Incidental extracardiac findings on cardiac MR: Systematic review and meta-analysis

Practical approach to extracardiac findings in CT and MR for the non-radiologist

Cross-sectional cardiac imaging plays an essential role in the evaluation of pediatric patients with congenital and acquired heart disease. While the focus of cardiac imaging is primarily on evaluating cardiac structures, it also provides valuable insights into extracardiac structures and associated abnormalities. The radiologists and cardiologists interpreting these exams play a critical role in recognizing these findings and providing recommendations for follow-up testing when indicated. Due to the excellent soft tissue resolution of cardiac magnetic resonance imaging (MRI) and computed tomography (CT), incidental findings can often be diagnosed without further imaging. Incidental findings are generally defined as lesions or masses detected by imaging that is performed for a different reason. In other cases, further imaging evaluation and testing may be necessary. This article aims to explore the spectrum of extracardiac findings encountered in pediatric cardiac imaging studies, their clinical significance, and the potential implications for patient care.

Clinically Relevant Extracardiac Findings at Cardiac Imaging: Insights from the European MR/CT Registry

Purpose To determine the prevalence of clinically relevant extracardiac findings at cardiac CT and MRI examinations from a multicenter, multinational MR/CT registry and the relationship of prevalence with examination indications and patient characteristics. Materials and Methods This was a retrospective analysis of data from the European Society of Cardiovascular Radiology MR/CT Registry. Data from 208 506 cardiac CT examinations (median patient age, 66 years [IQR, 55-77]; 121 617 [58.33%] male patients) and 228 462 cardiac MRI examinations (median patient age, 57 years [IQR, 42-69]; 145 792 [63.81%] male patients) entered into the registry between January 2011 and November 2023 were analyzed. Clinically relevant extracardiac findings were defined as findings requiring follow-up examinations or influencing clinical management. The association of examination indication and patient characteristics, including age, with prevalence of extracardiac findings was evaluated using incidence rate ratios (IRRs) derived from multivariable Poisson regression models. Results The prevalence of clinically relevant extracardiac findings was 3.28% (6832 of 208 506) at cardiac CT and 1.50% (3421 of 228 462) at cardiac MRI examinations. Extracardiac findings were more common at CT examinations performed for transcatheter aortic valve replacement (IRR, 2.07; P < .001) and structural heart disease (IRR, 1.44; P < .001) compared with CT performed for coronary artery disease (IRR, 1; reference). Extracardiac findings were more common at MRI examinations performed for myocarditis (IRR, 1.36; P < .001) and structural heart disease (IRR, 1.16; P < .001) than for coronary artery disease. Older patient age was also significantly associated with higher prevalence of extracardiac findings, with an IRR for both CT and MRI examinations of 1.02 (P < .001). Conclusion Data from the multicenter, multinational MR/CT registry indicate that clinically relevant extracardiac findings are present at cardiovascular CT and MRI examinations, and the prevalence of these findings is associated with examination indication and patient age. Keywords: Cardiac Imaging Techniques, Incidental Findings, MRI, CT Angiography, CT, Heart Disease Supplemental material is available for this article. © RSNA, 2024.

An audit of the establishment of a cardiac magnetic resonance imaging service in a public tertiary hospital setting in the Western Cape Province of South Africa

Introduction

cardiovascular magnetic resonance imaging is considered the standard of care for many clinical cardiovascular applications. Magnetic resonance imaging is a scarce resource in sub-Saharan Africa, with a paucity of cardiac magnetic resonance imaging clinical services and research. The aim of this audit was to review the cardiac magnetic resonance imaging service provided at a public tertiary hospital in Cape Town, Western Cape Province, South Africa.

Methods

a retrospective, descriptive audit via quantitative record review of Tygerberg Hospital´s cardiovascular magnetic resonance imaging service was conducted from the inception thereof on 1st April 2015 up to 31st October 2022.

Results

a total of 1,403 cardiovascular magnetic resonance imaging scans met the inclusion criteria. The mean age of the study population was 43 years, and 52% were female. The most common patient comorbidities were modifiable cardiovascular risk factors, including hypertension (22%; n=306), cigarette smoking (9.6%; n=134), diabetes mellitus type II (6.7%; n=94) and dyslipidaemia (4.4%; n=62). Sixty-three percent (n=888) of scans were performed after hours. In 93% of scans, intravenous gadolinium-based contrast agents were administered. Nonischaemic cardiomyopathy dominated the indications (56.7%; n=976) and final diagnosis (42%; n=589). The most common incidental extracardiac finding was hilar or mediastinal lymphadenopathy (6%; n=82).

Conclusion

the recently established, functional cardiovascular magnetic resonance imaging service at Tygerberg Hospital serves a unique patient population with a comparatively differently distributed cardiac disease spectrum, contributing to research diversity.

Extracardiac Findings on Cardiac Magnetic Resonance: A Children's Hospital Experience

Cardiac magnetic resonance (CMR) incorporates a field of view that has the potential to capture clinically relevant extracardiac findings (ECF); however, there has been minimal investigation of ECF prevalence in children's hospitals, where the patient population varies in age and diagnosis. We retrospectively reviewed consecutive, clinically indicated, CMR studies performed at a tertiary care children's hospital during a 1-year period from January 1 to December 31, 2019. ECFs were classified as significant or non-significant based on whether they were described in the final impression of the CMR report. A total of 851 distinct patients had a CMR study during the 1-year period. Mean age was 19.5 (range 0.2; 74.2) years. A total of 254 ECFs were present in 158 of the 851 studies (18.6%) with 9.8% of all studies having significant ECFs. A total of 40.2% of ECFs were previously unknown and 9.1% (23/254) of ECFs included further recommendations (2.1% of all studies). ECFs were most often found in the chest (48%) or abdomen/pelvis (46%). Three patients were incidentally found to have malignancy (renal cell, thyroid, and hepatocellular carcinoma). Comparing studies with significant ECFs to the group without, CMR indications for biventricular CHD (43% vs 31%, p = 0.036), single ventricle CHD (12% vs 3.9%, p = 0.002), and aortopathy/vasculopathy (16% vs 7.6%, p = 0.020) were more common. The odds of significant ECF increased with increasing age (OR 1.82, 95% CI 1.10-3.01) and increased most notably between ages 14 to 33 years old. Recognition of the high percentage of ECFs remains important for timely diagnosis of these incidental findings.

Major incidental findings on routine cardiovascular magnetic resonance imaging prior to first-time catheter ablation of atrial fibrillation

Introduction

Preprocedural cardiovascular magnetic resonance (CMR) or computed tomography (CT) imaging of the left atrium/pulmonary veins is usually employed to guide catheter ablation of atrial fibrillation (AFCA). Incidental findings (IFs) are common on cardiac imaging prior to AFCA. However, previous studies have mainly focused on extracardiac IFs detected on CT scan. We aimed to assess the prevalence of relevant cardiac and extracardiac IFs on routine preprocedural CMR in a large patient cohort scheduled for first-time AFCA and report its impact on clinical decision-making and management.

Methods and results

We included 2000 consecutive patients (62 ± 10 years; 59% male) who underwent CMR prior to first-time AFCA between April 2015 and March 2019. Among these patients 172 (8.6%) had a total of 184 major IFs. Detection of major IFs resulted in cancellation of the scheduled AFCA procedure in 88 patients (4.4%). Forty-two patients (2.1%) have never been ablated, 46 (2.3%) underwent postponed AFCA after a median time of 83 (32–213) days. The remaining 84 patients (4.2%) underwent an individualized approach to AFCA. The most common major IFs were accessory or anomalous PVs in 76 (3.8%), extracardiac abnormalities suspicious of malignancy in 29 (1.5%), and positive stress perfusion imaging in 19 (7.2% of 261 tested) patients. In 19 patients (1.0%) preprocedural CMR provided the diagnosis of a previously unknown structural cardiac disease.

Conclusions

Unexpected relevant findings on routine preprocedural CMR affected clinical decision-making and management in 8.6% of patients scheduled for first-time AFCA. However, whether preprocedural CMR imaging may improve overall clinical outcome needs to be addressed in future research.

Incidence and Outcome of Unexpected Non-Cardiac Abnormality on Cardiac Magnetic Resonance Imaging: A Report from Northeastern Thailand

Objective: To ascertain non-cardiac abnormality (NCA) incidence in patients undergoing clinical cardiovascular magnetic resonance imaging (CMR) and determine such patients' clinical importance. Methods: Consecutive patients undertaking CMR study from January 2012 to June 2017 for various cardiovascular diseases were enrolled. To assess NCA's therapeutic importance, all incidental findings that were not expected from the patient's history were analyzed. A careful review of medical history determines the information on mortality. Results: Three hundred and eighty-two consecutive patients (mean age 58 ± 11 years) who underwent CMR for different clinical indications were enrolled in the present study. Potentially significant results have been identified as abnormalities that require further clinical or radiological follow-up or therapy. On CMR, 118 NCA (30.9%) were found. In 25 patients, potential clinically significant NCAs, such as aortic aneurysm (n = 3), aortic dissection (n = 2), pulmonary thromboembolism (n = 2), and malignancy (n = 18), were identified (6.54%). In terms of one-year mortality data, in a patient without NCA, we observed a significantly higher survival rate than those with NCA (p = 0.0085) and a higher mortality rate in a patient with clinically significant NCA than a patient with irrelevant NCA (p = 0.02). Survival, as assessed via Kaplan‒Meier analysis, disclosed significantly higher mortality in the patients with clinically significant NCA than patients with irrelevant NCA (HR = 11.20, CI = 4.71-26.60, p < 0.001). Conclusions: We concluded that it is vital for the CMR study to determine the relevance of NCA, especially in the cholangiocarcinoma endemic region such as northeastern Thailand. Eventually, to reorganize the patients according to appropriate management, clinical correlation and prognosis must be summarily established.

Readability of extraspinal organs on scout images of lumbar spine MRI according to different protocols

Background

Scout images of lumbar spine MRI often include the extraspinal organs, which are barely included in routine MRI and can be a potential cause of lumbar pain.

Purpose

To evaluate the readability of scout images for extraspinal organs in lumbar spine MRI according to different protocols.

Materials and methods

A total of 150 patients who underwent 1.5 T or 3 T lumbar spine MRI from March to September 2015 at three hospitals with different scout image protocols, were selected. Two radiologists independently reviewed the scout images to investigate whether exclusive diagnosis of major diseases involving the femoral head, femoral neck, sacroiliac joint, and kidneys was possible. Readability levels were divided into four categories: definitely, possibly, limited, and non-evaluable. The readability of scout images according to the protocols was compared using Chi-square test. Interobserver agreement for the readability level of scout images was assessed using weighted κ statistics.

Results

Of 150 patients, “definitely evaluable” cases classified by two readers were 50–62 (33.3–41.3%) for femoral head (κ = 0.63–0.71), 37–66 (24.7–44.0%) for femoral neck (κ = 0.41–0.48), 72–93 (48.0–62.0%) for sacroiliac joint (κ = 0.35–0.37), and 63–73 (42.0–48.7%) for kidneys (κ = 0.45–0.47). More than 50% of femoral heads were classified as readable (definitely or possible evaluable) cases by two readers with excellent interobserver agreement. The readability level of scout images was significantly different according to image protocols including the MRI sequence, number of coronal plane slices, and intersection gap of coronal plane slices (p≤0.015).

Conclusion

Scout images of lumbar spine MRI may be readable enough to rule out some major diseases of extraspinal organs. Standardization of the protocol will be needed to validate the potential role of scout images for screening extraspinal organs.

Role of cardiovascular magnetic resonance in early detection and treatment of cardiac dysfunction in oncology patients

The purpose of this review is to provide an overview of the essential role that cardiovascular magnetic resonance (CMR) has in the field of cardio-oncology. Recent findings: CMR has been increasingly used for early identification of cancer therapy related cardiac dysfunction (CTRCD) due to its precision in detecting subtle changes in cardiac function and for myocardial tissue characterization. Summary: CMR is able to identify subclinical CTRCD in patients receiving potentially cardiotoxic chemotherapy and guide initiation of cardio protective therapy. Multiparametric analysis with myocardial strain, tissue characterization play a critical role in understanding important clinical questions in cardio-oncology.

The role of cardiac magnetic resonance imaging in the detection and monitoring of cardiotoxicity in patients with breast cancer after treatment: a comprehensive review

The use of chemotherapy medicines for breast cancer (BC) has been associated with an increased risk of cardiotoxicity. In recent years, there have been growing interests regarding the application of cardiovascular magnetic resonance (CMR) imaging, a safe and noninvasive modality, with the potential to identify subtle morphological and functional changes in the myocardium. In this investigation, we aimed to review the performance of various CMR methods in diagnosing cardiotoxicity in BC, induced by chemotherapy or radiotherapy. For this purpose, we reviewed the literature available in PubMed, MEDLINE, Cochrane, Google Scholar, and Scopus databases. Our literature review showed that CMR is a valuable modality for identifying and predicting subclinical cardiotoxicity induced by chemotherapy. The novel T1, T2, and extracellular volume mapping techniques may provide critical information about cardiotoxicity, in addition to other CMR features such as functional and structural changes. However, further research is needed to verify the exact role of these methods in identifying cardiotoxicity and patient management. Since multiple studies have reported the improvement of left ventricular performance following the termination of chemotherapy regimens, CMR remains an essential imaging tool for the prediction of cardiotoxicity and, consequently, decreases the mortality rate of BC due to heart failure.

Impact of CT venography added to CT pulmonary angiography for the detection of deep venous thrombosis and relevant incidental CT findings

OBJECTIVES

To assess the additional diagnostic value of CT venography (CTV) simultaneously performed with CT pulmonary angiography (CTPA) in the context of thromboembolic disease for the detection of deep venous thrombosis (DVT) and other relevant incidental CT findings.

MATERIALS AND METHODS

Retrospectively and consecutively, we included all patients referred to our emergency department within the last 24 months for suspected pulmonary embolism (PE) who underwent CTPA combined with CTV. Two radiologists blinded to clinical information and results independently analysed CTV images in the context of DVT of the lower extremities and other, unsuspected abdominal/pelvic findings. These latter were classified as relevant with therapeutic consequences or irrelevant. One radiologist reviewed patient clinical records. Inter-observer agreement for DVT detection was calculated.

RESULTS

Of 696 patients, 119 had PE (17.1%) and 54 had DVT (7.8%), 16 (2.3%) of them without concomitant PE. Inter-observer agreement between the two readers was substantial (kappa = 0.78). CTV examinations led to diagnosis of relevant incidental abdominal/pelvic findings in 40 (5.7%) patients, including 11 with new malignant tumours, and 8 with progressive metastatic disease. The evaluated clinical and biological risk factors were not significantly associated with the presence of relevant incidental findings. CTV changed therapeutic management in 29 patients (4.3%): 15 had DVTs without PE, and 14 had abdominal/pelvic findings with therapeutic consequences.

CONCLUSION

CTV simultaneously performed with CTPA offers limited incremental value for detecting DVT. It may reveal other relevant findings leading to therapeutic changes, but the low rate does not justify screening patients with suspected PE.

Magnetic Resonance Imaging to Detect Cardiovascular Effects of Cancer Therapy: JACC CardioOncology State-of-the-Art Review

This paper aims to empower and inform cardio-oncologists by providing a practical guide to the clinical application of cardiac magnetic resonance (CMR) in the rapidly evolving field of cardio-oncology. Specifically, we describe how CMR can be used to assess the cardiovascular effects of cancer therapy. The CMR literature, relevant societal guidelines, indication-specific imaging protocols, and methods to overcome some of the challenges encountered in performing and accessing CMR are reviewed.

Prevalence and Clinical Relevance of Extracardiac Findings in Cardiovascular Magnetic Resonance Imaging

PURPOSE

To assess the prevalence of extracardiac findings (ECF) during cardiovascular magnetic resonance (CMR) examinations and their downstream effect on clinical management.

MATERIALS AND METHODS

We retrospectively identified 500 consecutive patients. Trans-axial balanced steady-state free precession nongated images acquired from the upper thorax to the upper abdomen were evaluated independently by 2 radiologists. ECF were classified as nonsignificant (benign, with no need for further investigation), significant (mandatory to be reported/monitored), and major (clinically remarkable pathology, mandatory to be reported/investigated/treated). Fifteen-month clinical follow-up information was collected through hospital records.

RESULTS

Of 500 patients, 108 (21.6%) showed a total of 153 ECF: 59 (11.8% of the entire study population; 38.5% of all ECF) nonsignificant, 76 (15.2%; 49.7%) significant, and 18 (3.6%; 11.8%) major ECF. The most frequent ECF were pleural effusion, hepatic cyst, renal cyst, and ascending aorta dilatation. Of 94 significant and major ECF, 46 were previously unknown and more common in older patients. Newly diagnosed major ECF (n=11, 2.2% of the entire study population, and 7.2% of all ECF)-including 5 tumors (1% of study population)-were confirmed by downstream evaluations and required specific treatment. Patients with major ECF were significantly older than patients without with major ECF. Newly diagnosed clinically significant and major ECF prompted downstream diagnostic tests in 44% and 100% of cases, respectively.

CONCLUSIONS

The detection of significant and major ECF is common during CMR reporting. The knowledge and the correct identification of most frequent ECF enable earlier diagnoses and faster treatment initiation of unknown extracardiac pathologies in patients referred to CMR imaging.

Potentially serious incidental findings on brain and body magnetic resonance imaging of apparently asymptomatic adults: systematic review and meta-analysis

OBJECTIVES

To determine prevalence and types of potentially serious incidental findings on magnetic resonance imaging (MRI) in apparently asymptomatic adults, describe factors associated with potentially serious incidental findings, and summarise information on follow-up and final diagnoses.

DESIGN

Systematic review and meta-analyses.

DATA SOURCES

Citation searches of relevant articles and authors' files in Medline and Embase (from inception to 25 April 2017).

REVIEW METHODS

Eligible studies included prevalence and types of incidental findings detected among apparently asymptomatic adults undergoing MRI of the brain, thorax, abdomen, or brain and body. Data on study population and methods, prevalence and types of incidental findings, and final diagnoses were extracted. Pooled prevalence was estimated by random effects meta-analysis, and heterogeneity by τ2 statistics.

MAIN OUTCOME MEASURES

Prevalence of potentially serious incidental findings on MRI of the brain, thorax, abdomen, and brain and body.

RESULTS

Of 5905 retrieved studies, 32 (0.5%) met the inclusion criteria (n=27 643 participants). Pooled prevalence of potentially serious incidental findings was 3.9% (95% confidence interval 0.4% to 27.1%) on brain and body MRI, 1.4% (1.0% to 2.1%) on brain MRI, 1.3% (0.2% to 8.1%) on thoracic MRI, and 1.9% (0.3% to 12.0%) on abdominal MRI. Pooled prevalence rose after including incidental findings of uncertain potential seriousness (12.8% (3.9% to 34.3%), 1.7% (1.1% to 2.6%), 3.0% (0.8% to 11.3%), and 4.5% (1.5% to 12.9%), respectively). There was generally substantial heterogeneity among included studies. About half the potentially serious incidental findings were suspected malignancies (brain, 0.6% (95% confidence interval 0.4% to 0.9%); thorax, 0.6% (0.1% to 3.1%); abdomen, 1.3% (0.2% to 9.3%); brain and body, 2.3% (0.3% to 15.4%)). There were few informative data on potential sources of between-study variation or factors associated with potentially serious incidental findings. Limited data suggested that relatively few potentially serious incidental findings had serious final diagnoses (48/234, 20.5%).

CONCLUSIONS

A substantial proportion of apparently asymptomatic adults will have potentially serious incidental findings on MRI, but little is known of their health consequences. Systematic, long term follow-up studies are needed to better inform on these consequences and the implications for policies on feedback of potentially serious incidental findings.

SYSTEMATIC REVIEW REGISTRATION

Prospero CRD42016029472.

Incidental Non-cardiac Findings in Cardiovascular Imaging

Improvements in imaging techniques have led to an expansion in the number of cross-sectional cardiac studies being performed. This means that incidental non-cardiac findings (INCF) identified on cardiac imaging have become an important clinical concern. The majority of INCF are not clinically significant. However, some INCF will require follow-up or changes in management. Differentiating clinically significant from non-significant INCF can be challenging, particularly given the breadth of potential findings and the range of organ systems involved. Following up INCF also has economic implications. Recent changes to the lung nodule follow-up guidelines will reduce the cost of following up incidental lung nodules. In this manuscript, we discuss the common and important INCF which may be identified in cardiovascular imaging and explore potential implications of these findings.

Prevalence and outcomes of incidental imaging findings: umbrella review

OBJECTIVE

To provide an overview of the evidence on prevalence and outcomes of incidental imaging findings.

DESIGN

Umbrella review of systematic reviews.

DATA SOURCES

Searches of MEDLINE, EMBASE up to August 2017; screening of references in included papers.

ELIGIBILITY CRITERIA

Criteria included systematic reviews and meta-analyses of observational studies that gave a prevalence of incidental abnormalities ("incidentalomas"). An incidental imaging finding was defined as an imaging abnormality in a healthy, asymptomatic patient or an imaging abnormality in a symptomatic patient, where the abnormality was not apparently related to the patient's symptoms. Primary studies that measured the prevalence of incidentalomas in patients with a history of malignancy were also considered in sensitivity analyses.

RESULTS

20 systematic reviews (240 primary studies) were identified from 7098 references from the database search. Fifteen systematic reviews provided data to quantify the prevalence of incidentalomas, whereas 18 provided data to quantify the outcomes of incidentalomas (13 provided both). The prevalence of incidentalomas varied substantially between imaging tests; it was less than 5% for chest computed tomography for incidental pulmonary embolism in patients with and without cancer and whole body positron emission tomography (PET) or PET/computed tomography (for patients with and without cancer). Conversely, incidentalomas occurred in more than a third of images in cardiac magnetic resonance imaging (MRI), chest computed tomography (for incidentalomas of thorax, abdomen, spine, or heart), and computed tomography colonoscopy (for extra-colonic incidentalomas). Intermediate rates occurred with MRI of the spine (22%) and brain (22%). The rate of malignancy in incidentalomas varied substantially between organs; the prevalence of malignancy was less than 5% in incidentalomas of the brain, parotid, and adrenal gland. Extra-colonic, prostatic, and colonic incidentalomas were malignant between 10% and 20% of the time, whereas renal, thyroid, and ovarian incidentalomas were malignant around a quarter of the time. Breast incidentalomas had the highest percentage of malignancy (42%, 95% confidence interval 31% to 54%). Many assessments had high between-study heterogeneity (15 of 20 meta-analyses with I2 >50%).

CONCLUSIONS

There is large variability across different imaging techniques both in the prevalence of incidentalomas and in the prevalence of malignancy for specific organs. This umbrella review will aid clinicians and patients weigh up the pros and cons of requesting imaging scans and will help with management decisions after an incidentaloma diagnosis. Our results can underpin the creation of guidelines to assist these decisions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO: CRD42017075679.

Extracardiac findings at cardiac MR imaging: a single-centre retrospective study over 14 years

OBJECTIVES

To determine the prevalence and significance of extracardiac findings (ECF) in a large set of cardiac magnetic resonance (MR) imaging examinations.

METHODS

The institutional review board (IRB) of the Charité approved this retrospective, single-centre study. A total of 4376 cardiac MR imaging reports of 3553 patients (age 37.4 ± 20 years, 60.8 % male) examined from 2000 to 2014 were included. Findings with a recommendation for follow-up were considered "major ECF". To analyse the association of indication, age and gender with ECF, Poisson regression and computed incidence rate ratios (IRR) were evaluated.

RESULTS

The overall prevalence of ECF was 34% (95% confidence interval [CI] 32.5-35.6%). Major ECF were present in 3.4% (95% CI 2.9-4.1%) while findings that changed patient management were found in 0.9% (95% CI 0.7-1.3%). In the cases of congenital heart disease, ECF prevalence was higher compared to myocarditis (IRR, 6.0; 95% CI 5.1-7.1%; p < 0.001), while the prevalence of major ECF was lower (IRR, 0.2; 95% CI 0.02-0.51%; p < 0.05). Older patient age was associated with more nonvascular ECF (p < 0.001). Female patients had the same probability of having an ECF as male patients (IRR, 1.04; 95% CI 0.95-1.1%; p = 0.43).

CONCLUSION

ECF in cardiac MR imaging are present in about every third patient while relevant ECF that change patient management can be found in about one out of 100 patients. Our data suggest that it is important to involve well-trained radiologists in reading cardiac MR images, which often reveal ECF if congenital heart disease is the clinical indication.

KEY POINTS

• Extracardiac findings are present in about every third patient. • Relevant ECF changing patient management are found in one out of 100 findings. • Chance of ECF is high in patients with CHD and vascular indications.

Incidental Extracardiac Findings and Their Characterization on Cardiac MRI

Background

Cardiac magnetic resonance imaging (cMRI) has recently emerged as a new noninvasive imaging modality that offers superior structural and functional assessment of the heart. cMRI benefits from a large field of view but, consequently, may capture incidental extracardiac findings (IEFs). We aimed to evaluate the frequency and significance of IEFs reported from clinically indicated cMRI scans.

Methods

742 consecutive patients (402 males and 340 females) referred to the Cardiac Magnetic Resonance Center of our University Hospital between January 2015 and December 2016 for clinically indicated cMRI were retrospectively enrolled for the evaluation of IEF prevalence and relevance. The median age of the subjects was 51 years (range: 5–85 years).

Results

A significant number of patients who underwent cMRI had incidental and clinically significant IEFs (2% of the population, 11.4% of cases). cMRI allowed a correct diagnosis in 116/131 cases with a diagnostic accuracy value of 88.5%.

Conclusions

IEFs on cMRI are not uncommon and lesions with mild or no clinical significance represent the most frequent findings. cMRI can characterize incidental findings with high accuracy in most cases.

Extra-cardiac findings in cardiovascular magnetic resonance: what the imaging cardiologist needs to know

Cardiovascular magnetic resonance (CMR) is an established non-invasive technique to comprehensively assess cardiovascular structure and function in a variety of acquired and inherited cardiac conditions. A significant amount of the neck, thorax and upper abdomen are imaged at the time of routine clinical CMR, particularly in the initial multi-slice axial and coronal images. The discovery of unsuspected disease at the time of imaging has ethical, financial and medico-legal implications. Extra-cardiac findings at the time of CMR are common, can be important and can change clinical management. Certain patient groups undergoing CMR are at particular risk of important extra-cardiac findings as several of the cardiovascular risk factors for atherosclerosis are also risk factors for malignancy. Furthermore, the presence of certain extra-cardiac findings may contribute to the interpretation of the primary cardiac pathology as some cardiac conditions have multi-systemic extra-cardiac involvement. The aim of this review is to give an overview of the type of extra-cardiac findings that may become apparent on CMR, subdivided by anatomical location. We focus on normal variant anatomy that may mimic disease, common incidental extra-cardiac findings and important imaging signs that help distinguish sinister pathology from benign disease. We also aim to provide a framework to the approach and potential further diagnostic work-up of incidental extra-cardiac findings discovered at the time of CMR. However, it is beyond the scope of this review to discuss and determine the clinical significance of extracardiac findings at CMR.