Incidental finding on coronary multislice CT angiography: frequency and diagnostic value

ABSTRACT

Multislice Coronary CT angiography [MSCTA] has emerged over the past few years as an important diagnostic tool in patients with low-intermediate likelihood of coronary artery disease [CAD] presenting with chest pain. MSCTA images also include parts of the lungs, abdomen, and mediastinum. Reading physicians are obliged to evaluate and report incidental [non cardiac] findings. The purpose of our study was to retrospectively assess the prevalence and clinical diagnostic impact of incidental [non cardiac] findings in low intermediate likelihood patients presenting with chest pain to a specialized imaging center. MSCTA was performed in 600 consecutive patients age of 55.8 +/- 10.0 years, with 3.0 +/- 1.5 risk factors, underwent retrospective ECG-gated examination of the coronary arteries using a 64-MSCT scanner [Aquilion, Toshiba Medical Systems, Tokyo, Japan]. In each examination findings were assessed and reported by a consensus between a cardiologist and a radiologist. Incidental finding is defined as a non cardiac finding not previously known; clinical significance was defined as that requiring further, diagnostic or interventional procedure. The 64 MSCT showed a great window for examining the coronaries allowing the diagnosis of a great variety of findings including calcium scoring, non-obstructive and obstructive plaques. The number, size and exerted degree of stenosis of plaques can be examined and outlined in more or less easy and rapid to perform procedure and acceptable by most patients. A wide multitude of incidental findings were seen in our study. Parts of the lungs [and sometimes the hole lungs] are examined during cardiac imaging. Most of the thoracic esophagus, thoracic aorta, diaphragm and a glance of the upper abdomen and breasts are seen during MSCTA of the heart. The visualized portion of the lungs and mediastinum showed multiple lesions. Lung subcentimeter nodules were seen in 10 cases. Five cases showed lung wedge shaped consolidation with associated pleural thickening. Significant mediastinal adenopathy [more than 1 cm in diameter] were seen in two cases. Lung neoplastic process that was proved to be pulmonary carcinoma was seen in 2 cases. Pulmonary embolism was encountered in almost tenth of our cases and actually was the cause of chest pain. Aortic lesions were seen in 12 patients; most of them were aneurysms and two cases were dissection and were incriminated as the major cause of chest pain in those patients. Hiatal hernia was a more or less common incidental finding seen in 40 cases. Hepatic and breast lesions were so few not seen in more than two cases each. Coronary artery MSCTA can reveal important non-cardiac findings and disease in extracardiac structures; these incidental findings are common, many of which would impact patient management. Cardiologist must be aware of the normal and abnormal findings and the best laid plan is to have an integrated cardiologist-radiologist team to ensure that important findings are not missed and unnecessary follow-up examinations are avoided