CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Yoshinobu Onuma, MD,
Kengo Tanabe, MD, PhD* and
Kazuhiro Hara, MD, FACC
* Division of Cardiology, Mitsui Memorial Hospital, 1, Kanda-Izumi-cho, Chiyoda-ku, Tokyo, Japan (Email: kengo-t{at}zd5.so-net.ne.jp).
We thank Dr. Fleet for his interest in our study (1) and appreciate his comments. We agree with Dr. Fleet as to the necessity of further evidence to establish the clinical significance of noncardiac analysis in cardiac multidetector computed tomography (MDCT). Our study lacks long-term clinical follow-up to discuss clinical outcomes. In addition, we did not discuss cost because the actual cost of additional follow-up, including surgery, biopsy, and imaging, varies among countries and institutions. As clinical results and costs could be different depending on how referring physicians respond to the reports, a mathematical analysis regarding outcomes and cost might be suitable.
At this time, in our institution, we perform both cardiac and noncardiac analysis with large field-of-view in routine cardiac MDCT. The primary purpose of noncardiac analysis is to differentiate chest pain syndrome including aortic disease and pulmonary embolism. In our study, noncardiac analysis could diagnose the cause of chest symptom in 32 of 201 patients in whom coronary artery disease was ruled out. In these patients, additional diagnostic tests could be avoided and might result in reduced medical costs.
Furthermore, as Dr. Rumberger pointed out in his editorial comment (2), noncardiac analysis could be medico-morally necessary. We believe that physicians should review all images and areas irradiated in the cardiac scan. What is most needed at the present time is for the cardiology community to adopt an open mind so as to discuss this issue and to gather further input from various fields.
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References
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- 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]
- 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]
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