Impact of Extracardiac Findings during Cardiac MR on Patient Management and Outcome

Abstract

BackgroundCardiac magnetic resonance (CMR) is increasingly used to assess heart diseases. Relevant non-cardiac diseases may also be incidentally found on CMR images. The aim of this study was to determine the prevalence and nature of incidental extra-cardiac findings (IEF) and their clinical impact in non-selected patients referred for CMR.Material/MethodsMR images of 762 consecutive patients (515 men, age: 56±18 years) referred for CMR were prospectively interpreted by 2 radiologists blinded for any previous imaging study. IEFs were classified as major when requiring treatment, follow-up, or further investigation. Clinical follow-up was performed by checking hospital information records and by calling referring physicians. The 2 endpoints were: 1) non-cardiac death and new treatment related to major IEFs, and 2) hospitalization related to major IEFs during follow-up.ResultsMajor IEFs were proven in 129 patients (18.6% of the study population), 14% of those being unknown before CMR. During 15±6 month follow-up, treatment of confirmed major IEFs was initiated in 1.4%, and no non-cardiac deaths occurred. Hospitalization occurred in 8 patients (1.0% of the study population) with confirmed major IEFs and none occurred in the remaining 110 patients with unconfirmed/unexplored major IEFs (p<0.001).ConclusionsScreening for major IEFs in a population referred for routine CMR changed management in 1.4% of patients. Major IEFs unknown before CMR but without further exploration, however, carried a favorable prognosis over a follow-up period of 15 months.

Incidental Extracardiac Findings and Their Characterization on Cardiac MRI

“…Significant parts of neck, thorax, and upper abdomen are imaged at the time of routine clinical cMRI, particularly in the initial multislice axial and coronal images. A careful observation of the surrounding structures may therefore often identify during cMRI incidental extracardiac findings (IEFs) [ 3 ]. IEFs can represent unsuspected important diseases or benign findings, carrying several ethical, medicolegal, and financial implications [ 4 ].…”

“…Extracardiac findings during cMRI may also significantly modify clinical management of patients assessed by cMRI. Studies in literature showed different rates of prevalence of IEFs, ranging between 3 and 31% [ 3 ]. Moreover, cMRI differs from computed tomography (CT) in its use of several sequences which allows the recognizing of many differences in the appearance and conspicuity of IEFs [ 5 ].…”

Coronary Computed Tomography Angiography Results in More Computed Tomography Chest Follow-up for Incidental Findings at 1 Year Relative to Stress-perfusion Cardiac Magnetic Resonance Imaging

“…Incidental findings in cardiac imaging offer a distinct challenge in subsequent management of patients, oftentimes requiring computed tomography of the chest (CT chest) to assess for extracardiac findings, particularly lung nodules. 1 Prior studies have demonstrated significant rates of incidental findings within these imaging modalities, including up to 60% in cCTA [2][3][4][5][6][7] and 31% in sCMR. 1,3,[8][9][10][11][12] While some incidentalomas are significant and lead to a new, necessary diagnosis, studies show that most incidental findings are clinically insignificant.…”

“…1 Prior studies have demonstrated significant rates of incidental findings within these imaging modalities, including up to 60% in cCTA [2][3][4][5][6][7] and 31% in sCMR. 1,3,[8][9][10][11][12] While some incidentalomas are significant and lead to a new, necessary diagnosis, studies show that most incidental findings are clinically insignificant. 2,6,[8][9][10] Additional findings can be costly, [13][14][15] add emotional burden, and lead to additional radiation exposure for the patient.…”

“…Coronary computed tomography angiography (cCTA) and stress-perfusion cardiac magnetic resonance imaging (sCMR) are useful tools for evaluating coronary artery disease (CAD) but can both detect incidental findings. Incidental findings in cardiac imaging offer a distinct challenge in subsequent management of patients, oftentimes requiring computed tomography of the chest (CT chest) to assess for extracardiac findings, particularly lung nodules 1. Prior studies have demonstrated significant rates of incidental findings within these imaging modalities, including up to 60% in cCTA2–7 and 31% in sCMR 1,3,8–12.…”