|
Volume 3 No. 4, October 2008 |
|
Incidental Finding On Coronary Multislice CT Angiography: Frequency
and Diagnostic Value Departments of cardiology(1) & Radiology(2), Faculty of medicine, Alexandria University, Egypt
Tanta Med. Sc. J 2008; 3(4):163-171
Background/Aim: 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. Patients & Methods: 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. RESULTS:
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. Conclusion: 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.
 |
|
|