Document Detail

Clinical relevance and scope of accidental extracoronary findings in coronary computed tomography angiography: a cardiac versus thoracic FOV study.
MedLine Citation:
PMID:  19268514     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess the spectrum and clinical relevance of extracoronary findings in coronary CT angiography (CCTA), and to compare a small (cardiac) field of view (FOV) to a large (thoracic) FOV setting. MATERIAL AND METHODS: 1084 consecutive patients (mean 57 years) with low-to-intermediate risk of coronary artery disease were enrolled. 542 CCTA scans were interpreted with small FOV (160-190mm(2)) encompassing the cardiac region. In another 542 CCTA (patients matched for age and gender), read-out of an additional full FOV (>320mm(2)) covering the thorax was performed. Clinical relevance of extracoronary findings was considered as either "significant" or "non-significant". "Significant" findings were subclassified as either score 1: findings necessitating immediate therapeutic actions, or score 2: findings with undoubted clinical or prognostic relevance, requiring clinical awareness, follow-up or further investigations (non-urgent). "Non-significant" findings were assigned to either score 3: findings not requiring follow-up or further tests, or as score 4: irrelevant incidental findings. RESULTS: Significantly more patients with extracoronary findings were identified by using a full FOV with 43.2% (234/542) compared to a small FOV with 33.6% (182/542) (p=0.001). Similarly, a higher total number of extracoronary findings (n=394) was found on full FOV compared to small FOV (n=250) (p<0.001). The detection rate of clinically significant findings was higher by using full FOV compared to small FOV (25.6% versus 15.4%) (p<0.001), out of those 2.2% versus 1.8% of findings required immediate actions (score 1), and 23.4% versus 13.6% (p=0.0001), respectively were of clinical relevance (non-urgent, score 2). The rate of malign findings was 0.2%, and of acute pulmonary embolism 0.1%. More lung pathologies were observed by using full FOV compared to small FOV (22% versus 7%) (p<0.0001), and the detection rate of intrapulmonary nodules increased by 2.1%. Prevalence of aortic valve calcification (n=72) was 13.3%, out of those 7% had less than 2cm(2) aortic valve orifice area. CONCLUSIONS: The interpretation of extracoronary findings on CCTA scans is mandatory given high prevalence of clinically significant findings by using a full "thoracic" FOV.
Iman Aglan; Daniel Jodocy; Stefan Hiehs; Peter Soegner; Renate Frank; Berhard Haberfellner; Andrea Klauser; Werner Jaschke; Gudrun M Feuchtner
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Publication Detail:
Type:  Journal Article     Date:  2009-03-05
Journal Detail:
Title:  European journal of radiology     Volume:  74     ISSN:  1872-7727     ISO Abbreviation:  Eur J Radiol     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-05     Completed Date:  2010-08-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8106411     Medline TA:  Eur J Radiol     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  166-74     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
Department of Radiology II, Innsbruck Medical University, Innsbruck, Austria.
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MeSH Terms
Age Factors
Aged, 80 and over
Coronary Angiography*
Coronary Artery Disease / complications*
Diagnosis, Differential
Incidental Findings
Middle Aged
Radiography, Thoracic
Sex Factors
Tomography, X-Ray Computed*

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