This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (5) Citing Articles via Google Scholar Google Scholar Articles by MacHaalany, J. Articles by Chow, B. J.W. Search for Related Content PubMed PubMed Citation Articles by MacHaalany, J. Articles by Chow, B. J.W. Related Collections Related Articles

CLINICAL RESEARCH: CARDIAC IMAGING

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^_*,,_*

^_* Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Cardiovascular Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Department of Radiology, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada

Manuscript received April 6, 2009; revised manuscript received May 19, 2009, accepted June 11, 2009.

^_* Reprint requests and correspondence: Dr. Benjamin J. W. Chow, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada (Email: bchow{at}ottawaheart.ca).

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.

Key Words: multidetector computed tomography • incidental findings • noncardiac death • CTA • lung nodules • noninvasive imaging

Abbreviations and Acronyms   CDN = Canadian   CS = clinically significant   CT = computed tomography   IF = incidental finding(s)   NSCLC = nonsmall cell lung cancer

Related Articles

Reply

Nathan Goldstein, Elizabeth Bradley, and R. Sean Morrison
J. Am. Coll. Cardiol. 2010 55: 702. [Full Text] [PDF]

This article has been cited by other articles:

				M. Casella, F. Perna, G. Pontone, A. Dello Russo, D. Andreini, G. Pelargonio, S. Riva, G. Fassini, M. Pepi, G. Ballerini, et al. Prevalence and clinical significance of collateral findings detected by chest computed tomography in patients undergoing atrial fibrillation ablation Europace, February 1, 2012; 14(2): 209 - 216. [Abstract] [Full Text] [PDF]

				C. S. White The Pros and Cons of Searching for Extracardiac Findings at Cardiac CT: Use of a Restricted Field of View Is Acceptable Radiology, November 1, 2011; 261(2): 338 - 341. [Full Text] [PDF]

				J. P. Earls 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 Radiology, November 1, 2011; 261(2): 342 - 346. [Full Text] [PDF]

				M. C. Williams, J. H. Reid, G. McKillop, N. W. Weir, E. J. R. van Beek, N. G. Uren, and D. E. Newby Cardiac and coronary CT comprehensive imaging approach in the assessment of coronary heart disease Heart, August 1, 2011; 97(15): 1198 - 1205. [Abstract] [Full Text] [PDF]

				M. A. Hlatky and P. A. Heidenreich The Year in Epidemiology, Health Services Research, and Outcomes Research J. Am. Coll. Cardiol., May 10, 2011; 57(19): 1859 - 1866. [Full Text] [PDF]

				K. Alfakih and M. Budoff Multi-detector computed tomography coronary angiography: the incidental lung findings J R Soc Med, February 1, 2011; 104(2): 50 - 51. [Full Text] [PDF]

				S. L. Lansman, P. C. Saunders, R. Malekan, and D. Spielvogel Acute aortic syndrome J. Thorac. Cardiovasc. Surg., December 1, 2010; 140(6_suppl): S92 - S97. [Abstract] [Full Text] [PDF]

				K. M. Johnson, J. M. Dennis, and D. A. Dowe Extracardiac Findings on Coronary CT Angiograms: Limited Versus Complete Image Review Am. J. Roentgenol., July 1, 2010; 195(1): 143 - 148. [Abstract] [Full Text] [PDF]

				C. I. Lee, E. B. Tsai, B. M. Sigal, S. K. Plevritis, A. M. Garber, and G. D. Rubin Incidental Extracardiac Findings at Coronary CT: Clinical and Economic Impact Am. J. Roentgenol., June 1, 2010; 194(6): 1531 - 1538. [Abstract] [Full Text] [PDF]

				T. C. Booth, A. Jackson, J. M. Wardlaw, S. A. Taylor, and A. D. Waldman Incidental findings found in "healthy" volunteers during imaging performed for research: current legal and ethical implications Br. J. Radiol., June 1, 2010; 83(990): 456 - 465. [Abstract] [Full Text] [PDF]

				K. M. Johnson Extracardiac Findings on Cardiac Computed Tomography: A Radiologist's Perspective J. Am. Coll. Cardiol., April 13, 2010; 55(15): 1566 - 1568. [Abstract] [Full Text] [PDF]

				T. C. Gerber, M. C. Kontos, and B. Kantor Emergency Department Assessment of Acute-Onset Chest Pain: Contemporary Approaches and Their Consequences Mayo Clin. Proc., April 1, 2010; 85(4): 309 - 313. [Full Text] [PDF]

				A. Abraham, J. MacHaalany, and B. J.W. Chow Reply. J. Am. Coll. Cardiol., February 16, 2010; 55(7): 703 - 703. [Full Text] [PDF]

				S. Bartoletti, F. Perna, P. Santangeli, and M. Casella A Closer Look at Incidental Findings on Cardiac Computed Tomography J. Am. Coll. Cardiol., February 16, 2010; 55(7): 702 - 703. [Full Text] [PDF]

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, G. K. Feld, B. H. Greenberg, J. Hall, M. Hlatky, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, et al. Highlights of the Year in JACC 2009 J. Am. Coll. Cardiol., January 26, 2010; 55(4): 380 - 407. [Full Text] [PDF]

				Investigation of Incidental Findings on Cardiac CT Journal Watch (General), December 1, 2009; 2009(1201): 1 - 1. [Full Text]

				M. A. Hlatky and C. Iribarren The Dilemma of Incidental Findings on Cardiac Computed Tomography J. Am. Coll. Cardiol., October 13, 2009; 54(16): 1542 - 1543. [Full Text] [PDF]