Skip to main content
Erschienen in: Journal of Nuclear Cardiology 6/2016

01.12.2016 | Editorial

The good, bad, and ugly of incidental findings on cardiovascular-computed tomography

verfasst von: Pradeep Bhambhvani, MD

Erschienen in: Journal of Nuclear Cardiology | Ausgabe 6/2016

Einloggen, um Zugang zu erhalten

Excerpt

Technological advances have led to increased utilization of computed tomography (CT) for cardiovascular imaging. Common indications include coronary calcium assessment, detection of obstructive coronary artery disease (CAD) with coronary CT angiography (CCTA), and for attenuation correction (CTAC) when using myocardial perfusion imaging with single-photon emission-computed tomography (SPECT) or positron emission tomography (PET).1 CTAC is known to improve diagnostic accuracy by reducing attenuation artifact and has been shown to improve the specificity of SPECT and PET in the detection of obstructive CAD.1
Literatur
1.
Zurück zum Zitat Dorbala S, Di Carli MF, Delbeke D, Abbara S, DePuey EG, Dilsizian V, et al. SNMMI/ASNC/SCCT guideline for cardiac SPECT/CT and PET/CT 1.0. J Nucl Med 2013;54:1485-507.CrossRefPubMed Dorbala S, Di Carli MF, Delbeke D, Abbara S, DePuey EG, Dilsizian V, et al. SNMMI/ASNC/SCCT guideline for cardiac SPECT/CT and PET/CT 1.0. J Nucl Med 2013;54:1485-507.CrossRefPubMed
2.
Zurück zum Zitat Budoff MJ, Fischer H, Gopal A. Incidental findings with cardiac CT evaluation: Should we read beyond the heart? Catheter Cardiovasc Interv 2006;68:965-73.CrossRefPubMed Budoff MJ, Fischer H, Gopal A. Incidental findings with cardiac CT evaluation: Should we read beyond the heart? Catheter Cardiovasc Interv 2006;68:965-73.CrossRefPubMed
3.
Zurück zum Zitat Berland LL. Overview of white papers of the ACR incidental findings committee ii on adnexal, vascular, splenic, nodal, gallbladder, and biliary findings. J Am Coll Radiol 2013;10:672-4.CrossRefPubMed Berland LL. Overview of white papers of the ACR incidental findings committee ii on adnexal, vascular, splenic, nodal, gallbladder, and biliary findings. J Am Coll Radiol 2013;10:672-4.CrossRefPubMed
4.
Zurück zum Zitat Machaalany J, Yam Y, Ruddy TD, Abraham A, Chen L, Beanlands RS, et al. Potential clinical and economic consequences of noncardiac incidental findings on cardiac computed tomography. J Am Coll Cardiol 2009;54:1533-41.CrossRefPubMed Machaalany J, Yam Y, Ruddy TD, Abraham A, Chen L, Beanlands RS, et al. Potential clinical and economic consequences of noncardiac incidental findings on cardiac computed tomography. J Am Coll Cardiol 2009;54:1533-41.CrossRefPubMed
5.
Zurück zum Zitat Jaar BG, Zhang L, Chembrovich SV, Sozio SM, Shafi T, Scialla JJ, et al. Incidental findings on cardiac computed tomography in incident hemodialysis patients: the predictors of arrhythmic and cardiovascular events in end-stage renal disease (PACE) study. BMC Nephrol 2014;15:68.CrossRefPubMedPubMedCentral Jaar BG, Zhang L, Chembrovich SV, Sozio SM, Shafi T, Scialla JJ, et al. Incidental findings on cardiac computed tomography in incident hemodialysis patients: the predictors of arrhythmic and cardiovascular events in end-stage renal disease (PACE) study. BMC Nephrol 2014;15:68.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Mark DB, Berman DS, Budoff MJ, Carr JJ, Gerber TC, Hecht HS, et al. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: A report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 2010;121:2509-43.CrossRefPubMed Mark DB, Berman DS, Budoff MJ, Carr JJ, Gerber TC, Hecht HS, et al. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: A report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 2010;121:2509-43.CrossRefPubMed
7.
Zurück zum Zitat Brown SD. Professional norms regarding how radiologists handle incidental findings. J Am Coll Radiol 2013;10:253-7.CrossRefPubMed Brown SD. Professional norms regarding how radiologists handle incidental findings. J Am Coll Radiol 2013;10:253-7.CrossRefPubMed
8.
Zurück zum Zitat Hall WB, Truitt SG, Scheunemann LP, Shah SA, Rivera MP, Parker LA, et al. The prevalence of clinically relevant incidental findings on chest computed tomographic angiograms ordered to diagnose pulmonary embolism. Arch Intern Med 2009;169:1961-5.CrossRefPubMed Hall WB, Truitt SG, Scheunemann LP, Shah SA, Rivera MP, Parker LA, et al. The prevalence of clinically relevant incidental findings on chest computed tomographic angiograms ordered to diagnose pulmonary embolism. Arch Intern Med 2009;169:1961-5.CrossRefPubMed
9.
Zurück zum Zitat Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, et al. Managing incidental findings on abdominal CT: White paper of the ACR incidental findings committee. J Am Coll Radiol 2010;7:754-73.CrossRefPubMed Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, et al. Managing incidental findings on abdominal CT: White paper of the ACR incidental findings committee. J Am Coll Radiol 2010;7:754-73.CrossRefPubMed
10.
Zurück zum Zitat Morgan AE, Berland LL, Ananyev SS, Lockhart ME, Kolettis PN. Extraurinary incidental findings on CT for hematuria: The radiologist’s role and downstream cost analysis. AJR Am J Roentgenol 2015;204:1160-7.CrossRefPubMed Morgan AE, Berland LL, Ananyev SS, Lockhart ME, Kolettis PN. Extraurinary incidental findings on CT for hematuria: The radiologist’s role and downstream cost analysis. AJR Am J Roentgenol 2015;204:1160-7.CrossRefPubMed
11.
Zurück zum Zitat Decision Memo for Screening Computed Tomography Colonography (CTC) for Colorectal Cancer (CAG-00396N). May 12, 2009. Decision Memo for Screening Computed Tomography Colonography (CTC) for Colorectal Cancer (CAG-00396N). May 12, 2009.
12.
Zurück zum Zitat Goehler A, McMahon PM, Lumish HS, Wu CC, Munshi V, Gilmore M, et al. Cost-effectiveness of follow-up of pulmonary nodules incidentally detected on cardiac computed tomographic angiography in patients with suspected coronary artery disease. Circulation 2014;130:668-75.CrossRefPubMedPubMedCentral Goehler A, McMahon PM, Lumish HS, Wu CC, Munshi V, Gilmore M, et al. Cost-effectiveness of follow-up of pulmonary nodules incidentally detected on cardiac computed tomographic angiography in patients with suspected coronary artery disease. Circulation 2014;130:668-75.CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Rumberger JA. Noncardiac abnormalities in diagnostic cardiac computed tomography: Within normal limits or we never looked! J Am Coll Cardiol 2006;48:407-8.CrossRefPubMed Rumberger JA. Noncardiac abnormalities in diagnostic cardiac computed tomography: Within normal limits or we never looked! J Am Coll Cardiol 2006;48:407-8.CrossRefPubMed
14.
15.
Zurück zum Zitat Naidich DP, Bankier AA, MacMahon H, Schaefer-Prokop CM, Pistolesi M, Goo JM, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: A statement from the Fleischner Society. Radiology 2013;266:304-17.CrossRefPubMed Naidich DP, Bankier AA, MacMahon H, Schaefer-Prokop CM, Pistolesi M, Goo JM, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: A statement from the Fleischner Society. Radiology 2013;266:304-17.CrossRefPubMed
16.
Zurück zum Zitat MacMahon H, Austin JH, Gamsu G, Herold CJ, Jett JR, Naidich DP, et al. Guidelines for management of small pulmonary nodules detected on CT scans: A statement from the Fleischner Society. Radiology 2005;237:395-400.CrossRefPubMed MacMahon H, Austin JH, Gamsu G, Herold CJ, Jett JR, Naidich DP, et al. Guidelines for management of small pulmonary nodules detected on CT scans: A statement from the Fleischner Society. Radiology 2005;237:395-400.CrossRefPubMed
17.
Zurück zum Zitat Remy-Jardin M, Pistolesi M, Goodman LR, Gefter WB, Gottschalk A, Mayo JR, et al. Management of suspected acute pulmonary embolism in the era of CT angiography: A statement from the Fleischner Society. Radiology 2007;245:315-29.CrossRefPubMed Remy-Jardin M, Pistolesi M, Goodman LR, Gefter WB, Gottschalk A, Mayo JR, et al. Management of suspected acute pulmonary embolism in the era of CT angiography: A statement from the Fleischner Society. Radiology 2007;245:315-29.CrossRefPubMed
18.
Zurück zum Zitat Johnson PT, Horton KM, Megibow AJ, Jeffrey RB, Fishman EK. Common incidental findings on MDCT: Survey of radiologist recommendations for patient management. J Am Coll Radiol 2011;8:762-7.CrossRefPubMed Johnson PT, Horton KM, Megibow AJ, Jeffrey RB, Fishman EK. Common incidental findings on MDCT: Survey of radiologist recommendations for patient management. J Am Coll Radiol 2011;8:762-7.CrossRefPubMed
19.
Zurück zum Zitat Eisenberg RL, Bankier AA, Boiselle PM. Compliance with Fleischner Society guidelines for management of small lung nodules: A survey of 834 radiologists. Radiology 2010;255:218-24.CrossRefPubMed Eisenberg RL, Bankier AA, Boiselle PM. Compliance with Fleischner Society guidelines for management of small lung nodules: A survey of 834 radiologists. Radiology 2010;255:218-24.CrossRefPubMed
20.
Zurück zum Zitat ACR. ACR practice parameter for communication of diagnostic imaging findings 2014. ACR. ACR practice parameter for communication of diagnostic imaging findings 2014.
21.
Zurück zum Zitat Yankelevitz DF, Henschke CI. Does 2-year stability imply that pulmonary nodules are benign? AJR Am J Roentgenol 1997;168:325-8.CrossRefPubMed Yankelevitz DF, Henschke CI. Does 2-year stability imply that pulmonary nodules are benign? AJR Am J Roentgenol 1997;168:325-8.CrossRefPubMed
22.
Zurück zum Zitat Hunold P, Vogt FM, Schmermund A, Debatin JF, Kerkhoff G, Budde T, et al. Radiation exposure during cardiac CT: Effective doses at multi-detector row CT and electron-beam CT. Radiology 2003;226:145-52.CrossRefPubMed Hunold P, Vogt FM, Schmermund A, Debatin JF, Kerkhoff G, Budde T, et al. Radiation exposure during cardiac CT: Effective doses at multi-detector row CT and electron-beam CT. Radiology 2003;226:145-52.CrossRefPubMed
23.
Zurück zum Zitat Krishnasetty V, Bonab AA, Fischman AJ, Halpern EF, Aquino SL. Comparison of standard-dose vs low-dose attenuation correction CT on image quality and positron emission tomographic attenuation correction. J Am Coll Radiol 2008;5:579-84.CrossRefPubMed Krishnasetty V, Bonab AA, Fischman AJ, Halpern EF, Aquino SL. Comparison of standard-dose vs low-dose attenuation correction CT on image quality and positron emission tomographic attenuation correction. J Am Coll Radiol 2008;5:579-84.CrossRefPubMed
24.
Zurück zum Zitat Bluemke DA. Coronary computed tomographic angiography and incidental pulmonary nodules. Circulation 2014;130:634-7.CrossRefPubMed Bluemke DA. Coronary computed tomographic angiography and incidental pulmonary nodules. Circulation 2014;130:634-7.CrossRefPubMed
25.
Zurück zum Zitat Onuma Y, Tanabe K, Nakazawa G, Aoki J, Nakajima H, Ibukuro K, et al. Noncardiac findings in cardiac imaging with multidetector computed tomography. J Am Coll Cardiol 2006;48:402-6.CrossRefPubMed Onuma Y, Tanabe K, Nakazawa G, Aoki J, Nakajima H, Ibukuro K, et al. Noncardiac findings in cardiac imaging with multidetector computed tomography. J Am Coll Cardiol 2006;48:402-6.CrossRefPubMed
26.
Zurück zum Zitat Kim JW, Kang EY, Yong HS, Kim YK, Woo OH, Oh YW, et al. Incidental extracardiac findings at cardiac CT angiography: Comparison of prevalence and clinical significance between precontrast low-dose whole thoracic scan and postcontrast retrospective ECG-gated cardiac scan. Int J Cardiovasc Imaging 2009;25:75-81.CrossRefPubMed Kim JW, Kang EY, Yong HS, Kim YK, Woo OH, Oh YW, et al. Incidental extracardiac findings at cardiac CT angiography: Comparison of prevalence and clinical significance between precontrast low-dose whole thoracic scan and postcontrast retrospective ECG-gated cardiac scan. Int J Cardiovasc Imaging 2009;25:75-81.CrossRefPubMed
27.
Zurück zum Zitat Garcia MJ, Blankstein R, Budoff MJ, Dent JM, Drachman DE, Lesser JR, et al. COCATS 4 Task Force 7: Training in cardiovascular computed tomographic imaging. J Am Coll Cardiol 2015;65:1810-21.CrossRefPubMed Garcia MJ, Blankstein R, Budoff MJ, Dent JM, Drachman DE, Lesser JR, et al. COCATS 4 Task Force 7: Training in cardiovascular computed tomographic imaging. J Am Coll Cardiol 2015;65:1810-21.CrossRefPubMed
28.
Zurück zum Zitat Budoff MJ, Cohen MC, Garcia MJ, Hodgson JM, Hundley WG, Lima JA, et al. ACCF/AHA clinical competence statement on cardiac imaging with computed tomography and magnetic resonance: A report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. J Am Coll Cardiol 2005;46:383-402.CrossRefPubMed Budoff MJ, Cohen MC, Garcia MJ, Hodgson JM, Hundley WG, Lima JA, et al. ACCF/AHA clinical competence statement on cardiac imaging with computed tomography and magnetic resonance: A report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. J Am Coll Cardiol 2005;46:383-402.CrossRefPubMed
29.
Zurück zum Zitat Jacobs JE, Boxt LM, Desjardins B, Fishman EK, Larson PA, Schoepf J. ACR practice guideline for the performance and interpretation of cardiac computed tomography (CT). J Am Coll Radiol 2006;3:677-85.CrossRefPubMed Jacobs JE, Boxt LM, Desjardins B, Fishman EK, Larson PA, Schoepf J. ACR practice guideline for the performance and interpretation of cardiac computed tomography (CT). J Am Coll Radiol 2006;3:677-85.CrossRefPubMed
30.
Zurück zum Zitat Qureshi WT, Alirhayim Z, Khalid F, Al-Mallah MH. Prognostic value of extracardiac incidental findings on attenuation correction cardiac computed tomography. J Nucl Cardiol 2015. doi:10.1007/s12350-015-0223-3.PubMed Qureshi WT, Alirhayim Z, Khalid F, Al-Mallah MH. Prognostic value of extracardiac incidental findings on attenuation correction cardiac computed tomography. J Nucl Cardiol 2015. doi:10.​1007/​s12350-015-0223-3.PubMed
Metadaten
Titel
The good, bad, and ugly of incidental findings on cardiovascular-computed tomography
verfasst von
Pradeep Bhambhvani, MD
Publikationsdatum
01.12.2016
Verlag
Springer US
Erschienen in
Journal of Nuclear Cardiology / Ausgabe 6/2016
Print ISSN: 1071-3581
Elektronische ISSN: 1532-6551
DOI
https://doi.org/10.1007/s12350-015-0244-y

Weitere Artikel der Ausgabe 6/2016

Journal of Nuclear Cardiology 6/2016 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.