Incidental Cardiac Findings in Non-Electrocardiogram-gated Thoracic Computed Tomography of Intensive Care Unit Patients: Assessment of Prevalence and Underreporting

Abstract

Purpose: Cardiac findings frequently remain unreported on non-electrocardiogram (ECG)-gated computed tomography (CT). Although the clinical relevance of such findings may be limited in a general patient population, they may have significant impact in intensive care patients. Thus, the purpose of this study was to evaluate the prevalence, underreporting, and clinical relevance of incidental cardiac findings in intensive care unit (ICU) patients.

Materials and methods: Non-ECG-gated chest CT examinations of ICU patients were retrospectively analyzed for incidental cardiac findings. The findings were classified into 3 categories (A to C): category A findings, which carry potential for risk to life; category B findings, which have a potential for significant morbidity; category C findings, which have a possible effect on prognosis.

Results: A total of 500 patients who underwent non-ECG-gated thoracic CT examinations were included. Of the 500 patients, 403 presented with 1443 cardiac findings. Of all cardiac findings, 37% were described in the initial written report. Sixty category A findings were detected, of which 48% were not mentioned in the report. Six hundred forty category B findings were detected, of which 77% were not described in the report. The remaining 743 findings were classified as category C, 55% of which were not reported in the report.

Conclusions: The prevalence as well as the rate of underreporting of incidental cardiac findings in non-ECG-gated chest CT of ICU patients is very high. The results of this study underscore the importance of dedicated training for assessment of cardiac structures and conditions, which may be detected on non-ECG-gated chest CT.