CORRESPONDENCE: LETTER TO THE EDITOR
Noncardiac Findings in Computed Tomography Coronary Angiography
Stephen Fleet, MD*
* Lahey Clinic, One Essex Center Drive, Peabody, Massachusetts 01960-1260 (Email: smfleet{at}aol.com).
The report by Onuma et al. (1) on noncardiac findings in multidetector computed tomography (MDCT) and the accompanying editorial comment by Rumberger (2) raise interesting issues. Onuma et al. (1) found that approximately 23% of 503 patients undergoing CT coronary angiography demonstrated significant noncardiac pathology requiring follow-up. This included 2 lung and 2 breast malignancies. Similarly, Baum et al. (3) have recently reported a high prevalence of extracardiac disease, including malignancies, among over a thousand patients undergoing MDCT.
Rumberger (2) suggests medico-legal and moral imperatives to seek noncardiac pathology. The patient’s entire chest and upper abdomen have been irradiated, after all, and the imaging data are there awaiting reconstruction. Although this approach seems very reasonable, I believe we need to keep an open mind, recognizing the absence of hard evidence that the pursuit of extracardiac pathology leads to overall improved patient outcomes. Much of the noncardiac pathology, such as liver and renal cysts, is relatively unimportant and probably unrelated to the symptom of chest pain. With regard to more serious pathology, several questions arise: When found, are the newly discovered malignancies curable or amenable to treatment that prolongs life or improves quality of life? What percentage of patients requires repetitive imaging scans and further irradiation, and at what risk? What is the morbidity and mortality attendant to the biopsies and surgery for lesions that ultimately turn out to be benign?
I believe we are at a crossroads where additional input from epidemiologists, oncologists, radiologists, cardiologists, and others is required to delineate further how far to widen or restrict the MDCT "field of view." Because large randomized prospective studies are unlikely in this regard, perhaps mathematical models of outcomes and costs could be formulated.
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References
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1. Onuma Y, Tanabe K, Nakazawa G, et al. Noncardiac findings in cardiac imaging with multidetector computed tomography J Am Coll Cardiol 2006;48:402-406.[Abstract/Free Full Text]2. Rumberger JA. Noncardiac abnormalities in diagnostic cardiac computed tomography. Within normal limits or we never looked. J Am Coll Cardiol 2006;48:407-408.[Free Full Text] 3. Baum S, Smuclovisky C, McInnis P. Prevalence of extra cardiac disease in patients undergoing cardiac CTA (abstr) Int J Cardiovasc Imaging 2006;22(Suppl 1):31.
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