Key points
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Using CT scans as a cardiovascular screening tool increases the probability of detecting incidental findings in middle-aged women with reproductive disorders.
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Incidental findings can potentially cause anxiety and may generate extra costs for downstream diagnostic testing but can also reveal clinically relevant findings.
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Using a reconstructed small field of view resulted in a lower prevalence of incidental findings and required less follow-up diagnostics.
Introduction
Materials and methods
Study design and study setting
Study participants
Coronary CT imaging
Incidental findings
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Major: Always requiring further investigation and likely to have adverse health effects.
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Moderate: Usually requires further investigation but health effects are unclear.
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Minor: Rarely requires further investigation and unlikely to have adverse health effects.
Statistical analysis
Results
Prevalence and nature of incidental findings
PCOS (n = 101) | POI (n = 97) | PE (n = 288) | |
---|---|---|---|
Age, median (IQR) (years) | 48.6 (46.7–53.2) | 48.2 (46.5–51.9) | 46.2 (43.7–49.3) |
BMI, median (IQR) (kg/m2) | 27.3 (23.6–32.0) | 24.9 (22.3–27.7) | 26.5 (23.4–30.4) |
Ethnicity (Northern-European), n (%) | 86 (86.9) | 94 (96.9) | 123 (90.4) |
Educational level, n (%) | |||
Low | 15 (16.0) | 18 (19.4) | 41 (15.0) |
Middle | 41 (43.6) | 34 (36.6) | 109 (39.8) |
High | 38 (40.4) | 41 (44.1) | 124 (45.3) |
Ever smoker, n (%) | 39 (39.4) | 47 (49.5) | 104 (37.7) |
Current alcohol use, n (%) | 64 (64.6) | 70 (75.3) | 192 (68.8) |
Oral contraceptive use, n (%) | |||
Ever | 77 (77.8) | 90 (100.0) | 242 (89.0) |
Never | 9 (9.1) | – | 10 (3.7) |
Now | 13 (13.1) | – | 20 (7.4) |
Nulliparous, n (%) | 17 (20.0) | 10 (16.1) | – |
Menopausal status, n (%) | 27 (31.0) | 97 (100.0) | 99 (40.1) |
HRT use, n (%) | |||
Ever | 8 (27.6) | 59 (67.0) | 4 (4.9) |
Never | 21 (72.4) | 27 (30.7) | 73 (89.0) |
Now | – | 2 (2.3) | 5 (6.1) |
Relevant coronary artery diseasea | 5 (5.4) | 3 (3.1) | 18 (6.7) |
Women with IF(s) | 32 (31.7) | 22 (22.7) | 42 (14.6) |
Women with PCOS
PCOS (n = 101) | POI (n = 97) | PE (n = 288) | Total (n = 486) | |
---|---|---|---|---|
Women with 1 IF | 15 (14.9) | 7 (7.2) | 23 (8.0) | 45 (9.3) |
Women with 2 or more IFs | 1 (1.0) | 6 (6.2) | 2 (0.7) | 9 (1.9) |
Lung | 6 (5.9) | 5 (5.2)± | 6 (2.1)† | 17 (3.5) |
Liver | 4 (4.0) | 4 (4.1) | 7 (2.4) | 15 (3.1) |
Lymphadenopathy | 2 (2.0) | 3 (3.1) | 2 (0.7) | 7 (1.4) |
Breast | 1 (1.0) | – | 1 (0.3) | 2 (0.4) |
Heart | 2 (2.0) | 5 (5.2) | 8 (2.8) | 15 (3.1) |
Gastrointestinal tract | – | 1 (1.0) | – | 1 (0.2) |
Blood vessels | 1 (1.0) | – | 1 (0.3) | 2 (0.4) |
Kidney/adrenal | 1 (1.0) | – | – | 1 (0.2) |
Mediastinum | – | – | 1 (0.3) | 1 (0.2) |
Follow-up required | 12 (11.9) | 13 (13.4) | 23 (8.0) | 48 (9.9) |
Follow-up performed in EMC or UMCU | 7 (58.3*) | 7 (53.8*) | 16 (69.6*) | 30 (62.5*) |
Follow-up performed by: | ||||
Ultrasound | 1 (16.7**) | 2 (28.6**) | 5 (31.3**) | 8 (28.6**) |
CT scan or MRI | 5 (83.3**) | 3 (42.9**) | 6 (37.5**) | 14 (46.7**) |
PET scan | – | – | 2 (12.5**) | 2 (7.1**) |
X-ray | – | – | 1 (6.3**) | 1 (3.6**) |
Consultation | 1 (14.3**) | 2 (28.6**) | 2 (12.5**) | 5 (16.7**) |
Clinically relevant Findings a | 1 (14.3**) | 3 (42.9**) | 5 (31.3**) | 9 (32.1**) |
Women with POI
Women with a history of PE
Sensitivity analysis
Incidental findings based on double versus single reading
Incidental findings based on small FOV versus full FOV
Full FOV-EMC (n = 78) | Small FOV-EMC (n = 78) | |
---|---|---|
Women with IFs | 78 (100.0) | 60 (76.9) |
Women with 1 IF | 57 (73.1) | 49 (62.8) |
Women with 2 or more IFs | 21 (26.9) | 11 (14.1) |
Number of IFs | 101 (100.0) | 72 (71.3*) |
Minor IFs | 40 (39.6) | 33 (82.5*) |
Moderate IFs | 61 (60.4) | 39 (63.91) |
Major IFs | – | – |
Follow-up requireda | 46 (59.0) | 30 (38.5) |
Clinically relevant Findingsb | 7 (15.2**) | 6 (20.0**) |