Skip to main content

Extravascular and Extracardiac Findings on MDCT for Transcatheter Aortic Valve Planning

  • Chapter
  • First Online:
  • 1034 Accesses

Abstract

Multi-detector computed tomography (MDCT) is an imaging tool which has found a role in the planning of transcatheter aortic valve replacement (TAVR). MDCT provides high-quality images of not only cardiac and vascular findings but also detailed anatomic evaluation of other structures in the thorax, abdomen, and pelvis.

Incidental findings are commonly detected on MDCT exams performed for various indications, including those done for TAVR planning. Such findings are generally categorized according to their potential clinical significance to the patient. The age and level of comorbidity in a TAVR cohort not only increases the likelihood of detecting an incidental finding, but also increases the uncertainty with regard to how such findings, especially those of intermediate clinical significance, are handled.

This chapter provides insight into the basic principles of incidentally detected lesions on MDCT and discusses current management strategies for some of the more commonly encountered incidental lesions in the chest, abdomen, and pelvis.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   159.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   209.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Berland L, 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.

    Article  PubMed  Google Scholar 

  2. Berland L. The American College of Radiology strategy for managing incidental findings on abdominal computed tomography. Radiol Clin North Am. 2011;49:237–43.

    Article  PubMed  Google Scholar 

  3. Lumbreras B, Donat L, Hernandez-Aguado I. Incidental findings in imaging diagnostic tests: a systematic review. Br J Radiol. 2010;83:276–89.

    Article  PubMed  CAS  Google Scholar 

  4. Ding A, Eisenberg JD, Pandharipande PV. The economic burden of incidentally detected findings. Radiol Clin North Am. 2011;49:257–65.

    Article  PubMed  Google Scholar 

  5. Ben-Dor I, Waksman R, Hanna HN, Raizon A, Satler LF, Torquson R, et al. Utility of radiologic review for noncardiac findings on multislice computed tomography in patients with severe aortic stenosis evaluated for transcatheter aortic valve implantation. Am J Cardiol. 2010;105(10):1461–4.

    Article  PubMed  Google Scholar 

  6. Naidu SG, Hara AK, Brandis AR, Stone WM. Incidence of highly important extravascular findings detected on CT angiography of the abdominal aorta and lower extremities. Am J Roentgenol. 2010;194:1630–4.

    Article  Google Scholar 

  7. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Eng J Med. 2010;363:1597–607.

    Article  CAS  Google Scholar 

  8. Makkar RR, Fontana GP, Jilaihawi H, Kapadia S, Pichard AD, Douglas PS, et al. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. New Eng J Med. 2012;366:1696–704.

    Article  PubMed  CAS  Google Scholar 

  9. Reynolds MR, Magnuson EA, Lei Y, Leon MB, Smith CR, Svensson LG, et al. Health-related quality of life after transcatheter aortic valve replacement in inoperable patients with severe aortic stenosis. Circulation. 2011;124:1964–72.

    Article  PubMed  Google Scholar 

  10. Iezzi R, Cotroneo AR, Filippone A, Di Fabio F, Merlino B, Bonomo L. Extravascular incidental findings at multislice CT angiography of the abdominal aorta and lower extremities: a retrospective review study. Abdom Imaging. 2007;32:489–94.

    Article  PubMed  Google Scholar 

  11. Hussain A, Gordon-Dixon A, Almusawy H, Sinha P, Desai A. The incidence and outcome of incidental breast lesions detected by computed tomography. Ann R Coll Surg Engl. 2010;92:124–6.

    Article  PubMed  CAS  Google Scholar 

  12. Porter G, Steel J, Paisley K, Watkins R, Holgate C. Incidental breast masses detected by computed tomography: are any imaging features predictive of malignancy? Clin Radiol. 2009;64:529–33.

    Article  PubMed  CAS  Google Scholar 

  13. Moyle P, Sonoda L, Britton P, Sinnatamby R. Incidental breast lesions detected on CT: what is their significance? Br J Radiol. 2010;83:233–40.

    Article  PubMed  CAS  Google Scholar 

  14. Yi JG, Kim SJ, Marom EM, Park JH, Jung SI, Lee MW. Chest CT of incidental breast lesions. J Thorac Imaging. 2008;23(2):148–55.

    Article  PubMed  Google Scholar 

  15. Woo EK, Mansoubi H, Alyas F. Incidental vertebral fractures on multidetector CT images of the chest: prevalence and recognition. Clin Radiol. 2008;63:160–4.

    Article  PubMed  CAS  Google Scholar 

  16. Bartalena T, Giannelli G, Rinaldi MF, Rimondi E, Rinaldi G, Sverzellati N, et al. Prevalence of thoracolumbar vertebral fractures on multidetector CT: underreporting by radiologists. Eur J Radiol. 2009;69(3):555–9.

    Article  PubMed  Google Scholar 

  17. Ross PD. Clinical consequences of vertebral fractures. Am J Med. 1997;18(103):30s–43.

    Article  Google Scholar 

  18. Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001;285(3):320–3.

    Article  PubMed  CAS  Google Scholar 

  19. Pelkonen M, Notkola IL, Nissinen A, Tukiainen H, Koskela H. Thirty-year cumulative incidence of chronic bronchitis and COPD in relation to 30-year pulmonary function and 40-year mortality: a follow-up in middle-aged rural men. Chest. 2006;130(4):1129–37.

    Article  PubMed  Google Scholar 

  20. Remy-Jardin M, Remy J, Gosselin B, Copin MC, Wurtz A, Duhamel A. Sliding thin slab, minimum intensity projection technique in the diagnosis of emphysema: histopathologic-CT correlation. Radiology. 1996;200(3):665–71.

    PubMed  CAS  Google Scholar 

  21. Edey AJ, Hansell DM. Incidentally detected small pulmonary nodules on CT. Clin Radiol. 2009;64:872–84.

    Article  PubMed  CAS  Google Scholar 

  22. 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(2):395–400.

    Article  PubMed  Google Scholar 

  23. Hansen CP, Holtveg H, Francis D, Rasch L, Bertelsen S. Pulmonary hamartoma. J Thorac Cardiovasc Surg. 1992;104(3):674–8.

    PubMed  CAS  Google Scholar 

  24. Ahn MI, Gleeson TG, Chan IH, McWilliams AM, Macdonald SL, Lam S, et al. Perifissural nodules seen at CT screening for lung cancer. Radiol. 2010;254(3):949–56.

    Article  Google Scholar 

  25. Xu DM, van der Zaag-Loonen HJ, Oudkerk M, Wang Y, Vliegenthart R, Scholten ET, et al. Smooth or attached solid indeterminate nodules detected at baseline CT screening in the NELSON study: cancer risk during 1 year of follow-up. Radiology. 2009;250(1):264–72.

    Article  PubMed  Google Scholar 

  26. Wahidi MM, Govert JA, Goudar RK, Gould MK, McCrory DC. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132:94S–107.

    Article  PubMed  Google Scholar 

  27. Godoy MC, Naidich DP. Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung: recommended interim guidelines for assessment and management. Radiology. 2009;253(3):606–22.

    Article  PubMed  Google Scholar 

  28. Henschke CI, Yankelevitz DF, Mircheva R, McGuinness G, McCauley D, Miettinen OS. CT screening for lung cancer: frequency and significance of part solid and nonsolid nodules. Am J Roentgenol. 2002;178(5):1053–7.

    Article  Google Scholar 

  29. Dentali F, Ageno W, Becattini C, Galli L, Gianni M, Riva N, et al. Prevalence and clinical history of incidental, asymptomatic pulmonary embolism: a meta-analysis. Thromb Res. 2010;125(6):518–22.

    Article  PubMed  CAS  Google Scholar 

  30. Henschke CI, Lee IJ, Wu N, Farooqi A, Khan A, Yankelevitz D, et al. CT screening for lung cancer: prevalence and incidence of mediastinal masses. Radiology. 2006;239(2):586–90.

    Article  PubMed  Google Scholar 

  31. Nasseri F, Eftekhari F. Clinical and radiologic review of the normal and abnormal thymus: pearls and pitfalls. Radiographics. 2010;30(2):413–28.

    Article  PubMed  Google Scholar 

  32. Davenport E, Malthaner RA. The role of surgery in the management of thymoma: a systematic review. Ann Thorac Surg. 2008;86(2):673–84.

    Article  PubMed  Google Scholar 

  33. Stigt JA, Boers JE, Oostdijk AH, van den Berg JK, Groen HJM. Mediastinal incidentalomas. J Thorac Oncol. 2011;6:1345–9.

    Article  PubMed  Google Scholar 

  34. Alpert JB, Naidich DP. Imaging of incidental findings on thoracic computed tomography. Radiol Clin North Am. 2011;49(2):267–89.

    Article  PubMed  Google Scholar 

  35. Wiersema MJ, Vazquez-Sequeiros E, Wiersema LM. Evaluation of mediastinal lymphadenopathy with endoscopic US-guided fine-needle aspiration biopsy. Radiology. 2001;219:252–7.

    PubMed  CAS  Google Scholar 

  36. Washington K. Masses of the liver. In: Odze R, Goldblum JR, editors. Surgical pathology of the GI tract, liver, biliary tract and pancreas. 2nd ed. New York: Elsevier; 2009. p. 657–789.

    Google Scholar 

  37. Appelbaum L, Kane RA, Kruskal JB, Romero J, Sosna J. Focal hepatic lesions: US-guided biopsy-lessons from review of cytologic and pathologic examination results. Radiology. 2009;250:453–8.

    Article  PubMed  Google Scholar 

  38. Ahmed S, Horton KM, Fishman EK. Splenic incidentalomas. Radiol Clin North Am. 2011;49(2):323–47.

    Article  PubMed  Google Scholar 

  39. Ekeh AP, Walusimbi M, Brigham E, Woods RJ, McCarthy MC. The prevalence of incidental findings on abdominal computed tomography scans of trauma patients. J Emerg Med. 2010;38(4):484–9.

    Article  PubMed  Google Scholar 

  40. Laffan TA, Horton KM, Klein AP, Berlanstein B, Siegelman SS, Kawamoto S, et al. Prevalence of unsuspected pancreatic cysts on MDCT. Am J Roentgenol. 2008;191(3):802–7.

    Article  Google Scholar 

  41. Levy P, Jouannaud V, O’Toole D, Couvelard A, Vullierme MP, Palazzo L, et al. Natural history of intraductal papillary mucinous tumors of the pancreas: actuarial risk of malignancy. Clin Gastroenterol Hepatol. 2006;4(4):460–8.

    Article  PubMed  Google Scholar 

  42. Zhang XM, Mitchell DG, Dohke M, Holland GA, Parker L. Pancreatic cysts: depiction on single shot fast spin echo MR images. Radiology. 2002;223:547–53.

    Article  PubMed  Google Scholar 

  43. Lahav M, Maor Y, Avidan B, Novis B, Bar-Meir S. Nonsurgical management of asymptomatic incidental pancreatic cysts. Clin Gastroenterol Hepatol. 2007;5(7):813–7.

    Article  PubMed  Google Scholar 

  44. Lee CJ, Scheimann J, Anderson MA, Hines OJ, Reber HA, Farrell J, et al. Risk of malignancy in resected cystic tumors of the pancreas < or = 3 cm in size: is it safe to observe asymptomatic patients? A multi-institutional report. J Gastrointest Surg. 2008;12(2):234–42.

    Article  PubMed  CAS  Google Scholar 

  45. Weinberg BM, Spiegel BM, Tomlinson JS, Farrell JJ. Asymptomatic pancreatic cystic neoplasms: maximizing survival and quality of life using Markov-based clinical nomograms. Gastroenterology. 2010;138(2):531–40.

    Article  PubMed  Google Scholar 

  46. Young Jr WF. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med. 2007;356:601–10.

    Article  PubMed  CAS  Google Scholar 

  47. Song JH, Chaudry FS, Mayo-Smith WW. The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. Am J Roentgenol. 2008;190:1163–8.

    Article  Google Scholar 

  48. Haider MA, Ghai S, Jhaveri K, Lockwood G. Chemical shift MR imaging of hyperattenuating (>10HU) adrenal masses: does it still have a role? Radiology. 2004;231(3):711–6.

    Article  PubMed  Google Scholar 

  49. Caoili EM, Korobkin M, Francis IR, Cohan RH, Platt JF, Dunnick NR, et al. Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology. 2002;222(3):629–33.

    Article  PubMed  Google Scholar 

  50. Israel GM, Bosniak MA. How I do it: evaluating renal masses. Radiology. 2005;236:441–50.

    Article  PubMed  Google Scholar 

  51. Cambpell SC, Novick AC, Beldegrun A, Blute ML, Chow GK, Derweesh IH, et al. Guideline for management of the clinical T1 renal mass. J Urol. 2009;182(4):1271–9.

    Article  Google Scholar 

  52. Harisinghani MG, Maher MM, Gervais DA, McGovern F, Hahn P, Jhaveri K, et al. Incidence of malignancy in complex cystic renal masses (Bosniak category III): should imaging-guided biopsy precede surgery? Am J Roentgenol. 2003;180(3):755–8.

    Article  Google Scholar 

  53. Silverman SG, Israel GM, Herts BR, Richie JP. Management of the incidental renal mass. Radiology. 2008;249:16–31.

    Article  PubMed  Google Scholar 

  54. Thompson RH, Kurta JM, Kaag M, Tickoo SK, Kundu S, Katz D, et al. Tumor size is associated with malignant potential in renal carcinoma cases. J Urol. 2009;181(5):2033–6.

    Article  PubMed  Google Scholar 

  55. Tellez-Avila FI, Garcia-Osogobio S, Chavez-Tapia NC, Ramirez-Luna MA, Franco-Guzman A, Sosa-Lozano A, et al. Utility of endoscopy in patients with incidental gastrointestinal luminal wall thickening detected with CT. Surg Endosc. 2009;23(10):2191–6.

    Article  PubMed  Google Scholar 

  56. Moratis D, Singh P, Jayadevan R, Cayten CG. Colonic wall thickening on computed tomography scan and clinical correlation. Does it suggest the presence of an underlying neoplasia? Am Surg. 2006;72(3):269–71.

    Google Scholar 

  57. McDonald JM, Modesitt SC. The incidental postmenopausal adnexal mass. Clin Obstet Gynecol. 2006;49(3):506–16.

    Article  PubMed  Google Scholar 

  58. Pickhardt PJ, Hanson ME. Incidental adnexal masses detected at low-dose unenhanced CT in asymptomatic women age 50 and older: implications for clinical management and ovarian cancer screening. Radiology. 2010;257(1):144–50.

    Article  PubMed  Google Scholar 

  59. Levine D, Brown DL, Andreotti RF, Benacerraf B, Benson CB, Brewster WR, et al. Management of asymptomatic ovarian and other adnexal cysts imaged at US. Society of radiologists in ultrasound consensus conference statement. Ultrasound Q. 2010;26(3):121–31.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cameron John Hague MD, FRCPC .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Hague, C.J. (2014). Extravascular and Extracardiac Findings on MDCT for Transcatheter Aortic Valve Planning. In: Min, J., Berman, D., Leipsic, J. (eds) Multimodality Imaging for Transcatheter Aortic Valve Replacement. Springer, London. https://doi.org/10.1007/978-1-4471-2798-7_18

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-2798-7_18

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2797-0

  • Online ISBN: 978-1-4471-2798-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics