How to Report a Coronary CT Angiography Michael Poon, MD, FACC

The Prevalence and Significance of Incidental FindingsDuring Cardiac 64­ or 128­ Slice Computed TomographyDinh H*, Stecko J†, Mendelsohn S‡, Day B‡, Poon M†.*David Geffen School of Medicine at UCLA, Los Angeles CA, USA. †Cabrini Medical Center, New York, NY, USA. ‡Zwanger­Pesiri Radiology,BACKGROUND•The number of outpatient private practicefacilities offering multi­row detector computedtomography (MDCT) is on the rise.•Non­cardiac pathology may be imaged andmissed if not routinely assessed by theinterpreting physician.•Few studies have looked at the prevalence ofextracardiac incidental findings at outpatientfacilities.PURPOSE AND HYPOTHESISWe investigated the frequency and significance ofincidental findings during cardiac MDCT.MATERIALS AND METHODSA total of 512 consecutive patients underwent 64­or 128­slice MDCT (440 and 72, respectively)between the period of September 2005 to March2007 at two out­patient private practices.Radiology and cardiology final reports werereviewed for incidental findings, which weredefined as non­cardiac diagnoses not previouslyknown. Findings of clinical significance weredefined as those requiring follow up diagnosticimaging or intervention.RESULTSA total of 575 new, extra­cardiac findings wereidentified. Of this, 187 (33%) were clinicallysignificant. Per patient analysis showed that 117(23%) of patients had at least one new clinicallysignificant finding. The prevalence of allincidental findings, significant clinical findings,and specific significant incidental findings aresummarized in the table below.N = 511PulmonaryVascularHepaticGastrointestinalThyroidAdrenalOrthopedicOtherIncidentalFindings(No.Patients,%)189 (37%)105 (21%)61 (12%)41 (8%)25 (5%)22 (4%)9 (2%)47 (9%)E. Setauket, NY, USA.ClinicallySignificantIncidentalFindings(No.Patients,%)48 (9%)15 (3%)3 (0.6%)3 (0.4%)25 (5%)21 (4%)1 (0.2%)4 (0.8%)Clinically Significant Diagnoses(No. lesions)•Nodule/granuloma (>1cm) ­83•Cavitated granuloma ­1•Mass (1cm) ­14•Metastatic cancer ­1•Pulmonary embolus ­1•Ascending aorta aneurysm ­8•Descending aorta aneurysm ­3•Aortic arch aneurysm ­1•Type B dissection ­1•Splenic artery aneurysm (>1.5 cm) ­3•Celiac artery aneurysm (>1.5 cm) ­3•Mass 3.5 cm ­1•Lesions (not cysts) ­2•Hiatal hernia (entire stomach inthorax) ­1•Mesenteric lymph node >1.5 cm ­1•Pancreatic necrosis/fat/atrophy ­2•Thyromegaly ­3•Lesion/mass/nodule ­22•Adenoma (>1cm) ­19•Nodule (>1cm) ­1•Myelolipoma ­1•Sclerosis vertebral body/mets ­1•Angiomyolipoma ­1•Breast calcification ­1•Breast soft density ­1•Axillary lymph node ­1EXAMPLES OF INCIDENTAL FINDINGSCONCLUSIONSOutpatient private practice per patient prevalence ofclinically significant non­cardiac incidental findings isabout 23% during coronary MDCT examinations which issimilar to published data at academic centers and inpatientsettings. Review of all imaging data is important to avoidmissing potentially treatable disease.