Abstract
Noncardiac incidental findings on cardiac CT are remarkably common and some of these may have a significant impact on patient management. Herein, we present a straightforward and cost-effective step-by-step approach for identifying and reporting noncardiac incidental findings. In Step 1, we discuss the ‘ABCDEFG’ search pattern for systematically reviewing noncardiac organ systems. The most prevalent and clinically significant incidental findings are highlighted with strategies for increasing their conspicuity. In Step 2, the importance of reviewing clinical history and prior imaging studies is discussed. In Step 3, we provide a classification scheme and follow-up recommendations for incidental findings based on their potential clinical significance.
Similar content being viewed by others
References
Mark DB, Berman DS, Budoff MJ, 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.
Flor N, Di Leo G, Squarza SA, et al. Malignant incidental extracardiac findings on cardiac CT: systematic review and meta-analysis. Am J Roentgenol. 2013;201:555–64.
Earls JP. The pros and cons of searching for extracardiac findings at cardiac CT: studies should be reconstructed in the maximum field of view and adequately reviewed to detect pathologic findings. Radiology. 2011;261:342–6.
Kim JW, Kang EY, Yong HS, 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 Suppl 1:75–81.
Kim TJ, Han DH, Jin KN, et al. Lung cancer detected at cardiac CT: prevalence, clinicoradiologic features, and importance of full-field-of-view images. Radiology. 2010;255:369–76.
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.
Lee CI, Tsai EB, Sigal BM, et al. Incidental extracardiac findings at coronary CT: clinical and economic impact. Am J Roentgenol. 2010;194:1531–8.
Mayo-Smith WW, Gupta H, Ridlen MS, et al. Detecting hepatic lesions: the added utility of CT liver window settings. Radiology. 1999;210:601–4.
Killeen RP, Cury RC, McErlean A, et al. Noncardiac findings on cardiac CT. Part II: spectrum of imaging findings. J Cardiovasc Comput Tomogr. 2009;3:361–71.
Koonce J, Schoepf JU, Nguyen SA, et al. Extra-cardiac findings at cardiac CT: experience with 1764 patients. Eur Radiol. 2009;19:570–6.
Boyce CJ, Pickhardt PJ, Kim DH, et al. Hepatic steatosis (fatty liver disease) in asymptomatic adults identified by unenhanced low-dose CT. Am J Roentgenol. 2010;194:623–8.
Von Feldt JM. Managing osteoporotic fractures minimizing pain and disability. J Clin Rheumatol. 1997;3:65–8.
Onuma Y, Tanabe K, Nakazawa G, et al. Noncardiac findings in cardiac imaging with multidetector computed tomography. J Am Coll Cardiol. 2006;48:402–6.
Harish MG, Konda SD, MacMahon H, et al. Breast lesions incidentally detected with CT: what the general radiologist needs to know. Radiographics. 2007;27 Suppl 1:S37–51.
Restrepo CS, Martinez S, Lemos DF, et al. Imaging appearances of the sternum and sternoclavicular joints. Radiographics. 2009;29:839–59.
Aquino SL, Webb WR, Gushiken BJ. Pleural exudates and transudates: diagnosis with contrast-enhanced CT. Radiology. 1994;192:803–8.
Sandstrom CK, Stern EJ. Diaphragmatic hernias: a spectrum of radiographic appearances. Curr Prob Diagn Radiol. 2011;40:95–115.
Lehman SJ, Abbara S, Cury RC, et al. Significance of cardiac computed tomography incidental findings in acute chest pain. Am J Med. 2009;122:543–9.
Kawano Y, Tamura A, Goto Y, et al. Incidental detection of cancers and other noncardiac abnormalities on coronary multislice computed tomography. Am J Cardiol. 2007;99:1608–9.
Genereux GP, Howie JL. Normal mediastinal lymph node size and number: CT and anatomic study. Am J Roentgenol. 1984;142:1095–100.
Stein PD, Woodard PK, Weg JG, et al. Diagnostic pathways in acute pulmonary embolism: recommendations of the Pioped II investigators. Radiology. 2007;242:15–21.
Brandman S, Ko JP. Pulmonary nodule detection, characterization, and management with multidetector computed tomography. J Thor Imaging. 2011;26:90–105.
MacMahon H, Austin JH, Gamsu G, et al. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology. 2005;237:395–400.
Kazerooni EA. High-resolution CT, of the lungs. Am J Roentgenol. 2001;177:501–19.
Chung JH, Ghoshhajra BB, Rojas CA, et al. CT angiography of the thoracic aorta. Radiol Clin NA. 2010;48:249–64. VII.
Gomes AS, Bettmann MA, Boxt LM, et al. Acute chest pain—suspected aortic dissection. Am Coll Radiol. ACR appropriateness criteria. Radiology. 2000;215(Suppl):1–5.
Lin FY, Devereux RB, Roman MJ, et al. Assessment of the thoracic aorta by multidetector computed tomography: age- and sex-specific reference values in adults without evident cardiovascular disease. J Cardiovasc Comp Tomogr. 2008;2:298–308.
Kassing P, Duszak R. Neiman report brief #02: repeat medical imaging: a classification system for meaningful policy analysis and research. Harvey L. Neiman Health Policy Institute. 2013.
Compliance with Ethics Guidelines
Conflict of Interest
Christopher D. Maroules, Brian B. Ghoshhajra, Nagina Malguria, Michael Landay, Jed Hummel, Maros Ferencik, and Suhny Abbara declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is part of the Topical Collection on Cardiac Computed Tomography
Rights and permissions
About this article
Cite this article
Maroules, C.D., Ghoshhajra, B.B., Malguria, N. et al. Noncardiac Incidental Findings on Cardiac CT: A Step-by-Step Approach. Curr Cardiovasc Imaging Rep 7, 9283 (2014). https://doi.org/10.1007/s12410-014-9283-z
Published:
DOI: https://doi.org/10.1007/s12410-014-9283-z