Current Role of Cardiac and Extra-Cardiac Pathologies in Clinically Indicated Cardiac Computed Tomography with Emphasis on Status Before Pulmonary Vein Isolation

Abstract

Purpose: The aim of this study was to assess the incidence of cardiac and significant extra-cardiac findings in clinical computed tomography of the heart in patients with atrial fibrillation before pulmonary vein isolation (PVI). Materials and Methods: 224 patients (64???10 years; male 63?%) with atrial fibrillation were examined by cardiac 64-slice multidetector CT before PVI. Extra-cardiac findings were classified as ?significant? if they were recommended to additional diagnostics or therapy, and otherwise as ?non-significant?. Additionally, cardiac findings were documented in detail. Results: A total of 724 cardiac findings were identified in 203 patients (91?% of patients). Additionally, a total of 619 extra-cardiac findings were?identified in 179 patients (80?% of patients). Among these extra-cardiac findings 196 (32?%) were ?significant?, and 423 (68?%) were ?non-significant?. In 2 patients (1?%) a previously unknown malignancy was detected (esophageal cancer and lung cancer, local stage, no metastasis). 203 additional imaging diagnostics followed to clarify the ?significant? findings (124 additional CT, costs 38?314.69 US dollars). Overall, there were 3.2 cardiac and 2.8 extra-cardiac findings per patient. Extra-cardiac findings appear significantly more frequently in patients over 60 years old, in smokers and in patients with a history of cardiac findings (p?<0.05). Conclusion: Cardiac CT scans before PVI should be screened for extracardiac incidental findings that could have important clinical implications for each patient. Key points: ??Cardiac and extra-cardiac findings are common in patients with an indication for pulmonary vein isolation on previous CT scans. ??Malignancies can be detected in 1?% of all patients. ??32?% of all extra-cardiac findings can be of significant relevance with consequences for patients. ??Altogether, there are 3.2 cardiac and 2.8 extra-cardiac findings in patients with indication for pulmonary vein isolation and CT. ??Extra-cardiac findings appear significantly more frequently in patients over 60 years old, in smokers and in patients with a history of cardiac findings (p?<0.05). Citation Format: ??Sohns JM, Menke J, Staab W et?al. Current Role of Cardiac and Extra-Cardiac Pathologies in Clinically Indicated Cardiac Computed Tomography with Emphasis on Status Before Pulmonary Vein Isolation. Fortschr R?ntgenstr 2014; 186: 860???867

Extracardiac findings on computed tomography attenuation correction: Is it worth paying extra attention?

“…There is no doubt that extracardiac findings are common in cardiac CT if the examiner looks beyond the heart, reinforcing what has been reported previously for non-contrast-enhanced low-resolution studies such as CTAC 13,18 or coronary artery calcium scoring, 19 and contrast-enhanced studies such as cardiac CT angiography, 20 or cardiovascular CT prior to TAVI, 21 or pulmonary vein isolation. 22 The key question is whether the recognition of these non-cardiac findings translates into patient benefit or might even harm the patient. Yet potential benefits such as detection of cancer might outweigh the harms.…”

Screening of extravascular findings in pulmonary embolism computer tomography: 397 patients with 1950 non-pulmonary artery findings

“…These extra-artery findings were classified into none-relevant (Group A), intermediate (Group B) or relevant (Group C) findings, in line with previous studies. [6][7][8][9][10][11][12][13][14] An extra-pulmonary-artery finding was classified as "relevant", if it would have changed the diagnosis and/or the therapy. Otherwise, an extra-pulmonaryartery finding was classified as "non-relevant".…”

“…4,5 Dyspnea, thoracic pain, syncope or shock could be caused by a pulmonary embolism or by other pathologies like the rupture of an arterial aneurysm, pulmonary infection or a tumor disease. [6][7][8] Even degenerative skeletal or (non-) metastatic diseases could provoke thoracic discomfort. Some of the patients are already under medication prior to the appearance in the emergency unit; thus, clinical signs could be concealed.…”

“…These findings could change patients' treatment and could have an influence on the final outcome and quality of life. [6][7][8] Additionally, it would be worthwhile to further characterize the embolisms (peripheral/central) or detect, if symptoms could be caused by other thoracic, abdominal or skeletal origins. 5 The purpose of this study was to determine the frequency and relevance of extra-focal adjacent findings in computed tomography pulmonary angiographies (CTPA) using a relatively large patient cohort (n ¼ 400) with consecutive CT scans including a common field-of-view (FOV).…”

Radiological findings on irradiation-CT in patients with non metastatic breast cancer

“…Recently, further classification systems for incidental findings have been published, underlining their clinical importance. [8][9][10][11][12] Several studies have described the competence of planning CTs in detection of unexpected clinical findings, such as metastases of the primary tumour or other concurrent malignant diseases. 5,13,14 In this context, planning CTs for breast cancer patients are of special interest.…”