Outcomes of incidental findings on multi‐detector computed tomography for transcatheter aortic valve implantation assessment: A single‐centre study and review of the literature

Abstract

Introduction: Patients with severe aortic stenosis (AS) require multi-detector computed tomography (MDCT) when considered for transcatheter aortic valve implantation (TAVI). Incidental findings on MDCT are common given the age group and region imaged. Our aim was to evaluate the frequency and outcome of incidental findings (IF) identified on MDCT and the impact on survival.Methods: This single-centre analysis retrospectively reviewed severe AS patients who underwent MDCT during TAVI workup. MDCT reports were reviewed for any IF and defined into three categories: IF of no relevant clinical significance (IF-NoCS), IF of non-immediate clinical significance (IF-NICS) and IF of immediate clinical significance (IF-ICS). Demographics, follow-up of IF and survival were calculated from MDCT date. Results: Two hundred and sixty-five patients underwent MDCT for TAVI suitability (mean age 83 AE 6 years, 52% male). The majority proceeded to TAVI (65%). Renal lesions (25%) and lung nodules (18%) were the most common IF. Fifty-nine patients (22%) had IF-NICS; 39% (23/59) were benign, 59% were not further investigated and one patient had suspected lung cancer. Six patients (2.3%) had IF-ICS and all were diagnosed with lung cancer. During a median follow-up of 272 days, there was no survival difference between patients with IF-ICS or IF-NICS versus patients without IF or IF-NoCS in the overall cohort (P = 0.44) or in TAVI patients (P = 0.88). Conclusion: Incidental findings on MDCT are common with one-quarter having IF-ICS or IF-NCIS. Most patients with IF-NICS did not undergo further investigation. Standardized reporting of MDCT may assist in clarifying the need for further investigation which will in turn influence decision and timing to proceed with TAVI.

Concomitant surgery for aortic valve and lung cancer patients in an elder

“…The therapeutic strategy for these patients is controversial. The incidental finding rate of lung nodules on CT scans for TAVI is about 18% [ 1 ]. There are no guidelines marking clear treatment recommendations in this situation.…”

The Incidental finding and the false‐positive paradox

“…I read with interest the article in the recent article in JMIRO by Ha et al . on the outcomes of incidental findings during planning CT for transcatheter aortic valve implantation (TAVI).…”