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Yamamoto K, Takeji Y, Taniguchi T, Morimoto T, Tabata H, Ishizu K, Morofuji T, Hayashi M, Isotani A, Shirai S, Ohno N, Kakumoto S, Ando K, Minatoya K, Kimura T. Clinically significant incidental noncardiac findings on preprocedural computed tomography in patients with aortic stenosis undergoing aortic-valve replacement. J Cardiol 2024:S0914-5087(24)00087-X. [PMID: 38754762 DOI: 10.1016/j.jjcc.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND There is a scarcity of data on the prevalence of abnormal findings on preprocedural computed tomography (CT) before aortic valve replacement (AVR) in patients with aortic stenosis (AS). METHODS Among consecutive 593 patients with severe AS who were planned to undergo AVR, we evaluated the prevalence of clinically significant incidental noncardiac findings on preprocedural CT. Clinically significant incidental noncardiac findings were defined as newly detected abnormalities that required therapy, consultation for expert, further investigation, or clinical follow-up. RESULTS The mean age was 82.0 years and 39.5 % of the patients were men. Of those, 78.4 % of the patients were treated with transcatheter aortic valve implantation (TAVI) and 21.6 % of the patients were treated with surgical AVR (SAVR). There were 271 clinically significant incidental noncardiac findings in 227 patients (38.3 %) including 2.5 % of malignancy. The prevalence of clinically significant incidental noncardiac findings were higher in the TAVI group than in the SAVR group (40.2 % versus 31.3 %). The prevalence of clinically significant incidental noncardiac findings were lower in patients under 60 years of age (10.0 %) than in patients over 60 years of age (60-69 years: 40.0 %, 70-79 years: 34.3 %, 80-89 years: 39.7 %, and ≥90 years: 42.1 %). CONCLUSIONS Clinically significant incidental noncardiac findings were newly identified on preprocedural CT in approximately 40 % of patients with severe AS undergoing AVR including 2.5 % of malignancy.
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Affiliation(s)
- Ko Yamamoto
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroyuki Tabata
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kenichi Ishizu
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Toru Morofuji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Masaomi Hayashi
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Akihiro Isotani
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shinichi Kakumoto
- Department of Anesthesiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan.
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2
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Catapano F, Moser LJ, Francone M, Catalano C, Vliegenthart R, Budde RPJ, Salgado R, Hrabak Paar M, Pirnat M, Loewe C, Nikolaou K, Williams MC, Muscogiuri G, Natale L, Lehmkuhl L, Sieren MM, Gutberlet M, Alkadhi H. Competence of radiologists in cardiac CT and MR imaging in Europe: insights from the ESCR Registry. Eur Radiol 2024:10.1007/s00330-024-10644-4. [PMID: 38418626 DOI: 10.1007/s00330-024-10644-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
RATIONALE To provide an overview of the current status of cardiac multimodality imaging practices in Europe and radiologist involvement using data from the European Society of Cardiovascular Radiology (ESCR) MRCT-registry. MATERIALS AND METHODS Numbers on cardiac CT and MRI examinations were extracted from the MRCT-registry of the ESCR, entered between January 2011 and October 2023 (n = 432,265). Data collection included the total/annual numbers of examinations, indications, complications, and reporting habits. RESULTS Thirty-two countries contributed to the MRCT-registry, including 29 European countries. Between 2011 and 2022, there was a 4.5-fold increase in annually submitted CT examinations, from 3368 to 15,267, and a 3.8-fold increase in MRI examinations, from 3445 to 13,183. The main indications for cardiac CT were suspected coronary artery disease (CAD) (59%) and transcatheter aortic valve replacement planning (21%). The number of patients with intermediate pretest probability who underwent CT for suspected CAD showed an increase from 61% in 2012 to 82% in 2022. The main MRI indications were suspected myocarditis (26%), CAD (21%), and suspected cardiomyopathy (19%). Adverse event rates were very low for CT (0.3%) and MRI (0.7%) examinations. Reporting of CT and MRI examinations was performed mainly by radiologists (respectively 76% and 71%) and, to a lesser degree, in consensus with non-radiologists (19% and 27%, respectively). The remaining examinations (4.9% CT and 1.7% MRI) were reported by non-radiological specialties or in separate readings of radiologists and non-radiologists. CONCLUSIONS Real-life data on cardiac imaging in Europe using the largest available MRCT-registry demonstrate a considerable increase in examinations over the past years, the vast majority of which are read by radiologists. These findings indicate that radiologists contribute to meeting the increasing demands of competent and effective care in cardiac imaging to a relevant extent. CLINICAL RELEVANCE STATEMENT The number of cardiac CT and MRI examinations has risen over the past years, and radiologists read the vast majority of these studies as recorded in the MRCT-registry. KEY POINTS • The number of cardiac imaging examinations is constantly increasing. • Radiologists play a central role in providing cardiac CT and MR imaging services to a large volume of patients. • Cardiac CT and MR imaging examinations performed and read by radiologists show a good safety profile.
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Affiliation(s)
- Federica Catapano
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Lukas Jakob Moser
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Marco Francone
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rodrigo Salgado
- Department of Radiology, Antwerp University Hospital & Antwerp University, Holy Heart Lier, Lier, Belgium
| | - Maja Hrabak Paar
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Maja Pirnat
- Radiology Department, University Medical Centre Maribor, Maribor, Slovenia
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Giuseppe Muscogiuri
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
- University of Milano-Bicocca, Milan, Italy
| | - Luigi Natale
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, A. Gemelli University Hospital, Rome, Italy
| | - Lukas Lehmkuhl
- Clinic for Radiology, Heart Center Bad Neustadt a.d. Saale, Bad Neustadt a.d. Saale, Germany
| | - Malte Maria Sieren
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Ratzeburger Lübeck, Germany
- Institute of Interventional Radiology, University Hospital Schleswig-Holstein, Ratzeburger Lübeck, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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3
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Kotadia ID, O'Dowling R, Aboagye A, Crawley RJ, Bodagh N, Gharaviri A, O'Hare D, Solis‐Lemus JA, Roney CH, Sim I, Ramsey D, Newby D, Chiribiri A, Plein S, Sztriha L, Scott P, Masci P, Harrison J, Williams MC, Birns J, Somerville P, Bhalla A, Niederer S, O'Neill M, Williams SE. High Prevalence of New Clinically Significant Findings in Patients With Embolic Stroke of Unknown Source Evaluated by Cardiac Magnetic Resonance Imaging. J Am Heart Assoc 2024; 13:e031489. [PMID: 38240222 PMCID: PMC11056130 DOI: 10.1161/jaha.123.031489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/05/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Embolic stroke of unknown source (ESUS) accounts for 1 in 6 ischemic strokes. Current guidelines do not recommend routine cardiac magnetic resonance (CMR) imaging in ESUS, and beyond the identification of cardioembolic sources, there are no data assessing new clinical findings from CMR in ESUS. This study aimed to assess the prevalence of new cardiac and noncardiac findings and to determine their impact on clinical care in patients with ESUS. METHODS AND RESULTS In this prospective, multicenter, observational study, CMR imaging was performed within 3 months of ESUS. All scans were reported according to standard clinical practice. A new clinical finding was defined as one not previously identified through prior clinical evaluation. A clinically significant finding was defined as one resulting in further investigation, follow-up, or treatment. A change in patient care was defined as initiation of medical, interventional, surgical, or palliative care. From 102 patients recruited, 96 underwent CMR imaging. One or more new clinical findings were observed in 59 patients (61%). New findings were clinically significant in 48 (81%) of these patients. Of 40 patients with a new clinically significant cardiac finding, 21 (53%) experienced a change in care (medical therapy, n=15; interventional/surgical procedure, n=6). In 12 patients with a new clinically significant extracardiac finding, 6 (50%) experienced a change in care (medical therapy, n=4; palliative care, n=2). CONCLUSIONS CMR imaging identifies new clinically significant cardiac and noncardiac findings in half of patients with recent ESUS. Advanced cardiovascular screening should be considered in patients with ESUS. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04555538.
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Affiliation(s)
- Irum D. Kotadia
- School of Biomedical Engineering and Imaging Sciences, King’s College LondonLondonUnited Kingdom
- Guy’s and St Thomas’ National Health Service Foundation TrustLondonUnited Kingdom
| | - Robert O'Dowling
- Guy’s and St Thomas’ National Health Service Foundation TrustLondonUnited Kingdom
| | - Akosua Aboagye
- Guy’s and St Thomas’ National Health Service Foundation TrustLondonUnited Kingdom
| | - Richard J. Crawley
- School of Biomedical Engineering and Imaging Sciences, King’s College LondonLondonUnited Kingdom
| | - Neil Bodagh
- School of Biomedical Engineering and Imaging Sciences, King’s College LondonLondonUnited Kingdom
| | - Ali Gharaviri
- Centre for Cardiovascular Science, The University of EdinburghEdinburghUnited Kingdom
| | - Daniel O'Hare
- School of Biomedical Engineering and Imaging Sciences, King’s College LondonLondonUnited Kingdom
| | - Jose Alonso Solis‐Lemus
- School of Biomedical Engineering and Imaging Sciences, King’s College LondonLondonUnited Kingdom
| | - Caroline H. Roney
- School of Biomedical Engineering and Imaging Sciences, King’s College LondonLondonUnited Kingdom
| | - Iain Sim
- School of Biomedical Engineering and Imaging Sciences, King’s College LondonLondonUnited Kingdom
| | | | - David Newby
- Centre for Cardiovascular Science, The University of EdinburghEdinburghUnited Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King’s College LondonLondonUnited Kingdom
| | - Sven Plein
- School of Biomedical Engineering and Imaging Sciences, King’s College LondonLondonUnited Kingdom
| | | | - Paul Scott
- King’s College HospitalLondonUnited Kingdom
| | - Pier‐Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King’s College LondonLondonUnited Kingdom
| | | | - Michelle C. Williams
- Centre for Cardiovascular Science, The University of EdinburghEdinburghUnited Kingdom
| | - Jonathan Birns
- Guy’s and St Thomas’ National Health Service Foundation TrustLondonUnited Kingdom
| | - Peter Somerville
- Guy’s and St Thomas’ National Health Service Foundation TrustLondonUnited Kingdom
| | - Ajay Bhalla
- Guy’s and St Thomas’ National Health Service Foundation TrustLondonUnited Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College LondonLondonUnited Kingdom
| | - Mark O'Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College LondonLondonUnited Kingdom
- Guy’s and St Thomas’ National Health Service Foundation TrustLondonUnited Kingdom
| | - Steven E. Williams
- School of Biomedical Engineering and Imaging Sciences, King’s College LondonLondonUnited Kingdom
- Centre for Cardiovascular Science, The University of EdinburghEdinburghUnited Kingdom
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4
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Mumtaz ZUA, Desai SR, Padley SPG. Frequency of extracardiac findings on "negative" CT coronary angiography studies. Clin Radiol 2024; 79:e334-e343. [PMID: 38092649 DOI: 10.1016/j.crad.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 01/02/2024]
Abstract
AIM To evaluate the prevalence and nature of extracardiac findings identified on computed tomography (CT) coronary angiography (CTCA) in patients with chest pain but without evidence of coronary artery disease (CAD). MATERIALS AND METHODS CTCA studies in patients referred to the hospital between January 2017 to February 2021 with chest pain and a suspected diagnosis of CAD were reviewed retrospectively for the presence of extracardiac findings. Consensus review of CTCA studies was performed by two experienced thoracic radiologists. The presence and severity of extracardiac findings, together with the likelihood that chest pain might be attributed to these, was recorded. Patient records were reviewed to ascertain the recording of extracardiac findings on initial CTCA reports and, where applicable, the nature of the follow-up. RESULTS Extracardiac findings (n=210) were present in 110/180 patients (61%) with a mean of 1.9 findings per patient. Extracardiac findings were more prevalent in patients aged ≥65 years compared to those <65 years (p<0.001). At least one extracardiac finding with the potential to cause chest pain was present in 40 patients (22%): degenerative disc disease (n=23 [13%]) and hiatus hernia (n=6 [3.3%]) were the most common extracardiac findings. Only 37.6% (79) of all retrospectively identified findings had been initially reported and, of these, 12.7% (10) required further follow-up. CONCLUSION Extracardiac findings are common in patients with no evidence of CAD on CTCA. The entire dataset should be evaluated for the presence of extracardiac findings that could explain chest pain symptoms on wide field of view reconstructions.
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Affiliation(s)
- Z-U-A Mumtaz
- Faculty of Medicine, Imperial College School of Medicine, London, UK.
| | - S R Desai
- Department of Radiology, Royal Brompton and Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK; Margaret Turner-Warwick Centre for Fibrosing Lung Diseases, Imperial College London, UK
| | - S P G Padley
- Department of Radiology, Royal Brompton and Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
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5
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Chiong J, Ramkumar PG, Weir NW, Weir-McCall JR, Nania A, Shaw LJ, Einstein AJ, Dweck MR, Mills NL, Newby DE, van Beek EJR, Roditi G, Williams MC. Evaluating Radiation Exposure in Patients with Stable Chest Pain in the SCOT-HEART Trial. Radiology 2023; 308:e221963. [PMID: 37526539 PMCID: PMC10478793 DOI: 10.1148/radiol.221963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 05/19/2023] [Accepted: 06/09/2023] [Indexed: 08/02/2023]
Abstract
Background In the Scottish Computed Tomography of the Heart (SCOT-HEART) trial in individuals with stable chest pain, a treatment strategy based on coronary CT angiography (CTA) led to improved outcomes. Purpose To assess 5-year cumulative radiation doses of participants undergoing investigation for suspected angina due to coronary artery disease with or without coronary CTA. Materials and Methods This secondary analysis of the SCOT-HEART trial included data from six of 12 recruiting sites and two of three imaging sites. Participants were recruited between November 18, 2010, and September 24, 2014, with follow-up through January 31, 2018. Study participants had been randomized (at a one-to-one ratio) to standard care with CT (n = 1466) or standard care alone (n = 1428). Imaging was performed on a 64-detector (n = 223) or 320-detector row scanner (n = 1466). Radiation dose from CT (dose-length product), SPECT (injected activity), and invasive coronary angiography (ICA; kerma-area product) was assessed for 5 years after enrollment. Effective dose was calculated using conversion factors appropriate for the imaging modality and body region imaged (using 0.026 mSv/mGy · cm for cardiac CT). Results Cumulative radiation dose was assessed in 2894 participants. Median effective dose was 3.0 mSv (IQR, 2.6-3.3 mSv) for coronary calcium scoring, 4.1 mSv (IQR, 2.6-6.1 mSv) for coronary CTA, 7.4 mSv (IQR, 6.2-8.5 mSv) for SPECT, and 4.1 mSv (IQR, 2.5-6.8 mSv) for ICA. After 5 years, total per-participant cumulative dose was higher in the CT group (median, 8.1 mSv; IQR, 5.5-12.4 mSv) compared with standard-care group (median, 0 mSv; IQR, 0-4.5 mSv; P < .001). In participants who underwent any imaging, cumulative radiation exposure was higher in the CT group (n = 1345; median, 8.6 mSv; IQR, 6.1-13.3 mSv) compared with standard-care group (n = 549; median, 6.4 mSv; IQR, 3.4-9.2 mSv; P < .001). Conclusion In the SCOT-HEART trial, the 5-year cumulative radiation dose from cardiac imaging was higher in the coronary CT angiography group compared with the standard-care group, largely because of the radiation exposure from CT. Clinical trial registration no. NCT01149590 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Dodd and Bosserdt in this issue.
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Affiliation(s)
- Justin Chiong
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Prasad Guntur Ramkumar
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Nicholas W. Weir
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Jonathan R. Weir-McCall
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Alberto Nania
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Leslee J. Shaw
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Andrew J. Einstein
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Marc R. Dweck
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Nicholas L. Mills
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - David E. Newby
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Edwin J. R. van Beek
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Giles Roditi
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Michelle C. Williams
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
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6
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Kontos MC, de Lemos JA, Deitelzweig SB, Diercks DB, Gore MO, Hess EP, McCarthy CP, McCord JK, Musey PI, Villines TC, Wright LJ. 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2022; 80:1925-1960. [PMID: 36241466 PMCID: PMC10691881 DOI: 10.1016/j.jacc.2022.08.750] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Pinto E, Penha D, Hochhegger B, Monaghan C, Marchiori E, Taborda-Barata L, Irion K. Variability of pulmonary nodule volumetry on coronary CT angiograms. Medicine (Baltimore) 2022; 101:e30332. [PMID: 36107569 PMCID: PMC9439735 DOI: 10.1097/md.0000000000030332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to investigate the variability of pulmonary nodule (PN) volumetry on multiphase coronary CT angiograms (CCTA). Two radiologists reviewed 5973 CCTA scans in this cross-sectional study to detect incidental solid noncalcified PNs measuring between 5 and 8 mm. Each radiologist measured the nodules' diameters and volume, in systole and diastole, using 2 commercially available software packages to analyze PNs. Bland-Altman analysis was applied between different observers, software packages, and cardiac phases. Bland-Altman subanalysis for the systolic and diastolic datasets were also performed. A total of 195 PNs were detected within the inclusion criteria and measured in systole and diastole. Bland-Altman analysis was used to test the variability of volumetry between cardiac phases ([-47.0%; 52.3%]), software packages ([-50.2%; 68.2%]), and observers ([-14.5%; 27.8%]). The inter-observer variability of the systolic and diastolic subsets was [-13.6%; 31.4%] and [-13.9%; 19.7%], respectively. Using diastolic volume measurements, the variability of PN volumetry on CCTA scans is similar to the reported variability of volumetry on low-dose CT scans. Therefore, growth estimation of PNs on CCTA scans could be feasible.
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Affiliation(s)
- Erique Pinto
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal
- *Correspondence: Erique Pinto, MD, EBIR, Rua Luís DE Camões, nº 102, lt 8, 3º esq, 1300—356 Lisbon, Portugal. (e-mail: )
| | - Diana Penha
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal
- Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Bruno Hochhegger
- Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Colin Monaghan
- Radiology Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro Faculdade de Medicina, Rio DE Janeiro, RJ, Brazil
- Universidade Federal Fluminense Faculdade de Medicina, Niteroi, RJ, Brazil
| | | | - Klaus Irion
- Imaging Department, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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8
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Knol WG, den Harder AM, de Heer LM, Benke K, Maurovich-Horvat P, Leiner T, Merkely B, Krestin GP, Bogers AJ, Budde RP. Incidental findings on routine preoperative noncontrast chest computed tomography and chest radiography prior to cardiac surgery in the multicenter randomized controlled CRICKET study. Eur Radiol 2022; 33:294-301. [DOI: 10.1007/s00330-022-09001-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/13/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Abstract
Abstract
Objective
To describe the prevalence and consequences of incidental findings when implementing routine noncontrast CT prior to cardiac surgery.
Methods
In the multicenter randomized controlled CRICKET study, 862 adult patients scheduled for cardiac surgery were randomized 1:1 to undergo standard of care (SoC), which included a chest-radiograph, or an additional preoperative noncontrast chest CT-scan (SoC+CT). In this subanalysis, all incidental findings detected on the chest radiograph and CT-scan were analyzed. The influence of smoking status on incidental findings was also evaluated, adjusting for sex, age, and group allocation.
Results
Incidental findings were observed in 11.4% (n = 49) of patients in the SoC+CT group and in 3.7% (n = 16) of patients in the SoC-group (p < 0.001). The largest difference was observed in findings requiring follow-up (SoC+CT 7.7% (n = 33) vs SoC 2.3% (n = 10), p < 0.001). Clinically relevant findings changing the surgical approach or requiring specific treatment were observed in 10 patients (1.2%, SoC+CT: 1.6% SoC: 0.7%), including lung cancer in 0.5% of patients (n = 4) and aortic dilatation requiring replacement in 0.2% of patients (n = 2). Incidental findings were more frequent in patients who stopped smoking (OR 1.91, 1.03–3.63) or who actively smoked (OR 3.91, 1.85–8.23).
Conclusions
Routine CT-screening increases the rate of incidental findings, mainly by identifying more pulmonary findings requiring follow-up. Incidental findings are more prevalent in patients with a history of smoking, and preoperative CT might increase the yield of identifying lung cancer in these patients. Incidental findings, but not specifically the use of routine CT, are associated with delay of surgery.
Key Points
• Clinically relevant incidental findings are identified more often after a routine preoperative CT-scan, when compared to a standard of care workup, with some findings changing patient management.
• Patients with a history of smoking have a higher rate of incidental findings and a lung cancer rate comparable to that of lung cancer screening trials.
• We observed no clear delay in the time to surgery when adding routine CT screening.
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9
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Pinto E, Penha D, Hochhegger B, Monaghan C, Marchiori E, Taborda-Barata L, Irion K. Incidental chest findings on coronary CT angiography: a pictorial essay and management proposal. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2022; 48:e20220015. [PMID: 35584528 PMCID: PMC9064655 DOI: 10.36416/1806-3756/e20220015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022]
Abstract
Many health systems have been using coronary CT angiography (CCTA) as a first-line examination for ischaemic heart disease patients in various countries. The rising number of CCTA examinations has led to a significant increase in the number of reported incidental extracardiac findings, mainly in the chest. Pulmonary nodules are the most common incidental findings on CCTA scans, as there is a substantial overlap of risk factors between the population seeking to exclude ischaemic heart disease and those at risk of developing lung cancer (i.e., advanced age and smoking habits). However, most incidental findings are clinically insignificant and actively pursuing them could be cost-prohibitive and submit the patient to unnecessary and potentially harmful examinations. Furthermore, there is little consensus regarding when to report or actively exclude these findings and how to manage them, that is, when to trigger an alert or to immediately refer the patient to a pulmonologist, a thoracic surgeon or a multidisciplinary team. This pictorial essay discusses the current literature on this topic and is illustrated with a review of CCTA scans. We also propose a checklist organised by organ and system, recommending actions to raise awareness of pulmonologists, thoracic surgeons, cardiologists and radiologists regarding the most significant and actionable incidental findings on CCTA scans.
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Affiliation(s)
- Erique Pinto
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Diana Penha
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.,. Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Bruno Hochhegger
- . Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Colin Monaghan
- . Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Edson Marchiori
- . Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil.,. Faculdade de Medicina, Universidade Federal Fluminense, Niterói (RJ) Brasil
| | - Luís Taborda-Barata
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Klaus Irion
- . Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
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Kelion A, Sabharwal N, Holdsworth D, Dawkins S, Peschl H, Sykes A, Bashir Y. Clinical and economic impact of extracardiac lesions on coronary CT angiography. Heart 2022; 108:1461-1466. [DOI: 10.1136/heartjnl-2021-320698] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/28/2022] [Indexed: 12/17/2022] Open
Abstract
ObjectiveWhen reporting coronary CT angiography (CCTA), extracardiac structures are routinely assessed, usually on a wide field-of-view (FOV) reconstruction. We performed a retrospective observational cross-sectional study to investigate the impact of incidental extracardiac abnormalities on resource utilisation and treatment, and cost-effectiveness.MethodsAll patients undergoing CCTA at a single institution between January 2012 and March 2020 were identified. The indication for CCTA was chest pain or dyspnoea in >90%. Patients with ≥1 significant extracardiac findings were selected. Clinical follow-up, investigations and treatment were documented, and costs were calculated.Results4340 patients underwent CCTA; 717 extracardiac abnormalities were identified in 687 individuals (15.8%; age 62±12 years; male 336, 49%). The abnormality was already known in 162 (23.6%). Lung nodules and cysts were the most common abnormalities (296, 43.1%). Clinical and/or imaging follow-up was pursued in 292 patients (42.5%). Treatment was required by 14 patients (0.3% of the entire population), including lung resection for adenocarcinoma in six (0.1%). All but two abnormalities (both adenocarcinomas) were identifiable on the limited cardiac FOV. The cost of reporting (£20) and follow-up (£33) of extracardiac abnormalities was £53 per patient. The cost per discounted quality-adjusted life year was £23 930, increasing to £46 674 for reporting the wide FOV rather than the cardiac FOV alone.ConclusionsExtracardiac abnormalities are common on CCTA, but identification and follow-up are costly. The few requiring treatment are usually identifiable without review of the wide FOV. The way in which CCTAs are scrutinised for extracardiac abnormalities in a resource-limited healthcare system should be questioned.
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Coronary Computed Tomography Angiography Results in More Computed Tomography Chest Follow-up for Incidental Findings at 1 Year Relative to Stress-perfusion Cardiac Magnetic Resonance Imaging. J Thorac Imaging 2022; 37:292-299. [DOI: 10.1097/rti.0000000000000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Luu JM, Sergeant AK, Anand SS, Desai D, Schulze K, Knoppers BM, Zawati MH, Smith EE, Moody AR, Black SE, Larose E, Marcotte F, Kleiderman E, Tardif JC, Lee DS, Friedrich MG. The impact of reporting magnetic resonance imaging incidental findings in the Canadian alliance for healthy hearts and minds cohort. BMC Med Ethics 2021; 22:145. [PMID: 34711210 PMCID: PMC8551943 DOI: 10.1186/s12910-021-00706-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 09/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies. METHODS Between 2013 and 2019, 8252 participants (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported. RESULTS Severe structural abnormalities occurred in 8.3% (95% confidence interval 7.7-8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy. CONCLUSION The management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT02220582 .
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Affiliation(s)
- Judy M Luu
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
| | - Anand K Sergeant
- Arts and Science Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Sonia S Anand
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada. .,Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Dipika Desai
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
| | - Karleen Schulze
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada.,Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Bartha M Knoppers
- Centre of Genomics and Policy, McGill University, 740 Dr Penfield Ave, Suite 5200, Montréal, QC, H3A 0G1, Canada
| | - Ma'n H Zawati
- Centre of Genomics and Policy, McGill University, 740 Dr Penfield Ave, Suite 5200, Montréal, QC, H3A 0G1, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Alan R Moody
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada
| | - Sandra E Black
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Eric Larose
- Institut Universitaire de Cardiologie Et de Pneumologie de Québec - Université Laval, 2725 chemin Sainte-Foy, Québec, G1V 4G5, Canada
| | - Francois Marcotte
- School of Population and Public Health and Cancer Control Research, BC Cancer, University of British Columbia, 675 W 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Erika Kleiderman
- Centre of Genomics and Policy, McGill University, 740 Dr Penfield Ave, Suite 5200, Montréal, QC, H3A 0G1, Canada
| | - Jean-Claude Tardif
- Research Centre, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Douglas S Lee
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Matthias G Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
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Kilsdonk ID, de Roos MP, Bresser P, Reesink HJ, Peringa J. Frequency and spectrum of incidental findings when using chest CT as a primary triage tool for COVID-19. Eur J Radiol Open 2021; 8:100366. [PMID: 34189189 PMCID: PMC8226060 DOI: 10.1016/j.ejro.2021.100366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 01/22/2023] Open
Abstract
Of the 232 participants triaged with chest CT for COVID-19, 126 (54 %) showed one or more incidental findings (IF). 53 Participants (23 %) showed a potentially significant IF. A potentially significant IF requires further diagnostic or clinical work up. The most common potentially significant IFs were coronary artery calcifications, suspicious breast- and pulmonary nodules.
Purpose To determine the prevalence and spectrum of incidental findings (IFs) identified in patients undergoing chest CT as a primary triage tool for COVID-19. Methods In this study 232 patients were triaged in our COVID-19 Screening Unit by means of a chest CT (March 25–April 23, 2020). Original radiology reports were evaluated retrospectively for the description of IFs, which were defined as any finding in the report not related to the purpose of the scan. Documented IFs were categorized according to clinical relevance into minor and potentially significant IFs and according to anatomical location into pulmonary, mediastinal, cardiovascular, breast, upper abdominal and skeletal categories. IFs were reported as frequencies and percentages; descriptive statistics were used. Results In total 197 IFs were detected in 126 patients (54 % of the participants). Patients with IFs were on average older (54.0 years old, SD 16.6) than patients without IFs (44.8 years old, SD 14.6, P < 0.05). In total 60 potentially significant IFs were detected in 53 patients (23 % of the participants). Most often reported were coronary artery calcifications (n = 23, 38 % of total potentially significant IFs/ 10 % of the total study population), suspicious breast nodules (n = 7, 12 % of total potentially significant IFs/ 3% of the total study population) and pulmonary nodules (n = 7, 12 % of total potentially significant IFs/ 3% of the total study population). Conclusion A considerable number of IFs were detected by using chest CT as a primary triage tool for COVID-19, of which a substantial percentage (23 %) is potentially clinically relevant.
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Affiliation(s)
- Iris D. Kilsdonk
- Department of Radiology, OLVG Hospital, Amsterdam, the Netherlands
- Corresponding author at: OLVG Hospital Amsterdam, Dept. of Radiology, Oosterpark 9, 1091 AC, Amsterdam, the Netherlands.
| | - Marlise P. de Roos
- Department of Pulmonary Medicine, OLVG Hospital, Amsterdam, the Netherlands
| | - Paul Bresser
- Department of Pulmonary Medicine, OLVG Hospital, Amsterdam, the Netherlands
| | - Herre J. Reesink
- Department of Pulmonary Medicine, OLVG Hospital, Amsterdam, the Netherlands
| | - Jan Peringa
- Department of Radiology, OLVG Hospital, Amsterdam, the Netherlands
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Laskowski D, Feger S, Bosserdt M, Zimmermann E, Mohamed M, Kendziora B, Rief M, Dreger H, Estrella M, Dewey M. Detection of relevant extracardiac findings on coronary computed tomography angiography vs. invasive coronary angiography. Eur Radiol 2021; 32:122-131. [PMID: 34129067 PMCID: PMC8660731 DOI: 10.1007/s00330-021-07967-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/11/2021] [Accepted: 03/31/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To compare the detection of relevant extracardiac findings (ECFs) on coronary computed tomography angiography (CTA) and invasive coronary angiography (ICA) and evaluate the potential clinical benefit of their detection. METHODS This is the prespecified subanalysis of ECFs in patients presenting with a clinical indication for ICA based on atypical angina and suspected coronary artery disease (CAD) included in the prospective single-center randomized controlled Coronary Artery Disease Management (CAD-Man) study. ECFs requiring immediate therapy and/or further workup including additional imaging were defined as clinically relevant. We evaluated the scope of ECFs in 329 patients and analyzed the potential clinical benefit of their detection. RESULTS ECFs were detected in 107 of 329 patients (32.5%; CTA: 101/167, 60.5%; ICA: 6/162, 3.7%; p < .001). Fifty-nine patients had clinically relevant ECFs (17.9%; CTA: 55/167, 32.9%; ICA: 4/162, 2.5%; p < .001). In the CTA group, ECFs potentially explained atypical chest pain in 13 of 101 patients with ECFs (12.9%). After initiation of therapy, chest pain improved in 4 (4.0%) and resolved in 7 patients (6.9%). Follow-up imaging was recommended in 33 (10.0%; CTA: 30/167, 18.0%; ICA: 3/162, 1.9%) and additional clinic consultation in 26 patients (7.9%; CTA: 25/167, 15.0%; ICA: 1/162, 0.6%). Malignancy was newly diagnosed in one patient (0.3%; CTA: 1/167, 0.6%; ICA: 0). CONCLUSIONS In this randomized study, CTA but not ICA detected clinically relevant ECFs that may point to possible other causes of chest pain in patients without CAD. Thus, CTA might preclude the need for ICA in those patients. TRIAL REGISTRATION NCT Unique ID: 00844220 KEY POINTS: • CTA detects ten times more clinically relevant ECFs than ICA. • Actionable clinically relevant ECFs affect patient management and therapy and may thus improve chest pain. • Detection of ECFs explaining chest pain on CTA might preclude the need for performing ICA.
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Affiliation(s)
- Dominik Laskowski
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Feger
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maria Bosserdt
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Elke Zimmermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Mahmoud Mohamed
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Benjamin Kendziora
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Rief
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Henryk Dreger
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Melanie Estrella
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,Berlin Institute of Health and DZHK (German Centre for Cardiovascular Research) Partner Site, Berlin, Germany.
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15
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Incidental findings in a referral pathway for non-specific cancer symptoms. Clin Imaging 2021; 77:9-12. [PMID: 33610971 DOI: 10.1016/j.clinimag.2021.01.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/19/2021] [Accepted: 01/30/2021] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVES To determine the prevalence of incidental findings and define the rate and outcomes of further investigations in a referral pathway for patients with non-specific cancer symptoms. MATERIAL AND METHODS Incidental findings in each category of a structured report were documented and details of subsequent investigations were obtained from the local PACS and Electronic Patient Record system. RESULTS 1034 patients were included. Of these, 11% were diagnosed with cancer. The majority of patients (95%) had at least one additional finding reported. The majority of these were minor, but in 140 cases (14%), additional findings were considered to be of clinical significance. Further investigations were performed in 330 patients who did not receive a diagnosis of cancer (32%). In 301 patients (29%), further investigations were normal or non-significant. In 75 cases (7%), ongoing surveillance was required. Specialist referral was recommended for 102 patients (10%) who did not receive a diagnosis of cancer. CONCLUSIONS In this cohort, there was a high rate of non-significant incidental findings and normal further investigations. However, these risks are likely to be outweighed by the high number of cancer diagnoses and significant non-cancer findings.
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Malahfji M, Al-Mallah MH. Incidental findings on cardiac computed tomography: No new emergencies to declare! J Nucl Cardiol 2020; 27:2316-2319. [PMID: 30911951 DOI: 10.1007/s12350-019-01691-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Maan Malahfji
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA.
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17
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Amin SB, Stillman AE. SCOT-HEART trial: reshuffling our approach to stable ischemic heart disease. Br J Radiol 2020; 93:20190763. [PMID: 31642694 PMCID: PMC7465862 DOI: 10.1259/bjr.20190763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 11/05/2022] Open
Abstract
The role of diagnostic testing in triaging patients with stable ischemic heart disease continues to evolve towards recognizing the benefits of coronary CT angiography (CCTA) over functional testing. The SCOT-HEART (Scottish Computed Tomography of the HEART) trial highlights this paradigm shift finding a significant reduction of death from coronary heart disease or non-fatal myocardial infarction without a significant increased rate of invasive coronary angiography over a 5 year follow-up period when implementing CCTA with standard care vs standard care alone. The better negative predictive value and ability to identify nonobstructive coronary artery disease to optimize medical therapy highlight the benefits of a CCTA first strategy. With the advent of noninvasive fractional flow reserve (FFR) and widespread availability and ease of CT, CCTA continues to establish itself as a pivotal diagnostic exam for patients with stable ischemic heart disease. In this commentary, we review the SCOT-HEART trial and its impact on CCTA for patients with stable ischemic heart disease.
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Affiliation(s)
- Sagar B Amin
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Arthur E Stillman
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
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18
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Conventional Computed Tomographic Calcium Scoring vs full chest CTCS for lung cancer screening: a cost-effectiveness analysis. BMC Pulm Med 2020; 20:187. [PMID: 32631384 PMCID: PMC7336401 DOI: 10.1186/s12890-020-01221-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 06/22/2020] [Indexed: 11/12/2022] Open
Abstract
Background Conventional CTCS images the mid/lower chest for coronary artery disease (CAD). Because many CAD patients are also at risk for lung malignancy, CTCS often discovers incidental pulmonary nodules (IPN). CTCS excludes the upper chest, where malignancy is common. Full-chest CTCS (FCT) may be a cost-effective screening tool for IPN. Methods A decision tree was created to compare a FCT to CTCS in a hypothetical patient cohort with suspected CAD. (Figure) The design compares the effects of missed cancers on CTCS with the cost of working up non-malignant nodules on FCT. The model was informed by results of the National Lung Screening Trial and literature review, including the rate of malignancy among patients receiving CTCS and the rate of malignancy in upper vs lower portions of the lung. The analysis outcomes are Quality-Adjusted Life Year (QALY) and incremental cost-effectiveness ratio (ICER), which is generally considered beneficial when <$50,000/QALY. Results Literature review suggests that rate of IPNs in the upper portion of the lung varied from 47 to 76%. Our model assumed that IPNs occur in upper and lower portions of the lung with equal frequency. The model also assumes an equal malignancy potential in upper lung IPNs despite data that malignancy occurs 61–66% in upper lung fields. In the base case analysis, a FCT will lead to an increase of 0.03 QALYs comparing to conventional CTCS (14.54 vs 14.51 QALY, respectively), which translates into an QALY increase of 16 days. The associated incremental cost for FCT is $278 ($1027 vs $748, FCT vs CTCS respectively. The incremental cost-effectiveness ratio (ICER) is $10,289/QALY, suggesting significant benefit. Sensitivity analysis shows this benefit increases proportional to the rate of malignancy in upper lung fields. Conclusion Conventional CTCS may be a missed opportunity to screen for upper lung field cancers in high risk patients. The ICER of FCT is better than screening for breast cancer screening (mammograms $80 k/QALY) and colon cancer (colonoscopy $6 k/QALY). Prospective studies are appropriate to define protocols for FCT.
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19
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Miller RJH, Kwiecinski J, Shah KS, Eisenberg E, Patel J, Kobashigawa JA, Azarbal B, Tamarappoo B, Berman DS, Slomka PJ, Kransdorf E, Dey D. Coronary computed tomography-angiography quantitative plaque analysis improves detection of early cardiac allograft vasculopathy: A pilot study. Am J Transplant 2020; 20:1375-1383. [PMID: 31758640 DOI: 10.1111/ajt.15721] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/30/2019] [Accepted: 11/15/2019] [Indexed: 01/25/2023]
Abstract
Cardiac allograft vasculopathy (CAV) is an increasingly important complication after cardiac transplant. We assessed the additive diagnostic benefit of quantitative plaque analysis in patients undergoing coronary computed tomography-angiography (CCTA). Consecutive patients undergoing CCTA for CAV surveillance were identified. Scans were visually interpreted for coronary stenosis. Semiautomated software was used to quantify noncalcified plaque (NCP), as well as its components. Optimal diagnostic cut-offs for CAV, with coronary angiography as gold standard, were defined using receiver operating characteristic curves. In total, 36 scans were identified in 17 patients. CAV was present in 17 (46.0%) reference coronary angiograms, at a median of 1.9 years before CCTA. Median NCP (147 vs 58, P < .001), low-density NCP (median 4.5 vs 0.9, P = .003), fibrous plaque (median 76.1 vs 31.1, P = .003), and fibrofatty plaque (median 63.6 vs 27.6, P < .001) volumes were higher in patients with CAV, whereas calcified plaque was not (median 0.0 vs 0.0, P = .510). Visual assessment of CCTA alone was 70.6% sensitive and 100% specific for CAV. The addition of total NCP volume increased sensitivity to 82.4% while maintaining 100% specificity. NCP volume is significantly higher in patients with CAV. The addition of quantitative analysis to visual interpretation improves the sensitivity for detecting CAV without reducing specificity.
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Affiliation(s)
- Robert J H Miller
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jacek Kwiecinski
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Kevin S Shah
- Smidt Heart Institute, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Evann Eisenberg
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jignesh Patel
- Smidt Heart Institute, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jon A Kobashigawa
- Smidt Heart Institute, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Babak Azarbal
- Smidt Heart Institute, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Balaji Tamarappoo
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Piotr J Slomka
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
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20
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Canan A, Ranganath P, Goerne H, Abbara S, Landeras L, Rajiah P. CAD-RADS: Pushing the Limits. Radiographics 2020; 40:629-652. [PMID: 32281902 DOI: 10.1148/rg.2020190164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Coronary CT angiography is now established as the first-line diagnostic imaging test to exclude coronary artery disease (CAD) in the population at low to intermediate risk. Wide variability exists in both the reporting of coronary CT angiography and the interpretation of these reports by referring physicians. The CAD Reporting and Data System (CAD-RADS) is sponsored by multiple societies and is a collaborative effort to provide standard classification of CAD, which is then integrated into patient clinical care. The main goals of the CAD-RADS are to decrease variability among readers; enhance communication between interpreting and referring clinicians, allowing collaborative determination of the best course of patient care; and generate consistent data for auditing, data mining, quality improvement, research, and education. There are several scenarios in which the CAD-RADS guidelines are ambiguous or do not provide definite recommendations for further management of CAD. The authors discuss the CAD-RADS categories and modifiers, highlight a variety of complex or ambiguous scenarios, and provide recommendations for managing these scenarios. Online supplemental material is available for this article. ©RSNA, 2020 See discussion on this article by Aviram and Wolak.
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Affiliation(s)
- Arzu Canan
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Praveen Ranganath
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Harold Goerne
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Suhny Abbara
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Luis Landeras
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Prabhakar Rajiah
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
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21
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Affiliation(s)
- Ohad Oren
- Division of Hematology and Oncology, Mayo Clinic, Rochester, Minnesota
| | - Ron Blankstein
- Heart & Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Deepak L Bhatt
- Heart & Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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22
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Haase R, Dodd JD, Kauczor HU, Kazerooni EA, Dewey M. Developing a lung nodule management protocol specifically for cardiac CT: Methodology in the DISCHARGE trial. Eur J Radiol Open 2020; 7:100235. [PMID: 32637465 PMCID: PMC7327416 DOI: 10.1016/j.ejro.2020.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/26/2020] [Indexed: 12/03/2022] Open
Abstract
No lung nodule management algorithm exists specifically for cardiac CT. The DISCHARGE trial is a pragmatic prospective randomized trial currently being undertaken across 16 countries in Europe for patients with stable chest pain. As part of the trial a lung nodule algorithm is being evaluated based on modified lung-RADS nodule management algorithms. The methodology of this ‘Lung-RADS for cardiac CT’ algorithm is presented.
Purpose In this methodology paper we describe the development of a lung nodule management algorithm specifically for patients undergoing cardiac CT. Methods We modified the Lung-RADS algorithm specifically to manage lung nodules incidentally detected on cardiac CT (Lung-RADS for cardiac CT). We will evaluate the modified algorithm as part of the DISCHARGE trial (www.dischargetrial.eu) in which patients with suspected coronary artery disease are randomly assigned to cardiac CT or invasive coronary angiography across Europe at 16 sites involving 3546 patients. Patients will be followed for up to four years. Results The major adjustments to Lung-RADS specifically for cardiac CT relate to 1) incomplete coverage of the lungs by cardiac CT compared with chest CT, and when to order a completion chest CT versus a follow up chest CT, 2) cardiac CT findings will not trigger annual lung-cancer screening, and 3) a lower threshold of at least 10 mm for classifying new ground glass nodules as probably benign (category 3). Conclusions The DISCHARGE trial will assess a lung nodule management algorithm designed specifically for cardiac CT in patients with stable chest pain across Europe.
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Affiliation(s)
- Robert Haase
- Department of Radiology, Charité University Hospital, Chariteplatz 1, 10117, Berlin, Germany
| | - Jonathan D. Dodd
- Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
- Corresponding author at: Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin, Ireland.
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Ella A. Kazerooni
- Michigan Medicine - University of Michigan Medical School, Departments of Radiology & Internal Medicine, 1500 E. Medical Center Dr, RM 5482 Ann Arbor, MI, 48109, United States
| | - Marc Dewey
- Department of Radiology, Charité University Hospital, Chariteplatz 1, 10117, Berlin, Germany
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Concomitant screening of coronary artery disease and lung cancer with a new ultrafast-low-dose Computed Tomography protocol: A pilot randomised trial. Sci Rep 2019; 9:13872. [PMID: 31554878 PMCID: PMC6761135 DOI: 10.1038/s41598-019-50407-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 09/09/2019] [Indexed: 12/17/2022] Open
Abstract
We performed a pilot randomised study to assess the feasibility and radiation exposure of a new computed tomography (CT) protocol that allows screening of both coronary artery disease (CAD) and lung cancer. Current or former heavy smokers at high lung cancer risk with indication to cardiac CT for suspected or known CAD were randomised to undergo concomitant CT evaluation of either cardiac or thoracic area or cardiac CT only. Out of 129 subjects deemed eligible for the study, 110 agreed to participate and were randomised to simultaneous cardiac and lung CT (Gr.A; n = 55) or cardiac CT only (Gr.B; n = 55). The feasibility (i.e. adequate visualization of coronary artery segments) was noninferior with simultaneous cardiac and lung CT compared with the standard cardiac CT (870 of 889 segments [97%] in Gr.A vs 878/890 segments [99%] in Gr.B; mean difference 2.0% [90% confidence interval: -0.3% to 4.1%]). The safety (i.e. effective radiation dose) of the concomitant cardiac and lung CT protocol was noninferior to the standard cardiac CT (1.5 [95% confidence intervals: 1.2-1.7] vs. 1.4 [95% confidence intervals: 1.1-1.6] mSv; mean difference 0.1 mSv [90% confidence interval: -0.2 to 0.3 mSv]). In the two groups, a total of 25 significant (>70%) coronary stenoses were found at cardiac CT (9/55 cases of Gr.A vs 11/55 cases of Gr.B). Pulmonary nodules >2 mm were detected in 7 of the 55 Gr.A subjects. This pilot randomised study shows that concomitant CAD and lung cancer screening by means of a new CT protocol is both feasible and safe, thus allowing a comprehensive evaluation of both cardiac and thoracic regions during one CT scanning only. (ClinicalTrials.gov Identifier: NCT03727958).
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Kay FU, Canan A, Abbara S. Common Incidental Findings on Cardiac CT: a Systematic Review. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9494-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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25
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Abstract
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.
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