Prevalence and significance of incidental extracardiac findings at 64-multidetector coronary CTA

Abstract

Introduction: Computed tomography (CT) angiography of the coronaries has the ability to depict extracardiac lesions in the visualized thorax and upper abdomen. These incidental lesions can often present a challenge to physicians.

Methods: We performed a retrospective review of 100 consecutive patients referred for 64-multidetector CT coronary CT angiography performed on a 64-slice CT scanner. Two fellowship trained cardiac radiologists reviewed each study by consensus on a CT postprocessing workstation using commercially available software. Extracardiac CT findings (ECF) were classified as benign, indeterminate, or of clinical significance at the time of image evaluation. Benign findings were those considered to be of little clinical significance with no follow-up needed. Indeterminate findings were those deemed of potential clinical importance, requiring correlation of the patient history or a follow-up study. Clinically significant findings were those felt to be of definite clinical importance requiring immediate evaluation or intervention.

Results: The study cohort consisted of 68 males (68%) and 32 females (32%) with a mean (+/-standard deviation) age of 63.4+/-14.5 years and a range of 23 to 87 years. A total of 145 ECF were found in 67 patients (67%), 50 males and 17 females, with a mean age of 68.0+/-11.8 years and a range of 23 to 87 years. Of those, 107 (73.8%) were considered benign, 22 (15.2%) indeterminate, and 16 clinically significant findings (11.0%). By significance, a total of 107 benign ECF were found in 61 patients, 46 males and 15 females, with a mean age of 67.7+/-12.2 years and a range of 23 to 87 years. Only 22 ECF indeterminate findings were present, distributed in 21 patients, of which there were 17 males and 5 females, with a mean age of 68.5+/-13.9 and a range of 23 to 82 years. The 16 clinically significant ECF were distributed in 11 patients, all males, with a mean age of 68.0+/-8.8 and a range of 55 to 87 years.

Conclusions: The presence of ECF in our daily practice is frequent, and not limited to the identification of pulmonary nodules, and reinforces the notion that all the organs in the scan should be thoroughly and methodically evaluated.