METHODS: The institutional review board (IRB) of the Charité approved this retrospective, single-centre study. A total of 4376 cardiac MR imaging reports of 3553 patients (age 37.4 ± 20 years, 60.8 % male) examined from 2000 to 2014 were included. Findings with a recommendation for follow-up were considered "major ECF". To analyse the association of indication, age and gender with ECF, Poisson regression and computed incidence rate ratios (IRR) were evaluated. RESULTS: The overall prevalence of ECF was 34% (95% confidence interval [CI] 32.5-35.6%). Major ECF were present in 3.4% (95% CI 2.9-4.1%) while findings that changed patient management were found in 0.9% (95% CI 0.7-1.3%). In the cases of congenital heart disease, ECF prevalence was higher compared to myocarditis (IRR, 6.0; 95% CI 5.1-7.1%; p < 0.001), while the prevalence of major ECF was lower (IRR, 0.2; 95% CI 0.02-0.51%; p < 0.05). Older patient age was associated with more nonvascular ECF (p < 0.001). Female patients had the same probability of having an ECF as male patients (IRR, 1.04; 95% CI 0.95-1.1%; p = 0.43). CONCLUSION: ECF in cardiac MR imaging are present in about every third patient while relevant ECF that change patient management can be found in about one out of 100 patients. Our data suggest that it is important to involve well-trained radiologists in reading cardiac MR images, which often reveal ECF if congenital heart disease is the clinical indication. KEY POINTS: • Extracardiac findings are present in about every third patient. • Relevant ECF changing patient management are found in one out of 100 findings. • Chance of ECF is high in patients with CHD and vascular indications.

Extracardiac findings on coronary CT angiography: a systematic review.

UNLABELLED: Coronary computed tomography angiography (CCTA) is of growing importance in noninvasive diagnosis of coronary artery diseases. The CT data allow evaluation not only of coronary arteries but also of adjacent anatomical territories. Our objective was to review, to analyze, and to quantify the spectrum and the prevalence of extracardiac findings (ECF) in CCTA. Therefore, we searched MEDLINE, EMBASE, and ISI Web of Science. Prior to quantitative analysis, we categorized the ECF of all included studies into clinically significant and clinically non-significant findings. First, we calculated the average prevalences of ECF and clinically significant ECF performing a meta-analysis for proportions using the double arcsine transformation. Second, we analyzed the spectrum and location of clinically significant ECF. Third, we identified ECF of acutely life-threatening potential as well as malignancies and calculated their prevalences. Thirteen studies with a total of 11,703 patients were found to meet the inclusion criteria. The average prevalence of overall ECF was 41.0% (95% confidence interval [95% CI]: 27, 56; P < .0001) and 16.0% (95% CI (9, 24; P < .0001) 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 anatomical territories (6.4%). The prevalence of acutely life-threatening and malignant ECF accounted for 2.2% (95% CI: 1.9, 2.5; P < .0001) and 0.3% (95% CI: 0.2-0.4; P < .0001), respectively. In conclusion, clinically significant and acutely life-threatening ECF are common. Reading CCTA for ECF may lead to earlier detection of relevant disease. CONCLUSION: Clinically significant and acutely life-threatening ECF are common. Reading CCTA for ECF may lead to earlier detection of relevant disease.