Incidental non-cardiac findings of a coronary angiography with a 128-slice multi-detector CT scanner: should we only concentrate on the heart?

Abstract

Objective: To evaluate the spectrum, prevalence, and significance of incidental non-cardiac findings (INCF) in patients referred for a non-invasive coronary angiography using a 128-slice multi-detector CT (MDCT).

Materials and methods: The study subjects included 1,044 patients; 774 males (mean age, 59.9 years) and 270 females (mean age, 63 years), referred for a coronary CT angiography on a 128-slice MDCT scanner. The scans were acquired from the level of the carina to just below the diaphragm. To evaluate INCFs, images were reconstructed with a large field of view (> 300 mm) covering the entire thorax. Images were reviewed in the axial, coronal, and sagittal planes, using the mediastinal, lung, and bone windows. The INCFs were classified as severe, indeterminate, and mild, based on their clinical importance, and as thoracic or abdominal based on their locations.

Results: Incidental non-cardiac findings were detected in 56% of patients (588 of 1,044), including 435 males (mean age, 65.6 years) and 153 females (mean age, 67.9 years). A total of 729 INCFs were observed: 459 (63%) mild (58% thoracic, 43% abdominal), 96 (13%) indeterminate (95% thoracic, 5% abdominal), and 174 (24%) severe (87% thoracic, 13% abdominal). The prevalence of severe INCFs was 15%. Two severe INCFs were histologically verified as lung cancers.

Conclusion: The 128-slice MDCT coronary angiography, in addition to cardiac imaging, can provide important information on the pathology of the chest and upper abdomen. The presence of severe INCFs is not rare, especially in the thorax. Therefore, all organs in the scan should be thoroughly evaluated in daily clinical practice.

Keywords: Coronary computed tomography angiography; Incidental non-cardiac findings; Multi-detector computed tomography (MDCT).

Fig. 1

Description of further work-up of patients with indeterminate and severe incidental non-cardiac findings detected by coronary CT angiography.

Fig. 2

Liver cyst (arrow) and ascites (asterisk) incidentally detected in 71-year-old man who was referred for coronary CT angiography for congestive heart failure.

Fig. 3

Incidentally detected hiatus hernias. A. Hiatus hernia (arrow) is depicted in axial plane in 65-year-old man who underwent coronary CT for atypical chest pain. B. Hiatus hernia (arrow) is depicted in sagittal reconstruction of coronary CT angiography in 67-year-old man, also complaining of atypical chest pain.

Fig. 4

Consolidation of right lung discovered in 56-year-old man with cough who underwent coronary CT angiography for atypical chest pain.

Fig. 5

Aneurysm of ascending aorta measuring 4.7×4.8 cm incidentally found in 62-year-old man who was referred for coronary CT angiography for evaluation of cardiac aetiology of syncope.

Fig. 6

Incidentally detected bronchogenic carcinoma in 65-year-old man. A, B. Mass measuring 4.5 cm in diameter at right hilum is discovered. Pathology revealed squamous cell lung cancer (arrows) on axial plane soft tissue window (A) and coronal plane lung window (B) images.